What is postpartum psychosis?

Postpartum psychosis is a mental health condition characterized by hallucinations, delusions, severe confusion, and drastic changes in behavior. It typically develops within the first two weeks postpartum. It’s rare, affecting 1 to 2 per 1,000 people who give birth, and typically requires immediate intervention and hospitalization. 

Fortunately, medication, therapy, and strong support systems can help people resolve symptoms and safely resume caring for their baby.

Symptoms of postpartum psychosis

Postpartum psychosis typically occurs within the first two weeks after childbirth. Symptoms tend to begin suddenly and become more severe in a short period of time. With treatment, some symptoms may begin to improve within a week, though recovery often takes longer. But without care, the condition can persist and pose significant health and safety risks to both you and your baby.

Postpartum psychosis may look different for everyone, but some common symptoms include:

• Delusions (Strong, false beliefs that don’t align with reality) 
• Hallucinations (Seeing, hearing, or sensing things that aren’t there)
• Inability to sleep 
• Confused thinking and unpredictable actions
• Thoughts of self-harm* or harming others
• Loss of appetite
• Rapidly changing moods, such as mania, hypomania, and depression 
• Unusual risk-taking or impulsive behavior 
• Irritability or agitation
• Paranoia or severe anxiety

*The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.

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Postpartum blues vs. depression vs. psychosis

Childbirth affects mental, physical, and emotional well-being. Between fluctuating hormones, lack of sleep, and the demands of caring for a newborn, it’s normal to experience emotional and behavioral changes.

Many people will experience what’s known as the “baby blues” — temporary feelings of sadness, mood swings, or increased tearfulness in the first few days after childbirth. These symptoms typically resolve within two weeks after delivery.

Postpartum depression (PPD) is another condition that can affect people after childbirth. Unlike the baby blues, PPD is a serious mood disorder characterized by prolonged feelings of sadness, anxiety, and hopelessness. PPD can persist for months or even years and typically requires professional support. 

If you’re not sure how to tell the difference between PPD and postpartum psychosis, here are some key differences.

• Symptoms: PPD involves feelings of sadness, hopelessness, and fatigue, while postpartum psychosis is characterized by hallucinations, delusions, and changes in behavior.
• Prevalence: PPD affects approximately one in seven people who have recently given birth, making it much more common than postpartum psychosis.
• Treatment: Both conditions require mental health support, but postpartum psychosis typically calls for emergency intervention. 

Possible causes of postpartum psychosis

Some research shows that one-third of people with postpartum psychosis previously experienced mental health concerns like bipolar disorder or major depressive disorder. Postpartum psychosis is also associated with a history of schizophrenia and schizoaffective disorder. Your risk for postpartum psychosis may be even greater if you stop taking your psychiatric medications during pregnancy. If you have any concerns about your mental health or a history of these conditions, it’s important to talk to your healthcare provider for guidance and support.

Other possible causes of postpartum psychosis include:

• A history of postpartum psychosis in a previous pregnancy
• Family history of psychosis or bipolar disorder
• Sleep deprivation, with some research linking a longer labor and giving birth during the night to the development of postpartum psychosis in people who have a family history of psychosis. 
• Physical health conditions, such as high blood pressure, autoimmune disorders, thyroid conditions, and inflammatory diseases 

Caring for yourself while postpartum

While there’s no way to prevent postpartum psychosis, you can focus on how to best manage your mental health after childbirth. If you’re considered high risk for postpartum psychosis, meet with your partner, close family, and care team around week 32 of your pregnancy. This is a chance to discuss your care preferences, plan for emergencies, and ensure you and your baby have the help you need. You may also want to schedule regular visits with your care team for the first weeks when you’re home with your baby. 

Other self-care advice for managing postpartum psychosis includes: 

• Stay connected. There’s nothing wrong with enjoying the newborn bubble, but be mindful of your mental state in the days and weeks following childbirth. If you notice any serious changes, reach out to people you trust for support. 
• Be kind to yourself. Being a parent is a lot of responsibility, and coping with a mental health condition can create additional challenges. Show yourself some kindness in the weeks and months following delivery, and don’t feel guilty if things don’t go as planned. 
• Follow your treatment plan. If you have an existing mental health condition, it’s important to remain engaged in your care. This means attending your appointments, taking your medication as prescribed, and reporting any changes in symptoms to your provider.
• Prioritize sleep. It’s common for people with postpartum psychosis to struggle with insomnia, making it even more important to focus on sleep hygiene. This involves creating a regular sleep schedule and making sleep a priority.
• Practice self-care. Having a newborn can be a full-time job, but remember to make time for your own emotional and physical needs. This includes regular exercise, healthy eating, and relaxation.

Treatment for postpartum psychosis

Postpartum psychosis is a mental health condition that requires immediate medical attention and possibly emergency intervention. As soon as you show signs of postpartum psychosis, it’s important for you or a loved one to get in touch with your healthcare provider. They can provide the necessary support and care to ensure everyone stays safe and healthy during this time.

After conducting an initial evaluation to understand your symptoms and rule out any underlying causes, your care team will create a treatment plan to stabilize your condition, address your symptoms, and help you return home safely to your baby. 

This may include: 

• Talk therapy: Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness-based therapy can help manage distress associated with psychosis, as well as co-occurring mental health concerns like anxiety, depression, and low self-esteem. 
• Medication: Certain medications may be used to treat postpartum psychosis. You can work with your provider to determine if medication is right for you and your circumstances. 
• Self-care: Taking care of yourself is an important part of recovering from postpartum psychosis. Prioritizing rest, eating nourishing meals, and accepting help from loved ones can support your healing during this time. Gentle activities like short walks, deep breathing, or listening to calming music may help reduce stress and promote emotional stability as you regain your strength.

Find care with Rula

Postpartum psychosis can be scary and put you and your baby at risk. The good news is that access to timely treatment and support can help most people make a full recovery and a safe return to their new baby. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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