Even though postpartum psychosis is rare — affecting about 1 to 2 new moms out of 1,0001 — everyone should know about it, according to Teresa Twomey, author of Understanding Postpartum Psychosis: A Temporary Madness and a coordinator for Postpartum Support International.
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.
- 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.