What Is Postpartum Psychosis?

Having a new baby can bring many mental and physical changes. They may include the risk of developing postpartum psychosis. People with this mental disorder may have delusions, hallucinations, confusion, and changes in mood. Symptoms of postpartum psychosis can come on suddenly and usually start within two to four weeks of giving birth.

Postpartum psychosis is more than just mild mood changes. It needs to be treated by a mental health professional.

Tired mother holding her newborn child at home after trying to pump
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What Is Postpartum Psychosis?

Postpartum psychosis is rare but severe and can cause a new mother to lose touch with reality. People with this mental disorder may hear voices or see things that aren't there and believe things that aren't true. They may also exhibit paranoia and rapid mood swings.

Most cases of postpartum psychosis occur within two weeks of delivery, but they can come on as soon as two to three days after giving birth. Research has shown that the majority of people who develop postpartum psychosis immediately after childbirth either have bipolar disorder, which is characterized by extreme emotional highs and lows, or schizoaffective disorder, which causes symptoms of schizophrenia and mood disorders.

Postpartum psychosis should always be considered a medical emergency, especially because symptoms may lead to thoughts of harm.

How Common Is Postpartum Psychosis?

Postpartum psychosis is estimated to occur in about one to two of every 1,000 births.

Causes

A history of bipolar disorder is the best-recognized risk factor of postpartum psychosis. However, it's been found that up to half of those who experience postpartum psychosis have no prior history of mental illness.

A potential contributor to the rapid mood swings seen in postpartum psychosis is a decrease in pregnancy hormone levels, including estrogen and progesterone, which plummet in the postpartum period, affecting functions of the mood-associated neurotransmitters serotonin and dopamine.

Significant risk factors of postpartum psychosis include:

  • A previous psychotic episode
  • Family history of bipolar disorder or postpartum psychosis
  • Being a first-time mother
  • Extremes of reproductive age (being very young or very old)
  • Cesarean delivery (C-section)
  • Sleep deprivation, which is both a risk factor and symptom
  • Withdrawal from mood stabilizing medications
  • Postpartum complications with the newborn or mother

Postpartum immune system changes could also contribute to postpartum psychosis. During bipolar episodes, a person's immune system modulators (cytokines) are elevated. This is also commonly observed in postpartum psychosis. 

Postpartum Depression vs. Postpartum Psychosis

A severe hormonal drop happens in the 48 hours after giving birth, and it can cause mild mood swings. This period is unofficially called the baby blues. If the baby blues don't resolve on their own after a few days and symptoms of depression occur for at least two weeks, you may have postpartum depression (PPD).

Symptoms of postpartum depression can include:

  • Mood swings and crying spells
  • Anxiety and feelings of being overwhelmed
  • Appetite loss
  • Sleep troubles 
  • Feelings of emptiness or numbness
  • Being emotionless (feeling hollow or empty)
  • Worries about not loving the baby
  • Fears about caring for the baby
  • Suicidal thoughts and behaviors

PPD is a mood disorder, and its symptoms differ significantly from those of postpartum psychosis, which is a psychotic disorder. A mood disorder affects a person's emotional state, while a psychotic disorder causes someone to lose touch with reality.

Postpartum psychosis is much less common than postpartum depression, which affects 10%–13% of new mothers.

Risk and Symptoms

Mothers with postpartum complications were twice as likely to have postpartum psychosis compared to those without complications, and the offspring of mothers with postpartum psychosis who had been hospitalized were four times more likely to die within the first year after birth. Severe cases of postpartum psychosis increase the risk of suicide and harm to the baby.

Rarely do symptoms of postpartum psychosis appear later than a few weeks post-childbirth. But they do happen at a crucial time for bonding, resting, and recovering, which can be difficult to handle. Knowing the risks and symptoms will help you be on the lookout for this mental disorder and seek treatment as soon as possible.

Women with postpartum psychosis may appear:

  • Excited or elated
  • Depressed, anxious, or confused
  • Excessively irritable or have a changing mood

Noticeable and dramatic shifts in mood can occur over a few hours and are similar to bipolar episodes (shifting between depression and mania, or elevated moods and energy).

For partners, family members, and friends who aren't sure how to support their loved one, offering a listening ear and a helping hand is a good start. Seek help from a mental health professional if your loved one's symptoms are severe.

Diagnosis and Treatment of Postpartum Psychosis

There are no set criteria for the diagnosis of postpartum psychosis. Your doctor may ask you questions about your symptoms to determine the best course of action.

Treatment for postpartum psychosis may include the following:

  • Antipsychotic medications are the first-line treatment for psychosis, including Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).
  • Lithium is said to reduce the risks for someone who’s particularly vulnerable to developing postpartum psychosis.
  • Electroconvulsive therapy (ECT), a brief electrical stimulation of the brain, can help to rapidly decrease symptoms (including those of suicidal thoughts or behaviors), but it isn’t commonly used.

While it can take up to a year to fully recover from postpartum psychosis, the most severe symptoms tend to last for 2–12 weeks. Getting the right treatment and support is an essential component of recovering. Without treatment and support, recovery is still possible but can be more challenging and take longer.

Summary

Postpartum psychosis can cause delusions, hallucinations, confusion, and mood swings in people who have just given birth. It can appear within two to four weeks after delivery, but you can also develop this mental disorder much sooner.

People are more likely to develop postpartum psychosis if they have had a psychotic episode in the past or a history of bipolar disorder. Postpartum psychosis is a serious condition that requires treatment, so talk to your doctor if you think you have symptoms of this mental disorder or are at risk for developing it.

A Word From Verywell

Postpartum psychosis is a scary mental disorder, but it's actually quite rare. If you have risk factors for or concerns about postpartum psychosis, talk to your medical team so they can come up with the best plan to prevent or treat it.

If you’re concerned about the behavior of someone you love who has recently given birth, talk to them and offer them support, including emergency help, if needed. The sooner you can help your loved one seek the right resources, the better the outcome will be.

Frequently Asked Questions

How common is postpartum psychosis? 

Postpartum psychosis is rare, occurring in approximately one to two of every 1,000 births. It is more common in people with a history of bipolar disorder and psychotic episodes. Having a cesarean section, postpartum complications in the mother or baby, and sleep troubles have also been associated with postpartum psychosis.

How long does postpartum psychosis last? 

Symptoms can last anywhere from two to 12 weeks. Symptoms can remain for up to six to 12 months.

What is the best way to help someone with postpartum psychosis? 

If you know someone who has postpartum psychosis, support them by getting them immediate help and then help them follow through with their treatment plan. You also may be needed to care for the baby during treatment since postpartum psychosis is a serious mental disorder that requires care. Left untreated, it can potentially lead to harm to the mother and the baby.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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