What Is A Postpartum Psychotic Episode? Mental Health Care For Postpartum Psychosis

For new parents, the days and weeks following the birth of a child can be challenging, often marked by long nights, fluctuations in emotions, and elevated stress levels. In some cases, a birthing parent may also experience severe mental health challenges like psychotic symptoms. Postpartum psychosis is a serious mental illness characterized by a disconnection from reality, which can significantly impact the life of a parent. Understanding the disorder’s symptoms, risk factors, and treatment options may empower new parents to seek help if signs of psychosis arise following childbirth. Below, we’re providing an overview of postpartum psychosis, discussing contributors to the disorder, and outlining potential treatment options. 

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An overview of postpartum psychosis

Postpartum psychosis (PPP), also called puerperal psychosis or peripartum psychosis, is a rare psychiatric illness characterized by delusions, hallucinations, disorganized speech, and other psychotic symptoms. It is estimated that postpartum psychosis impacts 0.1–0.2% of birthing parents. Typically, the symptoms of postpartum psychosis arise within two to four weeks of birth. 

Risk factors for postpartum psychosis include a family history of mood disorders as well as other psychological and environmental contributors. Usually, a postpartum psychotic episode requires immediate hospitalization. Treatment often involves medication and psychotherapy. In some cases, brain stimulation therapy may also be utilized. 

Identifying symptoms of postpartum psychosis

Knowing how to recognize postpartum psychosis (PPP) symptoms can be crucial for new parents—particularly those with a history of psychosis or other risk factors, which we’ll outline in one of the following sections. The following are common symptoms of postpartum psychosis.  

Symptoms of a postpartum psychotic episode

Psychotic symptoms are marked by a loss of touch with reality, which may manifest as hallucinations, delusions, disorganized thinking, and/or related challenges. Postpartum psychotic symptoms can also include fluctuations in mood, sleep disruptions, and depersonalization. For birthing parents living with postpartum psychosis, these symptoms can lead to concerning sensory experiences and beliefs related to their new child. 

Marked by the sensory perception of non-existent stimuli, hallucinations may be visual, auditory, tactile, olfactory, or gustatory. The most common types of hallucinations in PPP involve hearing voices and seeing visions that aren’t there—sensory experiences that can be disturbing for caregivers. For example, a new parent may experience visual hallucinations that involve people harming their baby. 

Delusions are persistent beliefs that aren’t grounded in reality. Common examples of these irrational thought patterns are persecutory delusions (false beliefs that one is the target of mistreatment), delusions of grandeur (false beliefs that one has a heightened importance or abilities), and control delusions (false beliefs that one is being manipulated by certain forces). For example, persecutory delusions may cause a parent to believe that their baby is being given substandard care by doctors, even when this is not true. 

Disorganized thinking—often evidenced by disorganized speech—can cause a new parent to become confused and struggle to communicate. An individual experiencing disorganized thinking may make logical errors, use words incorrectly, create new words or phrases, or attempt to connect unrelated ideas. 

The subtypes of postpartum psychosis

Experts have identified three subtypes of postpartum psychosis. These are: depressive, manic, and atypical. 

Depressive postpartum psychosis

The most common subtype of PPP, depressive postpartum psychosis involves low mood, fatigue, and other depressive symptoms alongside psychotic symptoms. Psychotic symptoms associated with the depressive subtype may include irrational beliefs that their child is ill or is engaging in abnormal behavior, despite evidence to the contrary. This is considered the most severe form of PPP, as it is associated with an increased risk of suicide and infanticide. 

Manic postpartum psychosis

Manic postpartum psychosis is characterized by an elevated mood, high energy levels, and increases in activity. Psychotic symptoms associated with this subtype may be more likely to involve delusions of grandeur. Individuals may also exhibit pressured speech. 

Atypical postpartum psychosis

Also called the mixed subtype, atypical postpartum psychosis can involve both depressive and manic symptoms during the same episode. Individuals experiencing this subtype may display disorganized behavior and can also experience depersonalization and derealization, during which they may feel disconnected from their body. 

Risk factors for postpartum psychosis: a history of bipolar disorder, hormone levels, and others

While the exact causes of postpartum psychosis (PPP) are unknown, several risk factors are thought to contribute to the development of the disorder. The following are common biological, psychological, and environmental factors that may increase the chances of an individual experiencing PPP. 

History of psychosis, bipolar disorder, or related disorders

Individuals who have a personal or family history of psychosis, mood disorders, and/or other psychiatric disorders are thought to be at a higher risk of developing postpartum psychosis. As discussed above, bipolar disorder is closely connected to PPP, so having it is also considered a primary risk factor. Individuals who have experienced—or who have a family history of—a psychotic disorder (e.g., schizophrenia, schizoaffective disorder, or brief psychotic disorder) are also thought to be at an increased risk of PPP. 

Hormonal changes

A birthing parent’s hormone levels typically change following the birth of a child, which can lead to chemical imbalances in the brain. Studies suggest that estrogen withdrawal, which can occur after childbirth, may be associated with a greater incidence of psychotic episodes. Hormonal changes can also exacerbate environmental factors like sleep disruptions and stress. 

Environmental factors

Various non-biological and non-psychological factors can also contribute to the development of PPP. First, sleep disruptions are commonly cited contributors to psychosis. Following childbirth, parents frequently struggle to get enough rest due to the sporadic sleep schedule of a newborn, as well as challenges like stress and, in some cases, physical health complications.  

Research also suggests that there may be a link between stress and postpartum psychosis. One study indicates that people with PPP may have elevated levels of cortisol. Additionally, trauma during childbirth can increase the risk of the disorder. For example, research suggests a connection between emergency cesarean section deliveries and psychotic episodes. Other environmental contributors include a lack of social support, first-time parenthood, and having an income below the poverty threshold. 

Treatment by health professionals for a postpartum psychotic episode

Individuals who are exhibiting symptoms of psychosis during the postpartum period are urged to seek immediate treatment. One reason is that, compared to the general population, the risk of suicide is substantially higher in individuals experiencing a postpartum psychotic episode. Treatment for a postpartum psychotic episode typically involves the following.

Hospitalization

Postpartum psychosis is considered the most severe of the postpartum psychiatric disorders. As such, individuals experiencing symptoms are often placed in psychiatric care at a hospital. 

Medication

Various psychiatric medications are recommended for those living with postpartum psychosis. Commonly, antipsychotic medications are used to help alleviate symptoms like hallucinations and delusions. Mood stabilizers can often help address the emotional challenges of PPP.  

The specific medications prescribed depend on which subtype the individual is experiencing. For example, an individual with depressive PPP may be prescribed a selective serotonin reuptake inhibitor (SSRI). For someone with manic and psychotic symptoms, however, SSRIs may be contraindicated due to a risk of exacerbating mania. Always consult with a healthcare professional prior to starting, stopping, or changing any medication. 

Talk therapy with mental health professionals

Psychotherapy is often recommended as an adjunct treatment to hospitalization and medication. Therapy can provide a birthing parent with emotional support as they navigate the mood swings of a psychotic episode. A therapist can also help a participant develop coping strategies for psychosis. They can address symptoms of any potential comorbidities as well, such as bipolar disorder, depression, or anxiety. 

Brain stimulation therapy 

Electroconvulsive therapy (ECT) is considered a safe and effective treatment for symptoms of a postpartum psychotic episode that have not responded to other modalities. ECT involves a trained healthcare provider activating certain regions of the patient’s brain through electrical currents. Research suggests that ECT may reduce symptoms of both postpartum psychosis and postpartum depression. 

How new parents can work with a mental health professional online

Again, postpartum psychosis typically requires immediate, in-person care. However, once stabilized, a person may be advised by their healthcare provider to continue attending regular therapy sessions to help them maintain their mental health and continue receiving support. However, caregivers who are busy with a new child may not have the time to attend in-person therapy sessions. In such cases, online therapy can provide new parents with a more convenient and cost-effective option for mental health care. Ask your doctor or psychiatrist if this treatment may be an appropriate supplement to other care you’re receiving. Online therapy can also be a convenient form of support for partners of those living with a serious illness like PPP.

The potential benefits of online therapy

Using an online therapy platform like BetterHelp, a client can address parenting-related mental health challenges with a licensed therapist remotely, through video call, voice call, and/or in-app messaging. BetterHelp also offers affordable pricing options, which can be helpful for new parents as well. 

Navigating life as a new parent can be challenging

Receive emotional support in online therapy

The efficacy of online therapy

There is a growing body of evidence suggesting that online therapy may help new parents address certain mental health challenges. In one systematic review and meta-analysis that involved 18 studies, for example, researchers suggest that online therapy can be “effective in reducing symptoms of postpartum depression and anxiety” in birthing parents. The review also notes that online therapy platforms can serve as “more cost- and resource-effective interventions” that can increase the availability of care to new parents.