Postpartum psychosis is a potentially deadly illness that, when treated with appropriate medication, has an excellent chance of complete resolution even if an underlying mood disorder like depression or bipolar disorder needs ongoing treatment, said Dr. Renee Bibeault, a Seattle-based psychiatrist who specializes in women's mental health and reproductive psychiatry. She also has served on PSI of WA's advisory committee.
Anywhere from 1 in 1,000 to 1 in 2,500 women who give birth experience postpartum psychosis. They tend not to seek help themselves, but are brought to medical attention by their spouse or partner, a therapist or their child's pediatrician.
As yet, no formal criteria have been defined for diagnosing the illness. In clinical practice, it is diagnosed when a woman who is postpartum experiences the sudden onset of rapid changes in mood along with psychotic phenomena, usually bizarre ideas, called delusions.
Some symptoms are shared with other postpartum mental illnesses, including an inability to sleep, feeling agitated or restless and inexplicable bouts of crying and other intense emotion.
"The really frightening thing about postpartum psychosis is that the delusions women may have include ideas such as their baby is a demon and they need to kill it to save the universe," Bibeault said. "Tragically, women will sometimes take action based on these delusions."
Even when they don't, mothers with postpartum psychosis have trouble bonding and caring for their babies.
Postpartum psychosis can be easy to diagnose if a mother is talking openly about her fears and strange thoughts. "But a lot of women with this disorder will become more and more closed down and silent," Bibeault said. "Some women become paranoid, and the more paranoid they are, the less they talk. Others might think, 'This woman's just really depressed.'"
Onset tends to be within a couple weeks of birth, typically earlier than other postpartum mood disorders, which develop between three weeks and six months after birth.
Once it is diagnosed, postpartum psychosis is considered a psychiatric emergency. Unless the woman has 24-hour supervision and another person is taking care of the baby, the mother is hospitalized while the antipsychotic medication begins to work. Typically, it is prescribed along with a mood stabilizer or antidepressant.
"The psychosis is usually not a primary mental illness," Bibeault said. "In many cases, postpartum psychosis represents a form of bipolar disorder." The psychosis can also be secondary to depression.
Risk factors for postpartum psychosis include a personal or family history of bipolar disorder, having one's first child, lack of a supportive relationship and somewhat older age. A history of depression increases the risk of postpartum depression or anxiety, but not postpartum psychosis.
Although some postpartum illnesses might resolve in 9 to 18 months, even if they are untreated, it is unclear what the natural time course is for postpartum psychosis. "Untreated, it becomes such a dramatic illness," Bibeault said.
PSI of WA is a non-profit organization that provides personal support for women with postpartum mood disorders and their families. It strives to educate the public, families and health care practitioners about the nature and management of these disorders through conferences, networking and special publications. 