We need to talk about postpartum psychosis

You’ve heard of postpartum depression and postpartum anxiety, but this lesser-known, highly treatable mental illness can have devastating consequences when ignored.

Tima’s* experience with motherhood was unlike anything she could have imagined. The Toronto-based new mom knew about the postpartum period and expected her body to change. What she didn’t anticipate was how simply giving birth could cause her to lose her mind.

Tima couldn’t eat. She couldn’t sleep. “I thought the police were watching me with cameras,” she said. She saw police cars everywhere and even told police she knew they were out to kill her.

Postpartum psychosis has been at the root of some high-profile tragedies involving mothers taking the lives of their children. But not everyone knows that the condition has a name, or that it is highly treatable; public awareness of the condition can prevent not only a mental health crisis but suicide and infanticide.

We talked to an expert to learn more about this condition.

What is postpartum psychosis?

Postpartum psychosis is a severe mental illness that causes a complete break with reality. “Psychosis only occurs in one or two out of every thousand women who give birth,” says Dr. Diana Lynn Barnes, a psychologist specializing in perinatal mood disorders at the Center for Postpartum Health in Los Angeles. “About four percent of those women will commit infanticide, and five percent will commit suicide.”

For these reasons, postpartum psychosis is a medical emergency that usually requires immediate hospitalization.

What are the symptoms of postpartum psychosis?

“It’s a sudden onset illness,” says Barnes. “Generally speaking, we start to see symptoms within the first month.”

The main symptoms that characterize postpartum psychosis are:

Hallucinations: These can be visual, auditory, olfactory and/or tactile sensations that are real to the person experiencing them.

Delusions: A patient with psychosis may develop false beliefs that are not grounded in reality. Such beliefs cannot be changed even in the face of factual evidence.

Cognitive disorganization: Psychosis often causes irrational thoughts, confusion and disorientation.

People with postpartum psychosis can also experience extreme agitation, insomnia, feelings of detachment, memory loss and extreme mood fluctuations.

Too often, the terms postpartum depression and postpartum psychosis are used interchangeably, especially by the media. “While postpartum psychosis falls under the umbrella of perinatal illness, it’s not even in the same ballpark,” says Barnes. For those concerned, the difference is simple: “Once you see [hallucinations], then you’re talking about postpartum psychosis. You’re not talking about depression.”

When it came to Tima’s symptoms, she never doubted the police cars she saw everywhere were real and as a result never entertained the notion she could be ill. It’s when she hallucinated and saw her deceased grandfather coming toward her, that she became really scared. “I thought that I was going to die. I thought it was the end of the world and it was time for me to die,” she says.

In terms of her delusions, Tima experienced several simultaneously. And though her husband was the first to recognize that Tima was ill and tried his hardest to convince her to get help, his efforts only worsened her delusions.

“I thought that my husband was trying to kill me,” says Tima. Fully convinced of that delusion—which she now acknowledges couldn’t be further from reality—she called the police on him. While staying with friends in the aftermath, Tima grew frightened of her worsening hallucinations. They urged her to seek help, which is what finally pushed her to go to a hospital.

What are the risk factors for this kind of psychosis?

“Any psychotic illness or an illness with psychotic features is a significant risk factor,” says Barnes. This includes a history of bipolar, schizophrenia, schizoaffective disorder or major depression with psychotic features in oneself or even one’s extended family.

Having a history of trauma is an additional risk factor, adds Barnes, noting that some kinds of trauma “can cause brain damage [and/or] central nervous system damage.”

Sleep deprivation is another potential risk factor Barnes says to keep in mind. “One thing people have to be aware of is the importance of sleep hygiene after giving birth.

While such risk factors do make an individual more prone to postpartum psychosis, about 50 percent of women who experience postpartum psychosis have no previous history of mental illness.

What is the treatment for postpartum psychosis?

Hospitalization is initially needed for women experiencing the symptoms of postpartum psychosis, to quickly stabilize them. “We want to protect them, and we want to protect their babies,” says Barnes.

Once stabilized, many patients then begin a medication and psychotherapy regimen, the latter to address the emotional issues that may have contributed to the psychosis. Psychotherapy can also help the patient deal with the trauma of the illness, and their sadness over lost time with their newborn.

How long does postpartum psychosis last?

Postpartum psychosis typically emerges within the first month after giving birth. While it’s possible for the condition to resolve on its own, it is never advisable to leave it untreated, given the potential for infanticide and suicide.

According to the Royal College of Psychiatrists, the acute symptoms can last anywhere from 2 to 12 weeks, and a full recovery can take anywhere from 6 to 12 months.

How to support a partner with postpartum psychosis

Supporting a partner with postpartum psychosis should begin before one even embarks on parenthood. “There’s a tendency not to want to think about these things during pregnancy. It’s kind of like, ‘That’s not going to happen,’” says Barnes. Foresight, she says, is the first line of defence against postpartum psychosis: “Know your risks. Educate yourselves and your family.”

Her second piece of advice for partners is to not overlook concerning signs, and to seek out help from a health professional who specializes in perinatal mental health disorders.

Lastly, Barnes says, families should not hesitate or be afraid to take a loved one to the hospital. “If you’re worried that your partner or your daughter or your daughter-in-law is suffering with psychosis, it’s really important that you be in a safe place [with them],” adds Barnes. With a severe condition like postpartum psychosis, that action alone could prove life-saving.

* Name has been changed