What You'll Learn

• What Postpartum Psychosis Is (and What the Symptoms Are)
• What Causes Postpartum Psychosis
• The Difference Between Postpartum Psychosis and Postpartum Depression
• The Difference Between PPP and Intrusive Thoughts
• What Postpartum Psychosis Treatment Looks Like

Trigger warning: This blog post contains references to suicide and infanticide. Please use your discretion when reading. 

When you’re grappling with your mental health in the postpartum period, it can be hard to know what’s happening. Is this depression, anxiety, or something more severe? With recent tragedies in the news, many moms are left wondering what postpartum psychosis is and what causes it. 

Today, I’m joined by reproductive psychiatrist Dr. Sarah Oreck to discuss the causes, signs, risk factors, and treatments for postpartum psychosis and how it differs from postpartum depression.  

Unpacking PPP in the Wake of a Tragedy

‍Postpartum psychosis is one of those things that moms fear but don’t want to talk about. It’s understudied, misunderstood, and scary. It’s sensationalized in the movies and not covered in the media until major tragedies happen. 

When scary stories of infanticide or maternal suicide pop up in the news, moms are often scared. 

They wonder what causes these horrible tragedies. They wonder if they are at risk. They wonder if symptoms of postpartum depression or postpartum anxiety are signs of something more serious. 

I believe that the more we talk about postpartum psychosis, the better. We need to destigmatize maternal mental health and mood disorders. We need to understand the risks and signs. And we need to let moms know what to look for, what to expect, and when to seek treatment. 

In the wake of a recent tragedy, many moms have reached out to me about postpartum psychosis. I immediately thought about Dr. Sarah. I’m glad that I had the chance to sit down and clear up some of the misconceptions about PPP. 

What Postpartum Psychosis Is (and What the Symptoms Are)

There is sometimes a misunderstanding of what postpartum psychosis even is. PPP is a break from reality that occurs after a baby is born. It typically starts 2-4 weeks after birth but can happen up to a year after. This can include delusions, hallucinations that are typically auditory in nature, and impaired judgment. 

When a mom experiences PPP, there might be moments of lucidity and moments of confusion, ebbing and flowing. This can feel very overwhelming, leaving moms struggling to understand what is real, what isn’t, and what’s happening.

PPP is very rare. It occurs in 1 in 1,000 women—and of those the majority of cases are resolved quickly with effective treatment.

Dr. Sarah pointed out that PPP is very rare. It occurs in 1 in 1,000 women—and of those the majority of cases are resolved quickly with effective treatment. 

We hear about the most extreme cases in the news, and while they are very tragic they don’t occur often. Only 4% of PPP cases result in infanticide and 5% in suicide. 

That’s not to say it shouldn’t be taken seriously—PPP is considered a medical emergency, and moms experiencing symptoms should seek help immediately. But moms can take some comfort in understanding the rarity of such severe cases. 

There is a fear among moms, especially those who experience intrusive thoughts or symptoms of perinatal mood disorders, that their conditions might develop into PPP. But Dr. Sarah pointed out that’s not the case—PPP is an entirely separate disorder than PPD or PPA. 

For most moms with PPP, the signs, symptoms, and warning signs become clear very quickly. People around these moms usually notice behavior changes and grow concerned early on. It’s rare for it to go unnoticed and untreated. 

Dr. Sarah said that when we talk about PPP in a less stigmatized way, we can understand the differences between it and other mood disorders and view it as something that is treatable. 

What Causes Postpartum Psychosis

Dr. Sarah said that we don’t fully understand what causes postpartum psychosis There isn’t a definitive reason that we can point to. 

But there are some risk factors that moms should be aware of. The highest risk is if you have a personal or family history of bipolar disorder or psychosis. However, it can sometimes present without those risk factors. 

If you do have a personal or family history of bipolar disorder or psychosis, it’s important to be aware of the signs of PPP. Dr. Sarah pointed out that moms in this situation should talk to their doctors about medication and therapy. They should also put together a postpartum plan to address sleep, support, and other needs after a baby is born. 

Things like sleep deprivation can put people at risk for all perinatal mood disorders. Moms can create plans with their support systems to protect sleep and call in help. 

Having a baby doesn’t just affect a birthing mother, but the entire support system.

Dr. Sarah pointed out that a having a baby doesn’t just affect a birthing mother, but the entire support system. Having people to check in on us, our needs, and our mental health is important. 

Unlike PPD and PPA, postpartum psychosis doesn’t typically occur during pregnancy. Dr. Sarah said that there are some psychotic episodes that can happen during pregnancy, but they are unrelated to PPP and are most likely to present with schizophrenic disorder or bipolar disorder. 

While PPP can be scary, Dr. Sarah said that moms can take solace in the knowledge that it is very treatable. The vast majority of moms who experience it can and will return to their more typical baseline with effective treatment. 

The Difference Between Postpartum Psychosis and Postpartum Depression

It’s important to separate PPP out from other perinatal mood disorders and understand that more common conditions, such as PPD and PPA, are completely different. 

‍With PPD, moms most often experience low mood—but they don’t encounter a break with reality, hallucinations, or bizarre, paranoid ideas. PPD does come with a risk for suicide, and it’s important to seek treatment if you experience suicidal thoughts, but it’s not the same as PPP.

Sometimes PPD can present differently, with rage, anger, or irritability, leaving moms concerned. These thoughts can feel very frightening. But Dr. Sarah said that there is a major difference between irritable thoughts or Mom Rage and delusions. 

There is a major difference between irritable thoughts or Mom Rage and delusions.

For example, a mom with PPP might think that her baby is a cult leader who is going to destroy the Earth. Thoughts could enter into her mind that the only way to protect the world would be to harm her baby. This is entirely different than a moment of frustration or feeling of hopelessness.

With anger and rage that accompany PPD, we can typically notice triggers for our feelings or thoughts. We might be more irritable than usual, which can feel uncomfortable, but these thoughts don’t come out of nowhere—and they aren’t hard to distinguish from reality. 

The Difference Between Postpartum Psychosis and Intrusive Thoughts

Some moms might worry that intrusive thoughts are signs of something serious. These occur when uncharacteristic or scary thoughts pop into our heads. For example, we might have a vision of dropping our baby down the stairs while walking, causing us to want to hold our baby a little tighter. 

Intrusive thoughts can be a sign of postpartum anxiety or even postpartum OCD, but typically aren’t safety concerns for a mom or a baby. 

While intrusive thoughts can be disturbing, they come from a biological drive to protect our children.

Dr. Sarah pointed out that while intrusive thoughts can be disturbing, they come from a biological drive to protect our children. They stem from our alarm system going off to keep our baby safe. 

Sometimes intrusive thoughts include visions of intentionally harming our child. But these are not the same as PPP. These intrusive thoughts feel scary to moms. Dr. Sarah defined these as “egodystonic,” which are uncharacteristic or repulsive ideas that we would never act on. Sometimes moms even begin to avoid their babies or certain activities such as using kitchen knives or changing diapers due to intrusive thoughts. 

It might feel frightening to experience violent intrusive thoughts. But Dr. Sarah said that these happen because our amygdala grows during pregnancy to protect our baby. They are heightened alarm bells. 

PPP, on the other hand, includes breaks from reality or delusional thoughts—but these thoughts make sense in the framework of the psychosis. For example, it might make sense if our baby was an evil cult leader, to protect other people. This isn’t the same as an intrusive thought or fleeting vision we have no intention to act on. 

Moms with PPP signs aren’t trying to avoid their delusions or hide them—they might be confused by them but they don’t feel completely repulsive like violent intrusive thoughts would. 

What Postpartum Psychosis Treatment Looks Like

The treatment process for PPP is also very different than other perinatal mood disorders. With PPP, medication is very important at the outset. Moms diagnosed with PPP will typically be treated with inpatient care and medicine, such as mood stabilizing agents or antipsychotic agents, as the first intervention. 

With other perinatal mood disorders, mild to moderate conditions might include therapy and lifestyle interventions first, while medication would be reserved for more severe or persistent cases. If cases of PPD or PPA are more severe or don’t show improvement, then SSRIs or other antidepressants might be prescribed. 

But with PPP, medication can be lifesaving. It’s important to parse out the differences between PPP and other mood disorders or mental health concerns. 

With the right treatment, most cases of PPP get resolved and moms are able to return to their normal selves in time. 

While it can be scary, the more we understand it, the more we can destigmatize it and help moms get the treatment they need. 

‍If you believe that you or someone you know is experiencing PPP, seek emergency care immediately. 

‍If you are struggling with signs of PPD, PPA, or other postpartum mental health concerns, working with a mom therapist can help. Book a FREE 15 minute virtual Therapy Support consult today.