Having a baby can turn your world upside down.
Many new mothers experience a feeling of sadness that may last for a few weeks and go away on its own. And about one in eight women reported signs of a more significant postpartum depression, according to the Centers for Disease Control and Prevention (CDC).
A much smaller group of women, about one in a thousand, have a far more severe concern called postpartum psychosis. For years, there has been little awareness of postpartum psychosis. Lately, the condition has been in the news. When caught early, postpartum psychosis can be treated successfully.
In this Q&A, Veerle Bergink, MD, PhD, a psychiatrist and Director of Mount Sinai’s Women’s Mental Health Center, explains some of the key symptoms of postpartum psychosis, its likely causes, and some possible treatments.
Veerle Bergink, MD, PhD
“The most important thing to know is that postpartum psychosis is very treatable,” Dr. Bergink says. “If you detect and treat it, the woman will be fine. In our study, 98 percent of women got better, sometimes within days or weeks.” Under her leadership, Mount Sinai is researching the diagnosis and treatment of postpartum psychosis and has played a major role in attempting to shed light on this often-ignored condition.
How do you diagnose postpartum psychosis?
Postpartum psychosis is a severe mental illness that shows up during the first three months after childbirth. Women with this condition can display mania, psychosis, or depression with psychotic features. They may have these symptoms:
- Mania: When someone has a manic episode, thoughts race through their heads. They may behave in ways that are excessive. Sometimes people buy a lot, or they have grand plans. Their moods can be really over the top. They’re not happy, they’re over the moon. Or they are very irritable, they’re very, very annoyed by everyone and everything.
- Psychosis: This is when someone loses touch with reality. They may hear things that no one else does or see things that are not there. They might have weird ideas or become extremely paranoid or have delusions of grandiosity, religion or guilt.
- Depression with psychotic features: This is when someone’s mood is really low, and at the same time, they have lost touch with reality. For example, they don’t think that their child is crying a lot today but that they are the devil. They don’t think they’re responsible for a minor disagreement but that all wars are their fault.
These symptoms can vary, too. A woman might have mania, then dive quickly into a depression. She might have mania and depression at the same time. Or she might have symptoms one day, seem normal the next day, then display symptoms again later.
How does this look to family and friends?
Basically, you have a sense that something is off. You might think, “I know my sister, daughter, wife, and this is not her.”
How serious is postpartum psychosis?
Postpartum psychosis is very serious. If left untreated, there is a high risk of suicide. The infanticide risk is very low, but if it happens it gets understandably a lot of media attention. Fortunately, it is highly treatable.
What are treatments for postpartum psychosis?
To treat postpartum psychosis, we start women with antipsychotic medication and lithium. Antipsychotics can be tapered after the acute phase (usually a few weeks) and women are advised to take lithium for one year and then taper. Electroconvulsive therapy works as good as lithium. If a woman who had postpartum psychosis gets pregnant again, we advise to restart treatment the same day after they give birth to prevent another episode. There is no risk of postpartum psychosis during pregnancy, just after delivery. Women with bipolar disorder are at high risk for postpartum psychosis as well. They can prevent it by taking medication immediately after delivery.
It is also vital to make sure women with postpartum psychosis get enough sleep. They need a partner who can provide all the infant care overnight so the woman can sleep. This is especially key during the first few days and weeks after the birth.
What causes postpartum psychosis?
We are not sure exactly what causes postpartum psychosis, but we do have several ideas. After women give birth, they experience a sudden, sharp decrease in estrogen and progesterone called a “hormone free fall.” We think this is one of the triggers. But when researchers tried to prevent this freefall with hormone replacement therapy, it didn’t protect women from experiencing postpartum psychosis. So, while hormone free fall probably contributes to postpartum psychosis, it isn’t the sole cause.
What else might be involved?
We think the immune system is also part of the problem. While a woman is pregnant, her immune system adapts to avoid rejecting the fetus the way it might reject a donated liver or kidney. But after she gives birth, the immune system goes back to the way it had been. Most autoimmune diseases have a flare-up after delivery. We know, for instance, that women with rheumatoid arthritis usually feel better during pregnancy. But after they give birth, the rheumatoid arthritis symptoms come back. Given that all disorders with postpartum onset in general medicine are immune related, we think that immune dysfunction plays a major role in postpartum psychosis as well. We have done small studies and urgently need funding for larger studies.
Who is most likely to develop postpartum psychosis?
It is just bad luck. Postpartum psychosis happens in women of all backgrounds and educational levels all over the world. But there are two groups of women who have a very high risk of postpartum psychosis:
- Women who have bipolar disorder: Their risk goes from 1 in 1,000 to 1 in 6 for postpartum psychosis and 1 in 6 for postpartum depression. So that means women with bipolar disorder have a 1 in 3 risk for becoming mentally ill after childbirth.
- Women who have already had postpartum psychosis: Their risk also rises from 1 in 1,000 to 1 in 3 to get seriously ill after delivery (both postpartum depression and postpartum psychosis)
How do I reduce my risk of postpartum psychosis?
If you are at high risk of postpartum psychosis, you should begin treatment right after you give birth to prevent it.
What does scientific research say about postpartum psychosis?
Recent studies have underlined the link between the condition and bipolar disorder. Researchers are working hard to spread the word about postpartum psychosis and have it recognized as an official diagnosis.