How is postpartum psychosis different?

Many new parents feel overwhelmed, emotional or forgetful in the weeks after delivery. Others experience intrusive thoughts, anxiety or postpartum depression. Postpartum psychosis is different.  

Someone experiencing postpartum psychosis may hear voices, see things that aren’t there or develop beliefs that do not match reality. They may believe others are trying to harm them, even when there is no evidence of a threat. Their speech may become difficult to follow, or they may act in ways that are unusual or out of character. Some experience unusually high energy and seem to need very little sleep without feeling tired.

Postpartum psychosis often develops within the first two weeks after delivery, although it can occur later. Risk factors include a personal or family history of bipolar disorder or psychosis, as well as severe sleep disruption around childbirth.

Dr. Guth says that these changes go well beyond the forgetfulness, distraction or exhaustion many parents experience.  

"Having trouble keeping up with laundry or losing track of a task is different from losing touch with what is happening around you,” she says.

What about scary thoughts?

One of the most common misconceptions involves intrusive thoughts.  

Unwanted thoughts or images of something happening to a baby can be deeply upsetting, but they are common after childbirth and do not mean a parent is experiencing psychosis.

“These thoughts can be distressing, but they are not dangerous in themselves and do not mean that a parent wants to harm their baby or is likely to act on them,” Dr. Guth says.

A parent experiencing intrusive thoughts typically recognizes that the thoughts are unwanted. Someone experiencing psychosis may believe their thoughts or perceptions are real and may not recognize that anything is wrong.

Parents should still talk with their care team if anxiety, depression or intrusive thoughts are causing distress or interfering with daily life. Effective treatment is available for those concerns, too.

When to seek help

Because someone experiencing psychosis may not realize they are ill, family members and friends are often the first to notice changes. A person may also become suspicious of loved ones or avoid talking about what they are experiencing.

Postpartum psychosis is a medical emergency.  

If someone is showing signs of psychosis, they should be evaluated immediately,” Dr. Guth says.  

Bring the person to an emergency department, and do not leave them alone or alone with their baby. Call 911 if there is immediate danger or you cannot transport them safely. For concerns that do not require emergency care, Dr. Guth encourages families to contact the obstetric care team and explain what they have observed. Even when health care professionals cannot share private medical information, they can listen to concerns provided by family members.

Recovery is possible

Treatment for postpartum psychosis typically includes hospitalization, medication and support to restore sleep. Some people improve quickly, while others require longer periods of treatment and recovery.  

“I’ve seen most people recover well from it,” Dr. Guth says.

Family and friends play an important role by helping caring for the baby, supporting treatment and reassuring the parent that their baby is safe.  

A loved one may resist treatment or feel upset that others intervened. Dr. Guth says that should not keep families from seeking help.

“People should feel empowered to speak up,” she says.