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Postpartum psychosis is postpartum depression gone wild — complete with hallucinations and delusions. How can you recognize its symptoms, and how can these severe psychiatric disorder be treated?

The signs of postpartum depression and anxiety, which affect up to 20 percent of postpartum mothers [1], generally unfold between four and 30 weeks after a woman gives birth. Postpartum depression is now so frequently discussed that many new mothers and their loved ones will be familiar with at least some of its symptoms, which include a depressed mood, anxiety and irritability, feelings of guilt and worthlessness, insomia or excessively sleeping, fatigue and low energy, and trouble concentrating. Postpartum depression, which manifests in the same way as major depression at other times of life with identical diagnostic criteria, exists on a spectrum of severity, with women experiencing profound postpartum depression being plagued by suicidal or infanticidal thoughts. [2]

Though postpartum depression is now frequently discussed — in venues ranging from internet forums to parenting magazines, and from news outlets to perhaps your own home — research suggests that less than a fifth of women who meet the diagnostic criteria seek help. Postpartum depression, it is clear, still comes with an attached stigma, and both new mothers and their healthcare providers have a tendency to dismiss the symptoms as normal features of the enormous existential transition having a new baby represents. [3]

If you thought postpartum depression was taboo, meet postpartum psychosis, which can perhaps best be described as postpartum depression's "evil twin". This rare postpartum disorder affects an estimated one or two mothers per 1,000 births, and is a genuine psychiatric emergency. [4]

What Are The Symptoms Of Postpartum Psychosis?

The symptoms of postpartum psychosis tend to manifest quickly after a woman gives birth, within the first day or two, and they stretch far, far beyond what you would expect from the Baby Blues (crying spells, sadness, fatigue), or even postpartum depression. They include:

  • Paranoid or grandiose delusions — thinking patterns that are not consistent with reality. Women may think that someone is plotting to kill their baby, for example, or that their baby was switched with someone else's. 
  • Extreme mood swings or "up and downs", similar to those seen in Bipolar disorder. This means the mother may be ecstatic one moment, and severely depressed the next. 
  • Confused and disorganized thinking. 
  • Changes in physical behavior, such as talking rapidly or slowed movement. 
  • Visual, tactile, auditory, or olfactory hallucinations — seeing, feeling, hearing or smelling things that are not there. 
  • Anxiety and anger
  • Suicidal feelings. [5]

Who Is At Risk Of Postpartum Psychosis?

Research indicates that a large percentage of women who develop symptoms of postpartum psychosis right after they give birth suffer from either Bipolar disorder or schizoaffective disorder, while a much smaller number is affected by schizophrenia [6]. Other risk factors include a difficult pregnancy and birth, complications with the baby, an unwanted pregnancy, poverty, and recent traumatic experiences [7]. 

Postpartum Psychosis Sounds Terrible! What's The Prognosis?

 

It is terrible. Women suffering from postpartum psychosis not only experience extremely debilitating symptoms, they are at a high risk for both suicide and infanticide. Postpartum psychosis is a true psychiatric emergency. [8]

 

The most severe symptoms are usually present between weeks two to 12 postpartum, and it can take between six and 12 months to get better, with inpatient treatment being required. The good news, however, is that most women who receive treatment for postpartum psychosis will fully recover without recurrence. The most favorable outcomes are seen in those women who receive help within a month after giving birth. [9, 10]

Unlike postpartum depression, in which psychotherapy can offer sufficient treatment to help a mother recover and in which antidepressant therapy is seen only as the second line of treatment, the treatment for postpartum psychosis is first and foremost focused on stabilizing the affected woman with the help of medication (Lithium, Oxcarbazepine, and Risperidone, for instance). Once a woman's mood is stabilized sufficiently, follow-up therapy can begin. This can help affected women bond with their babies, deal with the family tensions that result from the postpartum psychosis, cope with lingering postpartum depression signs, and begin to look towards the future. [see 5]

Electroconvulsive therapy was also shown to improve symptoms of postpartum psychosis, reduce suicide rates, and lessen the chance of recurring psychosis. [11]

In Conclusion

Should you suspect that you or someone you care about is suffering from postpartum psychosis, it is important to act quickly. While postpartum psychosis represents a severe psychiatric emergency that places both mother and baby at very significant risk, we must also note that the prognosis is very good.

Symptoms appear shortly after affected women give birth, but they may make a full recovery within a year if adequate treatment is provided.

Whether you are worried about yourself or someone else, seeking assistance from a psychologist, psychiatrist, or even calling emergency response services is the best thing you can do at this point.

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