What is Postpartum Psychosis?

By Bonnie Steele. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Can you imagine being so sick or depressed that you’d actually want to harm your own children?

When Andrea Yates was convicted of drowning her five children in the bathtub in 2001, she shined a national spotlight on the dangers of postpartum psychosis (PPP). Generally considered more severe than postpartum depression, PPP is a mental disorder characterized by hallucinations and delusional thoughts that may provoke severe and irrational behavior in new mothers.

The shocking-but-temporary disorder affects about one in 1,000 new mothers and it requires immediate medical attention to prevent sufferers from harming themselves or their children. In fact, Yates attempted suicide several times in an effort to stop herself from harming her children.

Signs of PPP most often occur within days of delivery. According to mental health experts at Cleveland Clinic, symptoms include:

  • Severe agitation
  • Confusion
  • Feelings of hopelessness and shame
  • Insomnia
  • Paranoia
  • Delusions about her baby
  • Hallucinations, such as the mother hearing voices instructing her to hurt herself or her children
  • Hyperactivity
  • Rapid speech or mania

Deadly Effects of Postpartum Psychosis

Life as he knew it ended for Greg Burchett when his wife told him that God spoke to her through the car stereo, telling her to drive her car into a telephone pole. Though she survived the car crash unscathed, the voices continued. A few days later, she followed their instructions and killed their 17-month-old son, Garrison. Burchett, who details the events in his book “Missing the Links,” is hoping to draw attention to postpartum psychosis, a topic he believes many avoid because it is too horrific.

“Often a woman doesn’t see she is going down this path,” Burchett explains. “She thinks everyone around her is wrong.”

Because of this, family caregivers should look much harder to discover signs. Is the new mother sleeping? Is she eating normally, and does she feel an emotional connection to her new baby? If she’s not, PPP could be one prognosis.

Burchett recalls his wife having irrational thoughts for weeks before the suicide attempts. He notes that none of the doctors or birth specialists they visited back in 2001 ever mentioned the possibility of PPP.

Having bipolar disorder is a risk factor

While postpartum psychosis is rare, mothers with certain risk factors are more susceptible to developing it.

Many specialists believe postpartum psychosis and bipolar disorder are directly linked. According to Adele Viguera, MD, MPH, director for the Center for the Care and Study of Women’s Mental Health at Cleveland Clinic, women with bipolar disorder have a 50 percent chance of suffering a postpartum episode like Yates did.

In a recent study published in the Journal of Women’s Health, researchers say PPP resembles an overt presentation of bipolar disorder that coincides with hormonal shifts after delivery. New mothers with this condition can develop “frank psychosis, cognitive impairment and grossly disorganized behavior that represents a complete change from previous functioning,” the study’s authors write. This puts the mother and her child in direct harm’s way.  

Many experts, in fact, do believe that this type of psychotic strain is a form of mania among the severely depressed or mentally ill. However, there is very little research about the actual state of pregnancy and how this postpartum period negatively influences women who suffer from bipolar disorders, says Viguera.

Mental health experts recommend women with bipolar disorder discuss any variations in medication during pregnancy with their doctors. Depending on the underlying diagnosis and symptoms, drug tolerability and breastfeeding preferences, bipolar meds may need to be modified or altered throughout (and after) pregnancy.

Viguera also notes that women who have experienced a postpartum psychosis episode with one child have a greater than 90 percent risk of experiencing subsequent episodes with additional pregnancies. Women with a family history of postpartum depression episodes are also considered at risk and need to be closely monitored.

Yates was originally convicted of capital murder but later had her conviction overturned due to her plea of “not guilty by reason of insanity,” due to postpartum psychosis.

Take the Next Steps

Most new parents will acknowledge that a wiggly bundle of joy still places great demands on a new family, including sleep disruptions and mood swings. However, PPP is much more severe than mood swings.

Fortunately, with proper family concern, medication and treatment, PPP appears to be temporary and highly treatable. New mothers who are properly diagnosed may experience only a brief illness, rapid treatment responses and the absence of long-term impairment.

If you believe you or a loved one could be suffering from PPP, even if the symptoms appear to be subtle, don’t disregard them. She may be feeling more than “just the blues.” Seek medical attention immediately. 

  • Women with PPP should be admitted to the hospital and prescribed anti-psychotic medication as well antidepressants and/or mood stabilizers.
  • Electroconvulsive therapy may also be considered, based on severity of her condition. 

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