Postpartum psychosis: A complex mix of serious symptoms
Several risk factors cited
Amanda Brown struggled with infertility and suffered two miscarriages before she experienced a “text-book pregnancy.” However, a traumatic labor and delivery and a hemorrhage that left her unconscious and with no memory of the birth set the stage for a breakdown.
While she began to recover physically, Brown’s mental state began to deteriorate; she experienced intrusive thoughts and suffered a break from reality. She had not been sleeping and eventually started hallucinating, convinced she should kill her baby and herself.
Brown’s mother, who was providing in-home support, became alarmed at her daughter’s behavior and brought her to the emergency room. Diagnosed with postpartum psychosis, she was immediately admitted to the psychiatric ward for treatment.
Ariadna Forray, MD, is chief, Section of Psychological Medicine and director, Center for the Wellbeing of Women and Mothers at Yale School of Medicine.
Ariadna Forray, MD, is chief, Section of Psychological Medicine and director, Center for the Wellbeing of Women and Mothers at Yale School of Medicine. She defined postpartum psychosis as a change in a mother’s behavior and thought processes. A rare but serious condition of unknown causes, postpartum psychosis has been noted in one to two cases per 1,000.
Postpartum psychosis presents as a combination of symptoms that might include severe insomnia, restlessness, irritability, serious mood changes, loss of touch with reality, confusion, and bizarre thoughts, according to Forray, also a Yale associate professor of psychiatry.
“Unlike depression and anxiety, which is common and mild to moderate on a gradient, postpartum psychosis, when present, is a psychiatric emergency,” said Forray. Immediate evaluation is critical since the mother is unable to care for herself and the baby. “There is a five percent increase in the risk of suicide or infanticide.”
Forray cited several risk factors that might contribute to its onset, including a history of bipolar disorder; family history of mental illness; and prior episodes of postpartum psychosis.
Hospitalization is almost always the first treatment option, and a mood stabilizer or anti-psychotic medication may also help. Electroconvulsive Therapy (ECT) works quickly, usually within three treatments most women are doing better, Forray said. She reported that women with a history of postpartum psychosis have a 29 percent risk of developing the condition in subsequent pregnancies.
Preventative measures may help reduce the risk of developing postpartum psychosis. Forray said women should engage with a mental health provider and take prophylactic medications, manage stress, and prioritize sleep. Increased social supports are also important, she added.
Forray pointed out that postpartum psychosis is limited to the immediate postpartum period but might manifest as bipolar disorder after treatment.
It is very common for women to experience the baby blues and is not an indication of postpartum depression or anxiety, according to Simone Rollins, MA, private practitioner in Vermont and Maine.
If symptoms continue or worsen after the first two weeks postpartum, then those symptoms may be an indication of postpartum depression or anxiety and that would be a time to see your doctor or therapist and talk about how you are feeling and get screened for perinatal mood and anxiety disorders.
She said it is completely normal for women to experience some intense emotions throughout their transition to motherhood and that certainly includes the postpartum time because a woman is undergoing a major life transition while at the same time experiencing sleep deprivation and a complete shift in daily routines.
Rollins encourage women to find either trusted peers or providers with whom they can share their feelings and know they are not alone.
“The more women open up and share how they’re actually doing, the more realistic and compassionate of a narrative we create for what this transition in a woman’s life is actually like,” she said.
“Over time, it can decrease shame and stigma about perinatal mental health and the hard parts about the motherhood transition. Experiencing pain, when not mired in shame and isolation, becomes much more bearable.”
Shannon Erisman, Shannon Erisman, Ph.D, of the Women’s Wellness Collective in Riverside, RI.
Shannon Erisman, Ph.D, of the Women’s Wellness Collective in Riverside, RI, noted that sleep is the biggest controllable factor in the cascade of postpartum psychosis symptoms. Sleep deprivation is part of being a mom, she said, but protecting her sleep is an important prevention tool.
The National Center for Biotech Information found that new parents are at risk of developing insomnia. To ensure the mother gets sufficient rest, Johns Hopkins Medicine recommends sleeping when the baby sleeps and letting household chores go.
Additionally, Erisman emphasized that family involvement in post-partum care can help in many ways, specifically in ensuring that the mom gets sufficient sleep. The family approach benefits everyone, she noted.
Erisman explained that some hospitals have launched a new trend of “rooming in.”
“The baby is in the room [with the mother] all the time. Doctors think this is bonding time. But the mother might not be able to recover,” she said. “People can miss how much [sleep deprivation] throws off your system.”
Education prior to and after delivery is key to understanding the risks of postpartum depression and postpartum psychosis and how to manage the conditions, according to Erisman. In the pre-natal stage, medical professionals should inform the woman that postpartum changes may occur. Talking about this early on prepares the woman and raises her awareness. She pointed out that a list of mental health professionals and their contact information on the discharge summary could be a valuable resource.
Brown is now a Maine Support Coordinator for Postpartum Support International and works to help other women who might be experiencing symptoms of postpartum psychosis. “I connect women to treatment, support groups, and psychiatrists. It can be overwhelming for new moms, so I serve as the bridge to suitable resources,” she said.
A strong advocate for screening at obstetric and pediatric appointments, Brown said that the data collected can help identify potential problems at an early stage. She pointed out that this condition often carries stigma and emphasized that it’s not the mother’s fault. “I wished someone had told me that what I was going through was normal. It’s not your fault. Motherhood is not all sweet and lightness.”
Forray reported that a national hotline, 1-800-9HELP4moms, is available 24/7.