The period after childbirth is often described as joyful and fulfilling, but for many new mothers, it can also be emotionally overwhelming. While mood changes are common in the weeks following delivery, not all postpartum mental health conditions are the same.
Two conditions that are often confused are postpartum depression and postpartum psychosis. Although both occur after childbirth, they differ significantly in severity, symptoms, and urgency. Understanding the distinction can save lives.
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What is Postpartum Depression?
Postpartum depression is a depressive disorder that can affect a woman after she gives birth, according to the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 defines PPD as a major depressive disorder with peripartum onset, occurring during pregnancy or within four weeks after childbirth. Some health professionals, however, have documented the onset of postpartum depression within one year after childbirth.
Approximately 10 to 15% of mothers who have recently delivered will be affected by postpartum depression.
Some of the symptoms of postpartum depression are:
- Feeling hopeless or sad for long periods of time
- Disinterest in activities that once gave pleasure
- Difficulty forming a bond with one’s child
- Feelings of guilt or being inadequate
- Excessive irritability or angry outbursts
- Feeling fatigued or lacking energy
- Changes in appetite
- Problems sleeping beyond what is typical after birthing a newborn
- Symptoms of panic or anxiety
- Thoughts of self-harm (i.e., suicide)
Despite experiencing these symptoms, Women with postpartum depression typically maintain contact with reality, though functioning may be impaired.
Treatment for postpartum depression can range from mild to severe, but with the proper intervention from professionals, support, therapy, or medication, it is highly treatable.
What Is Postpartum Psychosis?
Postpartum psychosis is a serious psychiatric emergency that usually appears suddenly in the first two weeks postpartum. Unlike postpartum depression, which is a form of depression that occurs after having a child, postpartum psychosis is characterized by a break from reality.
Postpartum psychosis is not merely a “severe version” of postpartum depression but is a more serious and acute disorder. Postpartum psychosis occurs in approximately 1 to 2 per 1,000 births.
Symptoms of postpartum psychosis include:
- Hallucinations (seeing or hearing things that do not exist)
- Delusions (strongly held false beliefs that often concern the safety of the baby)
- Severe confusion/disorientation
- Rapid mood changes
- Paranoid thoughts
- Insomnia with no desire for sleep
- Agitation or acting strangely
- Disorganized thoughts
Delusional thoughts may include ideas of the baby being injured or possessed, or needing to be rescued. These false beliefs increase the possibility of the mother harming herself or her baby.
This serious condition requires immediate intervention by medical and mental health professionals.
Key Differences Between Postpartum Depression and Postpartum Psychosis
| Feature | Postpartum Depression | Postpartum Psychosis |
| Frequency | Common | Rare |
| Onset | Gradual | Sudden |
| Reality Testing | Intact | Impaired |
| Hallucinations/Delusions | Absent | Present |
| Severity | Moderate to severe | Psychiatric emergency |
| Hospitalization | Sometimes | Often required |
Causes and Risk Factors
Though both conditions are influenced by a mix of biological, psychological, and environmental factors, postpartum psychosis has a stronger association with some psychiatric predispositions.
1-Hormonal Changes
After having a baby, the estrogen and progesterone in a woman’s system decrease really quickly. Changing levels of hormones can impact brain chemistry and mood.
2-Lack of Sleep
Being severely sleep deprived can increase mood swings and lead to the development of psychiatric symptoms.
3-Personal or Family History of Mental Health Problems
Risk factors for developing postpartum depression include:
- Previous history of depression or anxiety
- History of postpartum depression
- Chronic stress
- Not enough social support
Risk factors for postpartum psychosis include:
- Women with bipolar disorder.
- People with a past history of postpartum psychosis.
- Family history of bipolar disorder.
Schizoaffective disorder or any other type of psychotic disorder. Women with bipolar disorder are at much greater risk of developing postpartum psychosis after giving birth.
Why Postpartum Psychosis Is a Medical Emergency?
Women with postpartum psychosis are at an increased risk of committing suicide as well as harming their children because their ability to think clearly and recognize the difference between reality and their own thought processes is impaired. As such, these individuals may not understand that their thinking is being distorted, and this can put both the mothers and their children in danger.
Postpartum psychosis usually requires immediate hospitalization in order to ensure the safety of the woman and to initiate treatment.
Treatment for women with postpartum psychosis may include:
- Mood stabilizers
- Antipsychotics
- Electroconvulsive therapy (ECT) in some cases
- Continual psychiatric monitoring
If diagnosed quickly enough, postpartum psychosis can be treated successfully.
Treatment of Postpartum Depression
Postpartum depression is very treatable, and common methods of treatment are:
- Cognitive behavioral therapy (CBT)
- Interpersonal therapy (IPT)
- Initiation of antidepressants
- Support groups
- Family and partner participation
If treated early, the outcomes can be very positive for both the mother as well as the child.
The Importance of Early Screening
The inability to distinguish early symptoms may result from symptom overlap (e.g., mood swings, sleep disturbances), which emphasizes the need for a thorough assessment by qualified professionals.
Emergencies exist when a mother demonstrates signs of hallucinations, delusions, severe confusion, or bizarre beliefs.
Reducing the Stigma
Postpartum depression and postpartum psychosis are two different forms of medical conditions; neither condition represents a mother’s failure.
Stress induced by the demands of motherhood can prevent people from acknowledging the existence of these conditions until they reach the point at which they are no longer able to provide care for their babies or themselves.
Both education and increased awareness can help to diminish the stigma associated with these conditions and encourage mothers to seek early treatment.
In Summary
Postpartum depression and postpartum psychosis are two separate conditions. While postpartum depression is very common, very real, and fully treatable, postpartum psychosis is much less common, much more serious, and a psychiatric emergency.
If you or someone you know has thoughts of self-harm, harming a baby, hallucinations, or delusions during the postpartum period, go to the nearest emergency room or call your local emergency services immediately. With intervention, both conditions can be treated, and recovery is highly likely.
