Signs, Causes, What to Expect From Treatment

• Signs of postpartum psychosis can include hallucinations, delusions, and changes in mood and sleep.
• If you begin to notice these signs around two weeks after delivery, contact your doctor right away.
• Getting prompt support is key to recovery — treatment might involve therapy, medication, and ECT.
• Visit Insider’s Health Reference library for more advice.

Postpartum psychosis is a rare but serious mental health condition that develops in the weeks following childbirth, after an estimated one to two of every 1,000 births. This condition frequently involves hallucinations and delusions, along with confused speech and odd or uncharacteristic behavior.

These symptoms can change your connection with reality in ways that can put your safety, or the safety of those around you, at risk.

“While most individuals who experience postpartum psychosis do not harm themselves or anyone else, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment,” says Rachele McCarthey, MD, a psychiatrist at the University of Utah Huntsman Mental Health Institute’s Behavioral Health Clinic.

Health professionals consider postpartum psychosis a medical emergency. So, if you believe you or a loved one could have this condition, it’s important to reach out for support and treatment as soon as possible.

Early signs and symptoms

The first signs of postpartum psychosis usually show up within two weeks after childbirth, though they can occasionally show up after this point.

Symptoms of postpartum psychosis can include:

• Difficulty with self-care
• Unusually impulsive behavior
• Frequent mood shifts
• Sleep problems, such as insomnia
• Restlessness or irritability
• Hallucinations
• Delusions, or beliefs that don’t match up with reality
• Mind fogginess or confusion
• Confused or incoherent speech
• Thoughts of death or suicide
• Thoughts of hurting or killing the baby

The hallucinations and delusions that come with postpartum psychosis can take many forms. For instance, a hallucination can be:

• Auditory: Hearing things only you can hear
• Visual: Seeing things only you can see

Delusions caused by postpartum psychosis can also vary from person to person, but they commonly involve unusual fears or beliefs that another person is trying to harm you or your infant, called persecutory delusions.

Up to 53% of new parents with postpartum psychosis experience delusions that involve their infant in some way, according to one small 2006 study.

“Examples include the mother worrying that a very dangerous person, or even the devil, is actively trying to harm them and their children,” says Neelima Kunam, MD, a psychiatrist with a private practice.

While persecutory delusions are common, sometimes delusions or hallucinations can lead to beliefs that the infant:

• Is a source of harm
• Needs to be sacrificed to prevent harm
• Is another person’s baby

What causes postpartum psychosis?

Experts don’t know the exact cause of postpartum psychosis, but research from 2021 suggests a variety of risk factors, including the following:

Hormone shifts

One hypothesis for the cause of postpartum psychosis is an imbalance in brain chemicals called neurotransmitters, says Kunam. The neurotransmitter dopamine in particular could play a part in postpartum psychosis.

Childbirth triggers a huge drop in hormones, including estrogen and progesterone. Some researchers suggest this hormonal shift could impact dopamine receptors and cause postpartum psychosis.

Sleep deprivation

Experts have linked the lack of sleep most new parents experience when caring for a newborn to postpartum psychosis, but more research is needed to confirm this.

While experts recommend most adults get seven to nine hours of sleep each night, you’re more likely to get closer to six hours of sleep if you’ve just given birth — and nighttime feedings can mean you might not get more than two to three hours of sleep at a time.

Mental health conditions

Roughly 50% of people who develop postpartum psychosis have had a previous mental health condition.

For example, a personal or family history of bipolar disorder — or a previous experience of psychosis — are key risk factors for postpartum psychosis, says McCarthey.

In fact, up to one in five people with bipolar disorder may develop postpartum psychosis after giving birth, according to a small 2019 study.

Other mental health conditions such as schizophrenia can also increase your risk of postpartum psychosis. For instance, an estimated 12% of people who experience postpartum psychosis live with schizophrenia.

Other risk factors

The following could also be risk factors for postpartum psychosis, according to 2020 research:

• Changes to your immune system as a result of pregnancy
• Lack of family support
• Relationship difficulties with your partner
• Being a first-time parent
• Thyroid disease
• A history of postpartum psychosis

Although having more of these risk factors may increase your chances of developing postpartum psychosis, keep in mind that anyone can experience it.

How to get support

Postpartum psychosis is a treatable condition, but a good outcome often depends on prompt care and monitoring within a hospital setting, says McCarthey.

Asking for support may feel frightening, though.

“One of the main reasons people are scared to reach out for help is the fear of being seen as a bad parent, or losing custody of children, or just losing their children in any way,” says Kunam.

But seeking care right away is actually a responsible move that shows how much you care about your family, along with your own safety and well-being.

If you think you or a loved one is experiencing postpartum psychosis, McCarthey says it’s a good idea to do one or more of the following:

• Contact your doctor or therapist and describe your symptoms.
• Call or text an emergency crisis line if you need immediate support at home.
• Go to your closest emergency room.

“You should request an urgent assessment on the same day you first begin experiencing symptoms,” she says.

Calling 911 is rarely necessary but sometimes relevant in intense situations.

If you do call 911, “it’s important to make it clear to the emergency personnel arriving that the individual is needing medical and psychiatric attention and not necessarily committing a crime,” says Kunam.

Although postpartum psychosis does increase the risk of suicide and infanticide, it’s important to remember the majority of people with the condition don’t harm themselves or their infant.

What to expect from treatment

According to McCarthey, treatment for postpartum psychosis involves:

Electroconvulsive therapy (ECT) can also be used to treat postpartum psychosis, and research on its effectiveness is promising.

Treatment usually happens in a psychiatric unit or hospital and you can be there anywhere from a couple of days to a few months depending on your symptoms.

Once you leave the hospital, you’ll typically continue treatment with regular check-ins, therapy, psychoeducation, and medication. It could take many months before you’re fully recovered.

For example, one small 2017 study found that nearly three in four people who received treatment for postpartum psychosis had recovered by nine months after delivery. Another small 2013 study found that a quarter of people had symptoms over a year after delivery. That said, some experts emphasize that it can take about one year to recover.

Insider’s takeaway

Postpartum psychosis is a serious, but treatable, mental health condition that develops soon after childbirth, one of the most vulnerable times of life for many.

While symptoms can feel frightening and confusing, there’s no shame in getting a diagnosis. “Know that having postpartum psychosis is not your fault — you are not to blame,” says McCarthey.

Connecting with professional support and treatment as soon as you recognize the symptoms can help ensure a healthy, safe outcome for both you and your child.