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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Alzheimer’s Disease - Testing ADHD Medicine

Alzheimer’s patients may soon be administered ADHD medication to improve their symptoms. At first glance, this may seem odd and illogical, but the science checks out. A recent analysis explains why and how ADHD medication works for Alzheimer’s.

One of the primary reasons why Alzheimer’s disease (AD) is so devastating is that it affects multiply brain areas. As more and more neurofibrillary TAU tangles (twisted protein fibers) accumulate in brain cells, they block nutrients from reaching the cells and ultimately cause whole clusters of neurons to die off. 

 

This damage to the brain cells, in turn, produces the infamous symptoms of Alzheimer’s disease, such as memory loss and cognitive decline. But there is one more group of Alzheimer’s symptoms that gets less press - the behavioral kind. These symptoms include depression, apathy, agitation, and even aggression. And they can be just as severe and disruptive to the life of the person with Alzheimer’s and their loved ones as memory loss and cognitive decline. 

 

A clear-cut review study published in July 2022 in the Journal of Neurology Neurosurgery & Psychiatry shows that both cognitive and behavioral symptoms of Alzheimer’s can be improved by treating patients with medications used to treat attention deficit hyperactivity disorder (ADHD).  

 

Why can an ADHD treatment help patients with Alzheimer’s?

Let’s begin by clarifying that the types of ADHD medication considered in the analysis are noradrenergic drugs - medications that target a compound called noradrenaline. 

 

And if the word “noradrenaline” rings a bell, you’re not mistaken. Adrenaline is a hormone released by the adrenal glands located on top of both kidneys in response to stress or low blood pressure. That is where we get the term “adrenaline rush.” But when adrenaline travels to the brain, it gets the name nor-adrenaline and turns into a neurotransmitter - a brain chemical used to communicate between nerve cells. 

 

Noradrenaline (also called norepinephrine) is made by specialized noradrenergic nerve cells in the brain as well as the adrenal gland. As a neurotransmitter, norepinephrine plays a huge role in cognition. It aids us to stay focused, improves our ability to learn and memorize new information, and helps us control inappropriate behaviors.

In Alzheimer’s disease, low noradrenaline levels and the loss of neurons that produce norepinephrine are well documented across many brain areas. These disruptions contribute to symptoms often observed in Alzheimer’s disease - from loss of appetite, depression, and sleep disturbances to restlessness, aggression, irritability, and anxiety. 

 

Given that we already have a selection of noradrenergic medications available, researchers have long posited that administering such drugs to people with Alzheimer’s may help reduce AD symptoms.

What did the research find? 

The study authors examined 19 clinical trials from 1980 to 2021 that used noradrenergic drugs (e.g.atomoxetine, guanfacine, and methylphenidate) in people with Alzheimer’s disease and mild cognitive impairment. These studies involved a total of 1811 participants. The results were examined across two main kinds of symptoms: 

 

Cognition involved memory, language, attention, and visuospatial orientation. 

 

Behavior and neuropsychiatric symptoms, such as depression, apathy, and agitation.

The analysis showed that noradrenergic drugs had a small positive effect on general cognition and a large improvement in apathy. And the researchers conclude, “Repurposing of established noradrenergic drugs is most likely to offer effective treatment in Alzheimer’s disease for general cognition and apathy.” 

 

Obviously, using existing medications to treat AD has many advantages. For one, these drugs don’t have to be tested separately for safety and needn’t be approved by the FDA. All the required testing and certification have already been done in the past, which is a massive time saver. 

 

But it's not all rainbows and unicorns. A few more specific questions regarding the use of noradrenergic medications for Alzheimer’s disease are yet to be answered. For instance, we still don’t know which particular patients would benefit from this treatment the most, as well as the specific doses at which noradrenergic drugs should be administered in AD.

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Hydroxychloroquine use may lead to irregular heartbeats, low blood sugar

The drugs chloroquine, hydroxychloroquine and azithromycin, being used to treat and prevent COVID-19 despite weak evidence for their effectiveness, may have adverse side effects on patients like irregular heartbeats and reduced blood glucose levels, a new study says.

The review research, published in the Canadian Medical Association Journal, provides an overview of potential harms associated with these drugs as well as their management based on the best available evidence. 

 Physician and patients should be aware of several rare but potentially life-threatening adverse effects of chloroquine and hydroxychloroquine," said David Juurlink, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, and a senior scientist at ICES.

According to the scientists, the potential adverse effects of these drugs include irregular heartbeats, reduced blood glucose levels, neuropsychiatric effects, such as agitation, confusion, hallucinations, and paranoia.

They said some people's bodies process chloroquine and hydroxychloroquine poorly, and a small percentage metabolise them rapidly, affecting their response to treatment.

Chloroquine and hydroxychloroquine, the scientists said, are highly toxic in overdose and can cause seizures, coma, and cardiac arrest.

 The researchers added that indescriminate use of hydroxychloroquine may make it unavailable to patients with autoimmune disorders -- such as rheumatoid arthritis, lupus, and other chronic diseases -- who are mainly prescribed the drug. 

According to the review, the evidence that these treatments might be beneficial in patients with COVID-19 is of poor quality,  and it is possible that the drugs could worsen the disease. 

"Despite optimism (in some, even enthusiasm) for the potential of chloroquine or hydroxychloroquine in the treatment of COVID-19, little consideration has been given to the possibility that the drugs might negatively influence the course of disease," said Juurlink. 

"This is why we need a better evidence base before routinely using these drugs to treat patients with COVID-19," he added.

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