Postpartum psychosis

Tahmina, a corporate lawyer, gave birth to her son in Gulshan in the cool of December. On the tenth night she did not sleep at all. By morning she was talking very fast, convinced the nurses had swapped her baby, and laughing and crying in turns. Her husband had never seen her like this.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding postpartum psychosis

Postpartum psychosis is a severe mental illness that usually begins in the first weeks after birth. Symptoms can include confusion, very high or very low mood, racing thoughts, not sleeping, strange beliefs, and hearing or seeing things. It can change quickly. Women with bipolar disorder, or a personal or family history of postpartum psychosis, are at higher risk.

How common is postpartum psychosis?

A 2017 systematic review in BMC Psychiatry found postpartum psychosis in between 0.89 and 2.6 of every 1,000 women after childbirth; the studies differed too much to be pooled.

Signs and symptoms of postpartum psychosis

• Not sleeping even when the baby sleeps, with high energy
• Confusion, rapidly changing mood, or saying things that do not make sense
• Unusual beliefs about the baby, or seeing and hearing things
• Any talk of harming herself or the baby

Treatment for postpartum psychosis

Postpartum psychosis is a psychiatric emergency. Treatment usually needs urgent specialist care, often in hospital, with medication chosen carefully for a new mother and, where possible, support for mother and baby to stay connected. With prompt treatment, recovery is common. Planning ahead helps those at known risk.

What getting better can look like

Tahmina’s recovery might take weeks, and then one ordinary morning she feeds her son, knows him, and knows herself again.

Common questions about postpartum psychosis

What is the difference between postnatal depression and postpartum psychosis?

Postnatal depression mainly brings low mood, tiredness and loss of interest, and it needs treatment too. Postpartum psychosis is rare and usually begins in the first weeks after birth, with confusion, racing thoughts, not sleeping, strange beliefs, or seeing and hearing things. Postpartum psychosis is a psychiatric emergency.

Can a mother recover fully from postpartum psychosis?

With prompt specialist treatment, recovery is common. Women with bipolar disorder, or a personal or family history of postpartum psychosis, are at higher risk, so planning ahead with a psychiatrist before a future pregnancy helps. Where possible, care also supports mother and baby to stay connected.

When to see a psychiatrist

If a new mother is confused, not sleeping, seeing or hearing things, or speaking of harm, seek emergency care now: call 999 or go to the nearest hospital emergency department.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• VanderKruik et al., BMC Psychiatry, 2017