What Is Postpartum Psychosis, Exactly? An Ob-Gyn Explains

Despite all the progress we've made with postpartum care, certain topics remain taboo. Postpartum psychosis, for instance, is among the least talked about and the most misunderstood conditions, thanks in large part to a lack of education and inaccurate portrayals in media. In essence, postpartum psychosis — the most severe form of postpartum psychiatric disorder — disrupts one's sense of reality shortly after giving birth. It can result in confusion, paranoia, and hallucinations . . . yet we still don't know why it happens in the first place.

While those dealing with postpartum psychosis may be judged or criticized as a result of misinformation, postpartum psychosis can ultimately happen to anyone. "Anyone who has delivered a baby in the last six weeks is at risk for postpartum psychosis," says Gregory Marchand, MD. To learn more about what postpartum psychosis actually is, we spoke with an ob-gyn about postpartum psychosis symptoms, potential treatments, and how it differs from the "baby blues." 

What Is Postpartum Psychosis?

Postpartum psychosis is the most severe form of postpartum psychiatric disorder. Postpartum psychiatric disorders include a wide range of conditions that may occur after giving birth, such as postpartum depression (PPD) and postpartum OCD. In the case of postpartum psychosis, Dr. Marchand says about one in 1000 pregnancies are affected (or between 320 and 9,400 births each year in the US), making it a rare but serious disorder.

What Causes Postpartum Psychosis?

The exact cause of postpartum psychosis is unknown. However, Dr. Marchand says that a history of psychiatric disorders may make you more likely to suffer from postpartum psychosis. Still, postpartum psychosis can affect you even if you don't have a mental illness. "People may believe that postpartum psychosis cannot happen to them because they don't have a history of mental illness," Dr. Marchand says. "This is not true, as postpartum psychosis can strike anyone who has recently delivered a baby." You can find a more comprehensive list of risk factors below:

• Mental Health Conditions: Both bipolar disorder and major depressive disorder are considered risk factors for postpartum psychosis. Preliminary research revised in March 2024 found that — within those diagnosed with postpartum psychosis (2,514 female participants) — 49 percent had a history of bipolar disorder and 24 percent had some other existing mental health diagnosis before their first childbirth. That means 73 percent of those with postpartum psychosis were found to have a pre-existing mental disorder diagnosis.
• Sleep Disturbances: Although more research is needed, some researchers believe sleep loss and sleep disturbance in the postpartum period could also contribute to postpartum psychosis.
• Number of Kids: According to the Cleveland Clinic, postpartum psychosis is more common in those who have given birth to their first child (although if you have a history of postpartum psychosis, there's a 30-50 percent chance, you'll experience it again with your next child).
• Family History: If you have a family history of postpartum psychosis, studies show you're more likely to develop it yourself. This suggests a possible genetic component to the condition, although more research still has to be done.

Postpartum Psychosis Symptoms

Postpartum psychosis is a serious mental health issue that can cause a wide variety of symptoms. "Postpartum psychosis generally begins with insomnia, and then more serious symptoms can develop," Dr. Marchand says. "These include hearing voices or having delusions. [It's] sometimes also associated with disorganized thinking and unusual behavior." Someone going through postpartum psychosis may also experience:

• Hallucinations
• Mood changes (depression or mania)
• Agitation
• Catatonia
• Thoughts of self-harm
• Thoughts of harming others
• Panic
• Changes in speech patterns
• Confusion

Postpartum Psychosis Treatment

When it comes to treatment for postpartum psychosis, time is of the essence. The most important aspects are immediate hospitalization and any additional measures necessary to ensure the safety of both the mother and child, Dr. Marchand says. After this, he says medications may be helpful in preventing postpartum psychosis, including anti-psychotics and mood stabilizers like lithium. "Only a psychiatrist can choose the best regiment for each individual patient, so seeking professional care is very important," he says. "Mothers with postpartum psychosis can harm or even kill their babies if they don't received help, so it is critical that anyone who has recently delivered and is exhibiting unusual behavior seek professional medical care quickly."

Postpartum Psychosis Versus "Baby Blues"

The "baby blues" is a term used to downplay very real elements of postpartum psychotic disorder, including postpartum psychosis. However, "postpartum blues are very different from postpartum psychosis," Dr. Marchand explains. "Postpartum blues involve a mild depression or sadness and will affect about half of women who have had a baby." The baby blues also aren't characterized by delusions or hallucinations — and according to Dr. Marchand, they typically don't require treatment. If you've just given birth and suspect you may be dealing with something more serious — including postpartum psychosis — reach out to your doctor right away. 

 

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