Worried About CTE? What to Know About Risk, Symptoms, and Diagnosis

Updated on Sep 15, 2026 | Featured, Neurology, Your Health

A football player in a red helmet looks down the field at a fellow player, who is blurred in the background

You may have heard about chronic traumatic encephalopathy (CTE), a brain disease linked to repeated hits to the head. CTE has been found in some former NFL players and others who had repeated head impacts.

If you or a family member played contact sports, you may wonder about the risk of CTE. The risk depends in part on how often and for how long a person experienced repeated head impacts. Even people with extensive exposure do not always develop CTE.

In this Q&A, Kristen Dams-O’Connor, PhD, Director of the Brain Injury Research Center of Mount Sinai, explains what researchers know about CTE, what may affect your risk, and what you can do if you are concerned.

headshot of Kristen Dams-O’Connor, PhD, Director of the Brain Injury Research Center of Mount Sinai

Kristen Dams-O’Connor, PhD

How do I know if I’m at risk for CTE?

The biggest known risk factor for CTE is extensive exposure to repeated hits to the head over a long period of time. Researchers call these repetitive head impacts.

American football is the best-studied example. Repeated head impacts can also happen in other contact sports, including soccer, and possibly during military service or from domestic violence.

In football, the risk appears to increase based on how many years a person played, the level at which they played, and their position. For example, someone who played football briefly as a child or teenager would have a very different level of exposure than an NFL player who experienced repeated impacts for many years. If someone played in a position that exposed them to more impact, like a lineman, that may also carry greater risk.

Just because someone experiences repetitive head impacts does not mean they will get CTE. In fact, most people who have played football never develop CTE, and it isn’t clear yet why some do but others don’t.

Can one concussion cause CTE?

Current evidence does not suggest that one traumatic brain injury, whether it’s a mild concussion or more severe traumatic brain injury, puts you at significant risk for CTE. Researchers have found very few cases of CTE in people whose only known exposure was a single traumatic brain injury. The concern is greater when a person has repeated head impacts over time. These impacts do not have to cause diagnosed concussions, it is the extent and duration of repetitive head impacts that seems to matter most.

Can I be tested for CTE?

There is currently no test that can definitively diagnose CTE while a person is alive. CTE can only be diagnosed by examining brain tissue under a microscope after death.

Researchers are studying ways to diagnose CTE during life. These include blood tests that may detect signs of disease and specialized brain imaging. These tools are still being studied and cannot currently diagnose CTE in patients.

What symptoms should I be concerned about?

People who were found to have CTE after death have experienced symptoms such as:

  • memory changes
  • acting without thinking
  • irritability
  • trouble controlling emotions
  • poor decision-making
  • problems with planning, organizing, and completing tasks

Having these symptoms does not mean you have CTE. They are common after traumatic brain injuries and can also occur with dementia and many other conditions. At this time, researchers cannot tell from symptoms alone whether a person has the brain changes associated with CTE.

Substance use, including alcohol and drug use, can also contribute to symptoms during life, and may also contribute to the deaths of some people who are later diagnosed with CTE. But these concerns should not automatically be attributed to CTE, and many can be treated.

What can I do if I’m worried about CTE?

First, do not assume you have CTE. Problems such as memory difficulties, emotional changes, depression, or trouble controlling anger may have other causes, and some can be treated effectively. Also, fearing you have CTE may cause psychological problems. For example, research has found that some people who fear they have CTE experience depression and even suicidal thoughts and behaviors. Instead, focus on getting treatment for the symptoms you are experiencing rather than assuming CTE is causing them.

Behavioral and psychological treatments may help with some symptoms. For example, the Brain Injury Research Center of Mount Sinai offers neuropsychology and brain injury rehabilitation services that can help patients manage problems with thinking, memory, emotions, and behavior. Treatment may include psychotherapy, cognitive rehabilitation, and learning strategies for managing emotions. Medications may also be appropriate for certain symptoms.

Learn about the Brain Injury Research Center of Mount Sinai

What to Know About mFlusiva, the New mRNA Flu Vaccine

Sep 15, 2026 | Cold and Flu, Family Medicine, Featured, Infectious Diseases, Vaccines, Your Health

For the first time, adults age 50 and older in the United States can get an mRNA flu vaccine.

The U.S. Food and Drug Administration (FDA) approved mFlusiva®, the first mRNA flu vaccine, in August 2026. Moderna makes mFlusiva. It uses the same basic vaccine technology as mRNA COVID-19 vaccines. But it targets influenza.

Unlike traditional flu vaccines, mFlusiva does not contain a live or killed influenza virus, or pieces of the virus. Instead, it uses messenger RNA (mRNA). This gives temporary instructions to your immune system, your body’s natural defense system. The instructions help it learn to recognize influenza.

This new approach might even have an edge over traditional flu vaccines.

“There is some evidence that suggests mFlusiva may offer somewhat better protection against the flu than traditional flu vaccines,” says Rebecca Choudhury, MD, Assistant Professor of Medicine (Infectious Diseases), Icahn School of Medicine at Mount Sinai.

How does mFlusiva work? How well does it protect against the flu? What do we know about safety and side effects? Dr. Choudhury explains the new mRNA flu vaccine and gives advice on getting your flu shot.

Rebecca Choudhury, MD, Assistant Professor of Medicine (Infectious Diseases), Icahn School of Medicine at Mount Sinai

How does mFlusiva work, and how is it different from traditional flu vaccines?

Traditional flu vaccines show the influenza virus or parts of it to the immune system. This teaches the immune system to recognize and fight the virus later. Depending on the vaccine, that may mean a killed virus, a weakened virus, or pieces of the virus.

mFlusiva is an mRNA vaccine. It does not contain a living or dead virus. It also does not contain viral parts. The vaccine uses messenger RNA designed to produce influenza surface proteins called hemagglutinin.

An image of the mFlusiva mRNA flu vaccine. Image credit: Moderna

It’s the same basic principle used by mRNA COVID-19 vaccines. But the target is different. COVID-19 vaccines tell cells to make the coronavirus spike protein. mFlusiva tells cells to make an influenza surface protein.

“This flu vaccine is creating a different protein, but the principle of how it works is the same,” says Dr. Choudhury.

Is mFlusiva more effective than traditional flu vaccines?

In one trial in adults age 50 and older, about 2 percent of people who received mFlusiva developed influenza confirmed by lab testing within six months of vaccination. By comparison, 2.8 percent of people who received a standard-dose flu vaccine developed influenza. The mFlusiva group had a 27 percent lower rate of flu.

For adults 65 and older, there is an important caveat. People in this age group typically receive a high-dose or adjuvanted flu vaccine rather than the standard-dose vaccine used in this trial. An adjuvanted vaccine has an added ingredient that helps the vaccine work better.

Studies comparing the immune response to mFlusiva with a high-dose flu vaccine have been encouraging. Immune response means how the body reacts to a vaccine to build protection.

“However, a stronger immune response does not necessarily mean better protection against actually getting the flu,” Dr. Choudhury notes.

Another study is expected to directly compare clinical outcomes between mFlusiva and a high-dose flu vaccine in adults 65 and older.

Is mFlusiva safe? What are the side effects?

Clinical trials so far suggest mFlusiva has a safety profile similar to traditional flu vaccines for serious adverse events. These are harmful or unexpected medical problems or side effects.

In a trial comparing mFlusiva with a standard-dose flu vaccine, serious vaccine-related adverse events were very rare. They occurred at similar rates in both groups.

Researchers also looked closely at heart-related events because of concerns previously raised about mRNA COVID-19 vaccines.

One participant who received mFlusiva developed cardiomyopathy and pericarditis. These are two heart-related conditions. This happened about three months later. It was unclear whether the vaccine caused them. One participant in the traditional flu vaccine group also developed pericarditis.

Dr. Choudhury says current data do not show a higher risk of these events with mFlusiva than with traditional flu vaccines.

The main difference so far is short-term side effects. Injection-site reactions, headaches, body aches, and fatigue occurred more often with mFlusiva than with traditional flu vaccines. This was seen across multiple studies.

“These symptoms are generally relatively mild, they go away on their own without any sort of treatment,” Dr. Choudhury says.

What are the advantages of an mRNA flu vaccine?

“The advantages are less so in how the vaccine itself works, and more so in how the vaccine is made,” Dr. Choudhury says.

Each year, scientists must predict which influenza strains will circulate months before flu season. Traditional flu vaccines take several months to produce. That can make it hard to change the vaccine if the strains that circulate are different from those expected.

Because mRNA vaccines do not rely on growing influenza virus in a lab, they can be produced more quickly. Dr. Choudhury says this could give vaccine makers more flexibility. They can update an mRNA vaccine when an unexpected flu strain begins circulating.

That flexibility could help produce flu vaccines that more closely match the strains actually circulating. It could also potentially improve how well seasonal flu vaccines protect people.

Who can get mFlusiva, and who may want to consider it?

mFlusiva is approved for adults age 50 and older. Based on the evidence so far, Dr. Choudhury says adults ages 50 to 64 may have the clearest reason to consider it.

People ages 50 to 64 typically receive a standard-dose flu vaccine. That was the same type used in the clinical trial. The trial found a lower rate of influenza among mFlusiva recipients.

Dr. Choudhury says mFlusiva may be especially worth considering for adults ages 50 to 64 with long-lasting (chronic) health conditions. These conditions can raise the risk of severe influenza. They include high blood pressure (hypertension), diabetes, chronic kidney or liver disease, obesity, or chronic lung disease.

Adults 65 and older can also receive mFlusiva. However, researchers are still gathering stronger clinical evidence. The studies compare mFlusiva with the high-dose or adjuvanted flu vaccines typically recommended for this age group.

Still, choosing between vaccines should not stop you from getting vaccinated.

“Ultimately, the best flu vaccine is the flu vaccine that you can get,” Dr. Choudhury says. If mFlusiva is not easy to get, she recommends getting an appropriate flu vaccine from your doctor’s office, pharmacy, or workplace rather than going without vaccination.

Can an mRNA flu vaccine change your DNA?

No. The mRNA in mFlusiva cannot change your DNA. It also cannot become part of your genetic code.

Dr. Choudhury says this has confused some people. Some worry that mRNA could reprogram their genetic code. But that’s not how the technology works.

Like other mRNA vaccines, mFlusiva gives cells temporary instructions to make a specific protein. Here, that protein is an influenza surface protein. The mRNA is then quickly broken down by the body.

“The mRNA in mFlusiva cannot become part of your genome,” says Dr. Choudhury.

When should you get your flu shot?

Flu season typically begins around October. Infections often peak around December. But the timing can vary from year to year.

Your immune system needs about two weeks after vaccination to build protection. Dr. Choudhury recommends planning ahead. The same timing applies to mFlusiva.

“I typically get the flu vaccine myself around early October,” Dr. Choudhury says.

Getting vaccinated is important even if you don’t consider yourself at high risk for serious problems from the flu. Influenza can cause severe illness that requires a hospital stay. Even a less serious case can leave you sick in bed for a week or longer.

“Getting your flu shot is a very easy, safe and effective step you can take to reduce your risk of getting sick and reduce your risk of making others sick,” Dr. Choudhury says.

Have questions about the new vaccine? Talk with your doctor.

U.S. Premiere for Opera on a Gender-Affirmation Pioneer Is Authored by Mount Sinai Neuroradiologist

Updated on Sep 11, 2026 | Featured

A photo of Lucia Lucas as Lili Elbe in the U.S. premiere

Lucia Lucas as Lili Elbe in the U.S. premiere at the Sante Fe Opera. Photo credits: Bronwen Sharp for the Sante Fe Opera

“It’s a love story,” says Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai and the librettist for the opera, Lili Elbe, which tells the story of one of the earliest recipients of gender-affirming surgery in 1930. The groundbreaking opera had its U.S. premiere at the Sante Fe Opera on August 1.

Lili Elbe is the true story of a successful Danish painter who was married to another painter, Gerda Wegener. Though Lili’s name and sex were legally changed, they remained in love with each other. Lili’s case drew international attention, and a semi-autographical account of her story was captured in a book, Man Into Woman: An Authentic Record of a Change of Sex.

“We based our story on historical sources,” emphasizes Dr. Stollman. “Lili Elbe was quite famous in her day, so we relied on her own writings and news accounts from the time.”

Lili Elbe discovers her true nature as a woman when her wife, Gerda, asks her to stand in for a female model who was delayed for a painting session. Gerda is entranced with the beauty of her husband, then called Einar Wegener, and it is she who bestows the name Lili. And as Lili embraces her identity, she says, “When you paint me now, I feel I have always been her.”

Lili becomes a muse to Gerda, whose paintings of Lili win acclaim. But Gerda wrestles with how much space to allow Lili in their marriage. At first, she insists that Lili transition back to Einar in the evening. But as Lili makes her true identity known among their circle of friends, Lili wants to experience all the feelings of womanhood, including marriage and motherhood, which were Lili’s ideas of what it meant to be a woman in her time. And even though their marriage is annulled and they become involved with other lovers, their love for each other endures.

The score was written by Tobias Picker, a Grammy Award-winning composer, who is married to Dr. Stollman. This is the second time Mr. Picker and Dr. Stollman have collaborated. The first was the opera Awakenings, based on the story of Oliver Sacks, MD, and his efforts to treat patients with sleeping sickness. That opera opened in June 2022 at the Opera Theatre of Saint Louis. Their third opera collaboration, Safe Haven, will premiere in June 2027 at the Opera Theatre of Saint Louis.

 

Originally commissioned by and performed at the Theater St. Gallen of Switzerland in 2023, Lili Elbe was named “Best World Premiere” at the OPER! AWARDS held at the Dutch National Opera in Amsterdam. The new production in Santa Fe is garnering applause and accolades as well.

“There was a standing ovation on both the first and second night in Sante Fe,” says Dr. Stollman. “It was quite wonderful.”

Lili Elbe is gaining favorable attention in the press as well, with the New York Times featuring the opera in its Arts and Leisure section, and the Wall Street Journal praising the premiere as “a multi-layered work” with Dr. Stollman’s “skillfully crafted libretto.” Musical America, the oldest and longest-running magazine for classical music and the performing arts in the United States said, “Picker’s score sustains this intertwined drama with assurance, at times expanding into passages of transporting lyricism.”

The opera Lili Elbe, in addition to being acclaimed for its artistry, is a significant milestone for being the first grand opera for and about a person with trans experience. It stars Lucia Lucas, a baritone, who reprises her role from the European production. Mr. Picker befriended Ms. Lucas when he cast her in Don Giovanni in a Tulsa Opera production—the first time a transgender singer had played the leading role in an American opera.

Mr. Picker, Dr. Stollman, and Ms. Lucas wanted to collaborate on an original project, and the story of Lili Elbe was chosen. “When Tobias asked me to write the libretto—or the story and lyrics—I wanted to work very closely with Lucia who served as dramaturg, a guide and advisor, to gain the insight of her experience and authenticity, and to better understand Lili who lived in different times,” says Dr. Stollman.

“We wanted Lili Elbe to have a mythic undercurrent,” Dr. Stollman says. “In Lili Elbe, the myth of Orpheus leading his lover, Eurydice, out of the underworld is a motif that reoccurs. The very first scene takes place with the main characters attending a play about Orpheus and Eurydice. In the myth, Orpheus is saying, ‘Don’t look back, you cannot return to your old life, but you are coming into a new life.’ I believe that myths have a strong emotional truth, and our characters are always moving to the future, to a new life, a new realization. And that’s the mythological underpinning.”

“Also, the opera is more than about love with a transgender person,” Dr. Stollman says. “It’s about love and transcending difficulties. It’s about a tragic heroine’s journey that starts with self-knowledge. And it’s about loss, because Gerda loses Lili. But also, because Lili dies in the end, as many tragic heroines do.”

There are significant differences between the Swiss and the American productions. “We were very happy with the production and interpretation done in St. Gallen, and the one done in Santa Fe is totally different, but we’re very happy with that too,” says Dr. Stollman. “It’s nice to see two different approaches to the same piece. It enriches the piece to have different directorial and production points of view.”

“For example, the staging and choreography of the opera in Saint Gallen were more modernistic, innovative, and witty. In the Santa Fe production, the scenery and costumes are more sumptuous and evoke the elegant, upper class European period of the 1920s and early 1930s. The director of the Sante Fe production, James Robinson, is renowned in the opera world and has directed at the Metropolitan Opera and is now the General and Artistic Director of the Seattle Opera, so we were very fortunate to work with him. The Santa Fe production is actually a co-production with the Seattle Opera, and he will be bringing Lili Elbe to Seattle in 2029.”

The creative process is different each time, according to Dr. Stollman.  “It’s always challenging to write a new opera from scratch. But I enjoy getting into the characters’ minds and emotions. I like that each character is different, and I get to learn more about different types of people and situations. What they all have in common is that they face challenges and adversity, and I’m fascinated by each of their journeys.”

“I am very fortunate that my career as a librettist continues to grow,” adds Dr. Stollman. “When I went with Tobias to the premiere of his first opera, Emmeline, in Santa Fe thirty years ago,  I never imagined that I would one day be on the stage, bowing with him—or that   I would have any part in  the opera world. I was writing award-winning novels, but I had no concept that I would be blessed with  the opportunity and great privilege to be involved in  that grand artistic tradition.”

How Much Do You Know About Prostate Cancer? Take the Quiz

Updated on Sep 9, 2026 | Featured, Your Health

Prostate cancer is one of the most common cancers among men, affecting about one in eight men in their lifetime. Knowing the facts about prostate cancer can help reduce your risk. Take the quiz below, then click “Done” to see your score and correct answers.

This quiz was developed with world-renowned urologist and prostate cancer specialist Ash Tewari, MBBS, MCh, FRCS, (Hon.), DSc (Hon.), Chair of the Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai.
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Learn more about prostate cancer screening and diagnosis at Mount Sinai

This Master of Public Health Student Is on a Mission to Prevent Diabetes and Obesity Through Nutrition Education

Sep 2, 2026 | Featured, School

“Mount Sinai has given me opportunities to grow professionally, serve people throughout New York City, and develop the skills I need to continue working toward my long-term goal of preventing diabetes, obesity, and other chronic diseases,” says Ayannah Riley, MPH.

Ayannah Riley, MPH, earned her Master of Public Health degree from the Icahn School of Medicine at Mount Sinai in 2026, with a concentration in Health Promotion and Disease Prevention. With a background in nutrition, exercise science, fitness, and community health, Ms. Riley is passionate about using public health education and research to prevent chronic diseases and improve health outcomes in underserved communities.

Ms. Riley was inspired to study public health because she has lost family members to chronic diseases and related health complications, including diabetes, heart disease, cancer, and conditions related to obesity.

These experiences showed her how chronic diseases can lead to life-changing and sometimes life-ending outcomes for individuals and their families. She wants to make meaningful contributions to the lives of those in her family and in underserved communities. Ms. Riley believes that nutrition, physical activity, wellness education, and access to preventive resources can play an important role in reducing the risk of chronic disease. Her vision is to see people live healthy, fulfilling lives without disruptions caused by preventable chronic diseases and their related complications.

“Being in the Department of Public Health has taught me so much about research, community health, and disease prevention,” she says. “I have learned how to use data to understand health challenges and how to translate research into practical programs and resources that can support communities. Mount Sinai has given me opportunities to grow professionally, serve people throughout New York City, and develop the skills I need to continue working toward my long-term goal of preventing diabetes, obesity, and other chronic diseases.”

Ms. Riley first became familiar with the Icahn School of Medicine while working as a nutrition and physical education instructor with FAN4Kids in Upper Manhattan. At the time, she was creating a morning wellness curriculum that taught children how to promote health among their peers and within their communities through projects such as exploring school lunch choices and developing a wellness newspaper.

One evening after leaving work, she needed a quiet place that stayed open late to continue developing her lesson plans and came across the Levy Library. Curious about how she could gain access, Ms. Riley began researching the Icahn School of Medicine and discovered its Master of Public Health program.

As she learned more about the Master of Public Health program, Ms. Riley became interested in how the program combined research, disease prevention, health education, and community health. She recognized that earning an MPH could help her build upon her background in nutrition and exercise science while developing the skills needed to address chronic disease at the community and population levels. Inspired by the program’s potential, she applied and began the next stage of her public health journey at Mount Sinai.

During her time in the program, Ms. Riley found several of her courses to be useful in preparing her for a career in public health. Classes such as Epidemiology, Biostatistics, Research Methods, and Global Health contributed to her academic and professional growth. Epidemiology introduced Ms. Riley to a new area of study and quickly became a strong interest. Learning how to examine patterns of disease and identify factors that influence health reinforced that she had made the right choice to study public health.

Her interest led her to take additional courses, including Nutritional Epidemiology, which allowed her to connect her background in nutrition with population health research. Ms. Riley also enjoyed Research Methods because it strengthened her ability to ask meaningful research questions, analyze data, interpret findings, and develop new insights. She later applied these concepts, along with her data-analysis skills, across several research and independent study projects.

Mentorship also played an important role during Ms. Riley’s time as a student. Geoffrey “Cappy” Collins, MD, Assistant Professor, Population Health Science and Policy, and Graduate Education, served as her capstone project advisor and helped her strengthen her research, develop her capstone, and prepare her poster for Public Health Research Day in May 2026. His guidance and support contributed greatly to her growth as a public health professional.

Ms. Riley also received support and encouragement from Maya Korin, PhD, Assistant Professor of Environmental Medicine, and Public Health. Dr. Korin provided helpful feedback on her poster and later supported her independent study focused on caregiver nutrition education and childhood undernutrition in Uganda.

All MPH students at the Icahn School of Medicine engage in practical skill-building opportunities throughout their coursework. They further develop these skills through an Applied Practice Experience and a Culminating Experience, which may be a master’s thesis, manuscript, or capstone project.

Ms. Riley completed her Applied Practice Experience with the New York City Department of Health and Mental Hygiene’s Healthy Eating Unit. During this experience, she supported community-based nutrition and health-promotion initiatives and saw how nutrition education could help individuals and families feel more confident in making healthy choices. Her experience also helped shape her interest in developing resources that community organizations can use when formal nutrition education programs and funding are limited.

Ms. Riley’s capstone project was titled “Development of a Culturally Tailored Nutrition Education Manual to Support Community-Based Organizations Following SNAP-Ed Elimination in New York City.”

For the project, she developed a practical manual with nutrition education lessons, culturally responsive resources, facilitator guidance, and tools that community-based organizations can use to assess and address the needs of the communities they serve. The manual covers topics such as food-label literacy, balanced meals, food safety, and navigating supermarkets and community food resources.

Ms. Riley hopes to further develop and pilot the manual with community organizations, schools, churches, and other programs serving families with limited access to nutrition education. She hopes to use the resource to help organizations continue providing practical and accessible nutrition education, even when funding and formal programs are limited.

Ms. Riley plans to measure the success of the pilot through pre- and post-program surveys that assess changes in participants’ nutrition knowledge, confidence in making healthy choices, and awareness of available community food resources. She also hopes to collect feedback from participants and facilitators to determine which parts of the manual are most useful and what should be improved before expanding the program to additional communities.

Ms. Riley’s Global Health independent study was a separate project. She was originally scheduled to travel to Uganda through the Global Health Summer Program, but the in-person experience was canceled because of an Ebola outbreak. She completed the work remotely by using data bases to analyze three years of malnutrition data from the Soft Power Health Community Clinic in Jinja, Uganda. She examined the data across years and quarters to better understand trends, patient characteristics, treatment patterns, and other factors related to malnutrition.

Her vision for the future is for people to be able to avoid preventable chronic diseases while having greater food security, confidence in making informed food choices, and continued access to reliable nutrition and wellness information.

In recognition of her commitment to serving communities and advancing public health, she received the 2026 Master’s Commencement Award for Community Service and Engagement in Public Health.

Ms. Riley plans to continue building a career in chronic-disease prevention, research, nutrition education, and community health. Ultimately, she hopes to develop and lead programs that help underserved communities reduce their risk of diabetes, obesity, and related chronic diseases while gaining the knowledge and resources needed to live healthier lives.

 

Learn more about the Master of Public Health program at the Icahn School of Medicine at Mount Sinai

Who Is at Risk of Postpartum Psychosis—and Is It Treatable?

Sep 1, 2026 | Featured, Psychiatry, Your Health

A photo of a new mother holding her baby.

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.

A photo of Veerle Bergink, MD, PhD

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.

 

Learn more about Mount Sinai's Women’s Mental Health Center