The weeks after having a baby bring major changes to your body, hormones, and daily routine. This can cause new parents to feel overwhelmed or more emotional than usual. While some changes are normal, others may be signs of something more serious.
Postpartum psychosis is a rare but serious mental health condition that causes a person to lose touch with reality. It can worsen quickly and should always be treated as a medical emergency.
What are the signs of postpartum psychosis?
Symptoms usually start suddenly, often within the first 2 weeks after delivery (but sometimes later). Signs may include:
- Seeing or hearing things that aren't there, like hearing voices or seeing people or things others don't see
- Strongly believing things that aren't true, which may involve the baby or a perceived threat
- Severe confusion or difficulty understanding where they are, what’s happening, or what’s real
- Intense fear, suspicion, or paranoia
- Racing thoughts, very rapid speech, or unusually high energy
- Sleeping very little or not at all without feeling tired
- Rapid or extreme shifts in mood
- Disorganized, impulsive, or otherwise unusual behavior
“A person experiencing postpartum psychosis may not recognize that they are ill or understand that what they are experiencing is not real. That is why partners, family members, and friends are often the first to recognize that something is wrong,” explains Jaclyn Nunziato, MD, Carilion Women’s.
How is postpartum psychosis different from the baby blues and PMADs?
The baby blues are extremely common, affecting up to 80% of people after delivery. Symptoms may include feeling teary, irritable, overwhelmed, or moody. The baby blues usually start within a few days of delivery and improve on their own within about 2 weeks.
Perinatal mood and anxiety disorders (PMADs) are more persistent. They can affect people during pregnancy and up to 3 years after childbirth. PMADs include conditions like:
- Perinatal depression
- Perinatal anxiety
- Perinatal obsessive-compulsive disorder (OCD)
- Postpartum post-traumatic stress disorder (PTSD)
Symptoms are more distressing than the baby blues and can interfere with daily life. PMADs are common and treatable.
Postpartum psychosis is different because it involves losing touch with reality. Hallucinations, delusions, severe confusion, or paranoia are not part of the baby blues and require immediate medical care.
What about scary or intrusive thoughts?
It can be very upsetting for a parent to have an unwanted thought about something bad happening to their baby. Having this kind of thought does not, by itself, mean the parent wants to act on it. It also does not mean the parent has postpartum psychosis.
Intrusive thoughts or images can occur with postpartum anxiety or OCD. Parents should feel safe telling their healthcare team about these thoughts so they can get appropriate support.
“Intrusive thoughts can feel terrifying, but they are not the same as losing touch with reality,” says Dr. Nunziato.
Who’s at risk for postpartum psychosis?
Postpartum psychosis is rare. It affects 1 – 2 people in every 1,000 who give birth. It can happen to anyone, even if someone has never had mental health issues in the past. But the risk is higher for people who:
- Have bipolar disorder, especially bipolar I disorder
- Have experienced postpartum psychosis before
- Have a personal history of psychosis or certain other serious mental health conditions
- Have a close family history of bipolar disorder or postpartum psychosis
Having a risk factor doesn't automatically mean someone will develop postpartum psychosis. And someone without any known risk factors can still develop it.
People who have bipolar disorder or have had postpartum psychosis should make a care plan during pregnancy. They can work with their OB/GYN and mental health care teams to plan ways to lower the risk and get support after the baby is born.
What should you do if you notice the signs?
Do not wait for a routine appointment. If you think you or someone you love may be experiencing postpartum psychosis:
- Call 911 or go to the nearest emergency department for help right away
- Tell the emergency team that the person recently gave birth and may be experiencing postpartum psychosis
- Stay with the parent and baby until trained help arrives, if it’s safe to do so
- Don’t leave the parent alone with the baby or other children while symptoms are active
- Don’t argue about whether something is real; stay calm and focus on getting help
- If there’s an immediate danger, move the baby and others to a safe place and follow the emergency responders’ instructions
“Trust what you are seeing. If a loved one is not acting like themselves, seems confused, or is losing touch with reality, seek emergency help. You do not need to be certain of the diagnosis before calling,” notes Dr. Nunziato.
Can postpartum psychosis be treated?
Yes. Postpartum psychosis is treatable, and recovery is possible. Because symptoms can escalate quickly, treatment usually begins in a hospital. Care may include medications to treat psychosis and mood symptoms, support sleep, and stabilize the illness. In some cases, electroconvulsive therapy may be recommended.
After the immediate symptoms improve, ongoing care is important. This may include regular visits with the healthcare team, a safety plan, family support, and continued treatment.
It isn’t anyone's fault
Postpartum psychosis is a medical condition. It’s not a sign that someone is a bad parent, doesn’t love their baby, or has done something wrong.
If a new parent is showing signs of postpartum psychosis, don’t wait. Call 911 or go to the nearest emergency department.
If you’re dealing with mental health issues, you’re not alone. The Carilion Clinic Women’s Mental Health Clinic is here to help.
If you need immediate help, visit the nearest Emergency Department or contact:
Carilion Clinic CONNECT – 540-981-8181
National Suicide Prevention Hotline – 988
National Maternal Mental Health Hotline – 1-833-TLC-MAMA (6262)
