Postpartum or puerperal psychosis is a rare but severe mental health condition that can emerge within the first few weeks after childbirth, affecting approximately 1 to 2 out of every 1,000 deliveries [3]. Women with a history of bipolar disorder face a higher risk of developing this condition [3]. Its symptoms may include delusions, hallucinations, and abrupt mood swings, encompassing both manic and depressive episodes [3].
Recognizing the gravity of postpartum psychosis is vital, as it poses serious risks to both the mother and the newborn. The potential for self-harm, harm to the infant, or other dangerous behaviors underscores the urgent need for timely and appropriate medical intervention. Prompt identification and treatment can significantly improve the prognosis for affected individuals and help safeguard the well-being of both the mother and the child. It’s crucial for new mothers, their families, and healthcare providers to be aware of the signs and symptoms of postpartum psychosis to facilitate swift support and treatment [2].
What causes postpartum psychosis?
The exact causes of postpartum psychosis are not yet fully understood, but researchers believe that several factors may be involved. Some studies indicate that genetic risk scores and polygenic risk scores for psychiatric disorders might make some women more susceptible to postpartum psychosis [3]. Additionally, changes in hormone levels and issues with the immune system, which can lead to inflammation, may also contribute to the development of postpartum psychosis [3].
It is important to note that a combination of genetics, hormones, and immune system issues could all contribute to the onset of this condition. Researchers are particularly interested in understanding how things like thyroid function and immune system responses, especially during the COVID-19 pandemic, might be linked to postpartum psychosis [3]. However, more research is needed to fully comprehend how all these factors interact to cause this complex disorder.
Usually, postpartum psychosis hits hardest in the first two weeks after childbirth, and it can stick around for a few weeks to a few months [3]. It affects about 1 to 2 out of every 1000 women [3]. Research suggests that women with postpartum psychosis may often think about hurting others, but actual cases of harming their babies are rare, happening in only 1 to 4.5% of cases [3]. These women also tend to think about hurting themselves more often [3].
Who is at risk?
Women who have a history of bipolar disorder are more likely to develop postpartum psychosis (PPP) [3]. Furthermore, mothers who have experienced PPP after a previous pregnancy have a 50-80% chance of experiencing another psychiatric episode, typically within the bipolar spectrum [3]. PPP can sometimes manifest as the first sign of a woman’s bipolar disorder, and it is crucial to monitor and manage this condition closely to ensure the safety and well-being of both the mother and the baby [3].
Certain individuals are at a heightened risk of experiencing postpartum psychosis. Women with a personal or family history of bipolar disorder or schizoaffective disorder, bipolar type, are particularly vulnerable to this condition, as indicated by the research [2]. Additionally, those with a previous history of perinatal affective psychosis or depression are more likely to encounter a recurrence of postpartum psychosis [2].
How is postpartum psychosis related to postpartum depression or bipolar disorder?
Postpartum psychosis and postpartum depression share some similarities, but they are different conditions. Postpartum depression is characterized by common symptoms found in mood disorders, such as feelings of sadness, hopelessness, and a lack of interest in the baby. In contrast, postpartum psychosis has more severe symptoms that can cause a loss of touch with reality and present a risk to the mother or the baby. Postpartum psychosis is associated with bipolar disorder, and women who have experienced perinatal bipolar disorder episodes are at a higher risk of recurrence [2].
This rare condition affects 1 to 2 out of every 1000 women [3] and typically occurs within the first six weeks after childbirth [2]. While the exact causes of postpartum psychosis are not fully understood, it is believed to result from a combination of hormonal fluctuations, genetic predisposition, sleep deprivation, and psychosocial stressors [2].
Symptoms of Postpartum Psychosis
Postpartum psychosis is characterized by a distinct set of symptoms that significantly impact the well-being of new mothers and their infants [3]. These psychotic symptoms often manifest abruptly within the first few weeks after childbirth, necessitating urgent psychiatric attention [3]. Delusions, hallucinations, and cognitive impairment are prominent indicators of this condition. Additionally, affected individuals may experience dysphoric mania and delirium-like mental symptoms, often with a strong focus on their infants [3].
Symptoms of postpartum psychosis can vary in intensity and occur rapidly. These symptoms may include [2-3]:
- Delusions: Strongly held false beliefs not rooted in reality.
- Hallucinations: Sensing things that don’t exist, such as seeing or hearing things others do not perceive.
- Extreme agitation or restlessness: A heightened state of physical and emotional turmoil.
- Confusion and disorientation: Difficulty concentrating, disorganized thinking, impaired judgment, or a lack of awareness of surroundings.
- Mood changes: Rapid and extreme shifts, ranging from euphoria to deep despair, may also include irritability or agitation.
- Paranoia: Irrational suspicions or fears that others are trying to harm the mother or her baby.
- Sleep problems: Inability to sleep despite exhaustion.
- Thoughts of harming oneself or the infant: Intrusive thoughts or urges to cause harm, although not all women with postpartum psychosis act on these thoughts.
Support and Care for Mothers Developing Postpartum Psychosis
Pregnancy and childbirth can be challenging, particularly for mothers at risk of postpartum psychiatric disorders, including psychosis [1]. Prioritizing comprehensive care and support is crucial for ensuring the well-being of both the mother and the baby [1].
Preconception Planning
Before planning a pregnancy, consulting specialists, such as perinatal psychiatrists, can provide valuable guidance on managing potential risks, especially regarding mental health [1]. These experts can offer support in understanding the implications of postpartum psychosis and the available treatment options [1].
During Pregnancy
During pregnancy, seeking specialized care becomes essential, particularly for mothers at a higher risk of postpartum psychosis [1]. Regular consultations with mental health professionals and midwives can ensure a well-structured care plan is in place for effective management [1].
Post-Birth Measures
After childbirth, ensuring adequate rest and support becomes paramount [1]. Whether arranging assistance with night feeds or limiting visitors in the initial phase, creating a conducive environment that promotes rest and recovery is critical [1].
Timely Intervention and Support Building
If postpartum psychosis symptoms arise, seeking timely intervention is crucial [1]. A robust support system, including peer support services, can significantly aid recovery [1]. Creating awareness among family members and friends about the signs and symptoms of postpartum psychosis can ensure prompt action and effective management [1].
How is Postpartum Psychosis Treated?
Given the potentially severe nature of symptoms, timely intervention is critical [2]. Treatment often involves a combination of medications, such as antipsychotics, mood stabilizers, and antidepressants, coupled with supportive therapy and counseling for both the affected individual and her family [2]. In some instances, hospitalization may be necessary to ensure the safety of the mother and the baby, providing intensive care and monitoring [2].
How is Postpartum Psychosis Diagnosed?
Diagnosing postpartum psychosis can be challenging as its symptoms can be mistaken for other health issues. However, efforts are being made to include it as a separate condition in future editions of diagnostic manuals, aiming to improve recognition and reduce the risk of missed diagnoses and legal challenges [3].
Risk Factors and Recurrence
More than 40% of women who experience postpartum psychosis have no prior severe psychiatric issues, while the rest may see a return of their previous mental health challenges [3]. Additionally, women with a history of postpartum psychosis who decide to have more children have a greater than 50% risk of facing another mood episode during pregnancy or after childbirth [3].
Insights from Research
A study involving 452 full-term pregnancies showed that 28% of women experienced a relapse of serious mental illness, like psychotic or bipolar disorders, within three months after giving birth [3]. A prior recent relapse was found to predict a relapse during the postpartum period [3]. Hence, women with a recent history of relapse should be warned about the high risk of experiencing another episode [3].
Interestingly, a study in Denmark and Sweden found that the death of a close relative, which is a significant source of stress before or during pregnancy, was not associated with postpartum psychosis [3]. This suggests that severe life events, such as bereavement during pregnancy, might not be directly linked to the development of postpartum psychosis [3].
In a separate research project, 128 women with bipolar disorder were followed from 12 weeks of pregnancy to 12 weeks after childbirth, revealing high rates of recurring symptoms during the perinatal period [3]. Furthermore, a study investigating the connection between personality traits and the development of postpartum psychosis in pregnant women with bipolar I disorder found no significant differences in personality traits, cognitive styles, or affective temperaments between women with a history of postpartum psychosis and those without any previous perinatal psychiatric symptoms [3].
Treatment for Postpartum Psychosis (PPP)
Prompt intervention is crucial in managing postpartum psychosis, given the potential severity of symptoms [4]. Treatment typically involves a combination of psychiatric medications, such as antipsychotics, mood stabilizers, and antidepressants, along with supportive therapy and counseling for the affected individual and her family [2].
Hospitalization may be necessary in some cases to ensure the safety of the mother and baby and to provide intensive care and monitoring [2]. Despite the existence of effective treatments, the identification and management of postpartum psychosis remain challenging, emphasizing the need for further research to enhance our understanding of the underlying mechanisms and develop more targeted interventions for the condition.
Postpartum psychosis (PPP) requires urgent and careful treatment, often involving a combination of the following methods:
Medications
- Benzodiazepines and Hypnotics: These can help manage insomnia and agitation in PPP. It’s essential to use low doses of benzodiazepines with a short half-life and no active byproducts, especially for breastfeeding mothers [4].
- Antipsychotic medications: Second-Generation Antipsychotics, such as risperidone, olanzapine, quetiapine, aripiprazole, and lurasidone, have been effective in treating PPP. They are relatively safe for breastfeeding mothers [4].
- Lithium and other mood stabilizers: Although promising for acute treatment and relapse prevention in PPP, using lithium during breastfeeding requires careful consideration.
- Antidepressants: While their efficacy is not fully established, there may be cases where antidepressants are necessary for managing severe and major depression with psychotic features in PPP.
Psychotherapy and Psychoeducation
Postpartum depression (PPD) is a challenging condition that can have a significant impact on new mothers and their babies [7]. One valuable approach to address the complex issues associated with PPD is psychotherapy, particularly Interpersonal Psychotherapy (IPT) [7]. IPT focuses on improving interpersonal relationships and alleviating depressive symptoms by targeting specific problem areas: psychiatric symptoms, interpersonal issues, and social support [7].
Involving the partner in therapy sessions is crucial to IPT, as their support and understanding can significantly impact the woman’s well-being [7]. Additionally, providing psychoeducation about PPD, child development, and childcare is essential for both the mother and her partner to gain a better understanding of the challenges at hand [7].
The IPT treatment utilizes communication analysis and role-playing in sessions to enhance communication and understanding within relationships [7]. The therapist guides on practical issues and childcare concerns while encouraging the development of problem-solving skills within the patient [7].
Furthermore, the treatment emphasizes the importance of maintenance therapy to prevent relapses, as the risk of PPD recurrence remains a concern for many new mothers [7]. IPT aims to provide ongoing support and monitoring to ensure long-term well-being and mental health stability [7].
Brain Stimulation Treatments
Electroconvulsive Therapy (ECT): intense mood swings and haven’t found relief from other treatments. Electroconvulsive therapy (ECT) may be a helpful option to alleviate severe symptoms of postpartum psychosis (PPP). However, it’s important to note that ECT can have temporary side effects like memory loss and requires close monitoring [4].
Repetitive Transcranial Magnetic Stimulation (rTMS):
Repetitive Transcranial Magnetic Stimulation (rTMS) employs magnetic fields to stimulate specific brain regions and shows promise in treating both PPP and other psychiatric disorders. A collaborative approach with a team of mental health professionals is crucial for comprehensive patient care and positive treatment outcomes [6].
Research has explored rTMS as a potential therapy for postpartum depression (PPD), providing a non-invasive alternative to medication and ECT [5]. Studies indicate that rTMS has a significant therapeutic effect on PPD with minimal side effects for both the mother and infant. However, limitations such as potential biases in non-randomized studies need consideration [5]. Standardized protocols are necessary to refine rTMS parameters and ensure their safety and effectiveness for treating PPD [5].
For mothers hesitant about medication or ECT, rTMS could offer a promising, safer, and more cost-effective option [5].
Prognosis
The long-term outlook for PPP can vary depending on the episode’s duration and other factors [4]. Prompt and appropriate treatment can significantly improve the overall prognosis, with many women returning to normal functioning after treatment [4]. It is crucial to continue researching and understanding the underlying causes of PPP for better outcomes in the future [4].
Ongoing research on alternative treatments, including rTMS, holds promise for improving the management of postpartum psychosis [4-5]. These innovative approaches may serve as viable alternatives for mothers who are reluctant to pursue conventional treatments like medication or ECT, potentially reducing risks to the fetus and offering cost-effective options [5]. Further research and the formulation of refined treatment protocols, encompassing alternative therapies like rTMS, can expand the available options and enhance the overall management of postpartum psychosis [4-5].
Supporting Perinatal Mental Health
Early diagnosis and intervention are vital, as treatments involving medications, psychotherapy, and brain stimulation have shown promise. Additional research into alternative therapies, such as repetitive Transcranial Magnetic Stimulation (rTMS), offers hope for more effective and less invasive treatments. The prognosis for postpartum psychosis can be positive with prompt and appropriate care, emphasizing the need for ongoing research and understanding of this complex condition.
Postpartum psychosis can be a challenging and overwhelming condition for new mothers. If you or someone you know is experiencing symptoms of postpartum psychosis or other perinatal mental health challenges, it is crucial to seek professional help. At Neuro Wellness Spa, we understand the importance of providing comprehensive mental health support for individuals struggling with perinatal mental health conditions ranging from baby blues to postpartum anxiety and depression, or postpartum psychosis. Our experienced team of professionals is here to offer you the care and guidance you need during this difficult time. Contact us today to schedule a consultation with a psychiatrist and take the first step toward reclaiming your mental well-being. Don’t suffer in silence. Reach out to Neuro Wellness Spa and let us help you on your path to mental wellness.
References
- Action on Postpartum Psychosis (n.d.). Planning pregnancy. https://www.app-network.org/postpartum-psychosis/planning-pregnancy/
- Di Florio, A., Gordon-Smith, K., Forty, L., Kosorok, M. R., Fraser, C., Perry, A., Bethell, A., Craddock, N., Jones, L., & Jones, I. (2018). Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum. The British journal of psychiatry: the journal of mental science, 213(3), 542–547. https://doi.org/10.1192/bjp.2018.92
- Friedman, S. H., Reed, E., & Ross, N. E. (2023). Postpartum Psychosis. Current psychiatry reports, 25(2), 65–72. https://doi.org/10.1007/s11920-022-01406-4
- Jairaj, C., Seneviratne, G., Bergink, V., Sommer, I. E., & Dazzan, P. (2023). Postpartum psychosis: A proposed treatment algorithm. Journal of psychopharmacology (Oxford, England), 37(10), 960–970. https://doi.org/10.1177/02698811231181573
- Lee, H. J., Kim, S. M., & Kwon, J. Y. (2021). Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis. BMC pregnancy and childbirth, 21(1), 118. https://doi.org/10.1186/s12884-021-03600-3
- Mann SK, Malhi NK. Repetitive Transcranial Magnetic Stimulation. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568715/
- Stuart S. (2012). Interpersonal psychotherapy for postpartum depression. Clinical psychology & psychotherapy, 19(2), 134–140. https://doi.org/10.1002/cpp.1778
