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You’ve likely heard of postpartum depression, and maybe even postpartum anxiety, but have you heard of postnatal or postpartum psychosis? Postpartum psychosis generally starts with finding it hard to get sleep, feeling restless or irritable, and feeling strong, even invincible. It typically starts early: within a couple of days up two about 12 weeks after baby’s birth. Postpartum psychosis can progress to seeing things or hearing voices or other sounds that aren’t there and to fear that someone will hurt you or your baby. This diagnosis can also include manic symptoms—high energy levels, talking quickly, racing thoughts, impulsive plan-making—and depressive symptoms, such as negative thinking, suicidal ideation, and fatigue or lack of energy.
Postpartum depression, on the other hand, does not typically include hearing or seeing things that aren’t there, and doesn’t often include manic symptoms either. It also can occur up to a year after birth—or if you’re breastfeeding, up to a year after weaning your baby. And postnatal psychosis is less common than postpartum depression: it affects 1 to 2 women in every 1000, whereas postpartum depression occurs in as many as 1 in 4 new moms. The most common features of postpartum depression are depressed mood or mood swings, crying, withdrawal from loved ones, and overwhelming fatigue.
In a study published in 2021 in the journal Midwifery, Diana Jeffries, a nursing researcher at Western Sydney University in Australia, and her colleagues interviewed 10 women about their experiences of postnatal psychosis.  The researchers found that the participants’ experiences were traumatic and perhaps made more so by discussions with care providers who assured these women that their symptoms were part of the normal adjustment to parenthood.
In the study, the commonality between the 10 women was a “profound lack of sleep,” ranging from sleeping just a few hours to not sleeping at all. Often lack of sleep is attributed to the challenges of caring for a baby at all hours, but the participants in the study reported that they couldn’t sleep even when their baby was sleeping. Sleep deprivation is known to provoke symptoms such as hallucinations and delusions in people who have not just had a baby, so it makes sense that this lack of sleep can also contribute to postpartum psychosis. Another commonality to the experience of the study participants is that stressful or traumatic events, during pregnancy, birth, or both, preceded their development of postnatal psychosis.
The rarity of postpartum psychosis may make it harder for care providers to detect, but it’s been shown that care providers with whom patients are most comfortable are the people to whom they are most likely to disclose mental health symptoms.  If you are experiencing symptoms and know that something isn’t right, tell different people until someone believes you. There are treatments for postpartum psychosis—therapy, medication, and hospitalization are all options—and the earlier it’s detected, the easier it is to treat. The best practices for treating postpartum psychosis depend upon when the condition is detected. In the early stages, it can be treated in an outpatient setting with the coordination of mental health and physical care teams, which might include therapists, social workers, doctors, and midwives. If hospitalization is required, it’s preferred that hospitalization take place in a mother-baby unit, so that mother and baby can be cared for together and the bond between parent and infant is allowed to continue to develop.
Recovery from postpartum psychosis does not always follow a linear path, according to a study published in the Archives of women’s mental health in 2020.  In that paper, Anja Wittkowski, a clinical psychologist at the University of Manchester in the UK, and colleagues analyzed existing research on postpartum psychosis. They suggest that treatment of and recovery from postpartum psychosis could be expedited by increasing public knowledge of the disorder, providing continuous support to women and families throughout the experience, not just in the early stages of disease and recovery, and that considerations about future pregnancies and past mental health history should be supported by the community and healthcare professionals.
- Jefferies, D. et al. (2021). The river of postnatal psychosis: A qualitative study of women’s experiences and meanings. Midwifery.
- Kingston, D. E. et al. (2015). Disclosure during prenatal mental health screening. Journal of affective disorders.
- Forde, R., Peters, S., & Wittkowski, A. (2020). Recovery from postpartum psychosis: a systematic review and metasynthesis of women’s and families’ experiences. Archives of women’s mental health.