That’s because postpartum psychosis (PPP) is a “psychiatric emergency,” said Margaret Spinelli, M.D., associate professor of psychiatry at Columbia University Medical Center. Think of it as a heart attack, Twomey said. “You might survive it without immediate aid, but why risk it?”

PPP is a temporary but serious illness characterized by delusional thinking. Twomey, a survivor of PPP, described it as “a different reality superimposed onto this reality.” For instance, it’s like watching a TV show and believing that it’s perfectly normal for the actors to be speaking to you, she said.

PPP has a rapid onset, usually starting in the first days or weeks after the baby’s birth, said Katherine Stone, an advocate for women who suffer pregnancy- or childbirth-related mental illnesses and founder and editor of the award-winning blog Postpartum Progress.

This illness requires immediate medical attention because there is a risk of suicide or infanticide, Stone said. In other words, “postpartum psychosis has the potential to lead a mother to take actions that she would never otherwise take that could harm herself or others,” she said.

Still, it’s common for people to dismiss this risk. We know that our loved ones are good people who’d never hurt their kids (as are we), Twomey said. However, this has nothing to do with a woman’s character or ability to be a good mom, Stone said. (It’s also not her fault!) Again, PPP is an illness — and one with unpredictable actions, Dr. Spinelli said.

Fortunately, PPP is fully treatable. Below, experts discuss the warning signs, risk factors and how families and friends can help.

Warning Signs of Postpartum Psychosis

“Since women with postpartum psychosis often experience a lack of insight, it’s usually the people around her who will be the ones to recognize something is wrong,” Stone said. In fact, Twomey called family members “the first line of defense.”

That’s why it’s key for families to step in and call the doctor immediately or go to the emergency room. You might be thinking, “But what if I’m wrong?” What if she isn’t struggling with PPP? As Stone said, “I’d rather have it turn out that you were wrong, than have a person ignore the symptoms and have that lead to a tragedy.”

These are the most common signs of PPP.

• Hallucinations: seeing or hearing things that aren’t there
• Delusions: bizarre beliefs that only make sense to the individual. Delusions often have religious undertones. For instance, she might believe “…that her child is a savior or has been sent to save the world, or is possessed or going to come to some harm from nefarious forces if she doesn’t take action,” Stone said.
• Confusion
• Paranoia
• Mania (high energy)
• Depressed mood or irritability
• Inability to sleep

(In some cases, a woman might be rational enough to seek help. Twomey wanted women to know that “no matter what you experience, [PPP] is recognizable, diagnosable and treatable.”)

“PPP can wax and wane,” Twomey said. So even if a postpartum woman seems reasonable at times, don’t let that dissuade you from getting help. It’s a myth that women with PPP are either completely delusional or totally normal. As Twomey said, “a woman can seem perfectly normal one moment and psychotic the next.”²

Risk Factors of Postpartum Psychosis

Women with bipolar disorder or schizophrenia (or who have a family history of these illnesses) are most at risk, Stone said. Some women might not even know that they have either disorder. For instance, some moms might’ve never received a diagnosis of bipolar disorder, Stone said. In fact, according to Spinelli, PPP “usually signals a first episode of bipolar disorder.”

If you fit these risk factors, consider writing a letter to yourself explaining that you might have PPP, listing some of the symptoms and including the individuals you trust, Twomey said. If you do experience PPP, you’ll have given yourself important and sound information, she said.

Not having these risk factors doesn’t put you in the clear. Twomey emphasized that every expectant mom is potentially vulnerable.

How Family & Friends Can Help

• “Be informed before it happens,” Twomey said. This way you “can be an advocate, be aware of the warning signs, appreciate the dangers and treat her with compassion, love and understanding,” she said.
• Don’t ignore the signs. “I think family members sometimes want to explain away the symptoms of postpartum psychosis rather than admit a new mom has it and likely needs to be hospitalized,” Stone said. You might worry that she’ll be “locked up forever,” she said. But getting your loved one help is the best thing you can do for them — and their baby. Women with PPP are often hospitalized so they can get proper treatment. (This usually consists of close monitoring and taking antipsychotic medication.) But after they’re stabilized, women can return home. “Please don’t ignore the symptoms because of fear or lack of understanding!” Stone said.
• Don’t confuse your loved one with their illness. Twomey often hears husbands say that this isn’t the woman they married. Women with PPP can act completely out of character, even becoming verbally abusive, Twomey said. This might lead some families to alienate their loved one or view her as the enemy, she said. But it’s vital to understand that this isn’t your loved one, she said. PPP is causing this kind of odd behavior, Stone said. “…It would be unfair to blame her or stigmatize her for that behavior,” she said.
• Support your loved one. Give her your full support both while she’s in the hospital and after she comes home, Stone said. This includes helping her care for the baby and making sure she gets enough sleep, Spinelli said. Also, make sure your loved one is getting the best treatment, and go with her to doctor’s appointments, Twomey added. Stone recommended reading the valuable guides from the UK organization Action Postpartum Psychosis.

PPP is a serious illness that requires urgent treatment. If your loved one is experiencing any of the warning signs, don’t hesitate to get her help — and always be on her side, Twomey said.

Further Reading

Check out Postpartum Support International, a non-profit organization that’s filled with valuable information and resources. Also, Twomey wrote a helpful post on the three important bricks of PPP.

1. Statistic from Postpartum Support International
2. Check out Stone’s site, Postpartum Progress, for more on symptoms “in plain mama English.”

Yet, it’s exceedingly misunderstood — even by medical and mental health professionals.

“You should hear the things I hear from moms across the country — awful things that are said to them by partners, family members, co-workers, nurses and doctors,” said Katherine Stone, an advocate for women with PPD, founder and editor of the award-winning blog Postpartum Progress and a survivor of postpartum OCD.

After reaching out for help, some moms don’t even hear back. Some receive a prescription with no followup or monitoring. Some are informed that they can’t have PPD. And some are told to simply perk up, stop being selfish or get out of the house more, she said.

There’s confusion about everything from PPD’s symptoms to its treatment. Myths also often portray women with PPD in a negative light, which dissuades many from seeking help. Moms worry what others will think, whether they’re even fit for motherhood or, worse, if their kids will be taken away, according to Stone and Meltzer-Brody.

As a result, most moms with PPD don’t get the treatment they need. “Some studies show that only 15 percent of moms with PPD ever get professional help,” Stone said. Untreated PPD can lead to long-term consequences for both mom and child, she said.

The good news is that PPD is treatable and temporary with professional help, Stone said. And education goes a long way! Below Stone and Meltzer-Brody dispel five common myths about PPD.

1. Myth: Women with PPD are sad and cry constantly.

Fact: According to Meltzer-Brody, “Women with PPD usually have low mood, prominent anxiety and worry, disrupted sleep, feelings of being overwhelmed, and can also feel very guilty that they are not enjoying their experience of motherhood.”

But this disorder can look different in every woman. “PPD is not a one-size-fits all illness,” Stone said. She frequently hears from moms who didn’t even realize that their symptoms fit the PPD criteria.

Indeed, some women do feel sad and cry nonstop, she said. Others report feeling numb, while still others mainly feel irritable and angry, she said. Some moms also have fears that they’ll inadvertently harm their kids, which amplifies their anxiety and distress, Meltzer-Brody said. (The myth that moms with PPD harm their kids only heightens these fears and fuels their suffering, she said. More on that below.)

Many moms appear to function just fine but struggle in silence. They still work, take care of the kids and seem calm and polished. That’s because most women experience more moderate symptoms of PPD, Meltzer-Brody said. “They are able to function in their roles but have significant anxiety and mood symptoms that rob them of the joy of being a mother and interfere with their ability to develop good attachment and bonding with their infants.”

2. Myth: PPD occurs within the first few months of childbirth.

Fact: Most women tend to recognize their symptoms after three or four months post-childbirth, Stone said. However, “you can have postpartum depression any time in the first year postpartum.”

Unfortunately, the DSM-IV criteria for PPD leaves this information out. According to Stone, “Since it doesn’t say that in the DSM-IV, I can’t tell you how many moms finally get up the courage to go see the doctor in the second half of their baby’s first year and are told that they ‘can’t have postpartum depression.’ So then the mom goes back home and wonders whether she should have asked for help in the first place and why no one can help her.”

3. Myth: PPD will go away on its own.

Fact: Our society views depression as something to “rise above and overcome,” Meltzer-Brody said. Depression gets dismissed as a minor issue, fixed with a mere attitude adjustment. “I’ve had many patients tell me that they felt so guilty and judged by friends and family for not being able to ‘just snap out of it and focus on the positive,’” she said.

Again, PPD is a serious illness that requires professional help. It’s highly treatable with psychotherapy and medication. The medication part worries some women, and they avoid seeking help. However, treatment is individual, so what works for one woman won’t work for another. Don’t let such misconceptions stop you from seeking the help you need. Both experts underscored the importance of prompt treatment. (See below on how to find help.)

4. Myth: Women with PPD will hurt their kids.

Fact: Almost without fail when the media reports on a mom who hurt or killed her kids, there’s mention of postpartum depression. As Stone reiterated, women with PPD don’t harm or kill their kids, and they’re not bad mothers. The only person a woman with PPD may harm is herself if her illness is so intense that she has suicidal thoughts.

There is a 10 percent risk for infanticide or suicide with a different disorder called postpartum psychosis, Stone said. Moms may harm their kids during psychosis.

Postpartum depression is often confused with postpartum psychosis. But, again, they’re two different illnesses. Postpartum psychosis is rare. “About 1 in 8 new moms gets postpartum depression whereas 1 in 1,000 gets postpartum psychosis,” Stone said.

(Here’s some information about postpartum psychosis symptoms.)

5. Myth: Having PPD is somehow your fault.

Fact: Women often blame themselves for having PPD and experience guilt over their symptoms because they’re not basking in some magical bliss of motherhood. But remember that PPD isn’t something you choose. It’s a serious illness that can’t just be willed away.

According to Meltzer-Brody, hormones play a substantial role in PPD susceptibility. Some women are especially susceptible to rapid fluctuations in estrogen and progesterone, which occur at childbirth, she said. It’s likely that genetics predispose women to mood symptoms during these fluctuations. A history of abuse and trauma also might increase risk in women who are already genetically vulnerable, she said.

As Stone said, “I know it’s hard to believe that it’s not your fault, that you ever should have become a mother, and that you’ll ever get better. I know because I’ve been there. You will get better.”

Again, PPD is a real illness that requires expert help. Dismissing it can negatively affect both mom and baby. Don’t be casual about PPD, and don’t hope for the best, Stone said. Instead, find real hope and recovery with professional treatment.

Getting Help for Postpartum Depression

Below, Stone offered several suggestions for finding a professional for a proper diagnosis and treatment. Many of the links come from Stone’s Postpartum Progress, which is an excellent resource! In fact, just recently it ranked #6 in Babble’s list of top 100 mom blogs.

• Start by reading this page on Postpartum Progress, which lists the best PPD treatment programs.

• Contact the nonprofit organization Postpartum Support International, which has coordinators in almost every state who can help you find an experienced professional in PPD and related illnesses.
• See if your state has its own advocacy organization for moms with perinatal mood and anxiety disorders. Postpartum Progress has a list of advocacy organizations.
• If you’re not sure how to talk to a doctor or therapist about your symptoms, print out Postpartum Progress’s list of PPD symptoms to start the conversation.