The Difference Between Postpartum Depression & Postpartum Psychosis

Compared with postpartum depression, which affects 15% of people who have had a baby, postpartum psychosis is rare, only occurring in one to two of every 1,000 births. But the condition is in the spotlight after Massachusetts mother Lindsay Clancy was charged in the murders of her three children. Her defense attorney, Kevin Reddington, cited her struggle with the condition during her arraignment.

To better understand postpartum psychosis — including what it’s like for the person experiencing it — Romper spoke with mental health experts. They explain the condition, what to be aware of if you suspect you or someone you love may be suffering from it, and how families can find help and healing.

What is postpartum psychosis?

Postpartum psychosis falls under the umbrella of perinatal mood and anxiety disorders (PMADs), which are mental health conditions that affect a person while they’re pregnant or up to one year postpartum. Like any mental health condition, it’s defined by its symptoms.

“Some of the chief symptoms of psychosis are hallucinations — like seeing, hearing, or feeling things other people can’t see, hear, or feel — and delusions,” says Dr. Jill Garrett, PsyD, a psychologist at Baptist Health Jacksonville and program director of The Motherhood Space, a maternal mental health program. “Delusions are like strange beliefs, like being more paranoid and suspicious or having more mistrust. They might hear voices telling them to hurt their baby, or have worries someone is trying to get in their house or is spying on them, and they have to hide themselves and their baby in a room and put aluminum foil over the windows.”

Postpartum psychosis can sometimes be confused with perinatal OCD, Garrett says. With perinatal OCD, a person can have repetitive intrusive thoughts, usually about causing harm, like, “What if, while I’m giving my baby a bath, I push them under the water?”

“With perinatal OCD, the parent is quite distressed [by these thoughts] and oftentimes absolutely afraid to be left alone with the baby, and worried that if they tell anyone about this they’ll have their baby taken away. The person knows it’s wrong and it’s a problem.”

But with postpartum psychosis, that recognition that something is wrong (what Garrett calls “insight”) is not there. She emphasizes that psychosis doesn’t make a parent evil or cause them to want to harm their baby or themselves; it’s out of their control.

“Psychosis, in some ways, is like having a dream while you’re awake. In your dreams, you might make choices that are bizarre and not in touch with reality.”

For that reason, postpartum psychosis is considered a psychiatric emergency. “The parent doesn’t recognize that they’re having these thoughts and they’re not reasonable, and they might be tempted to act on them. They’re sick, and they just don’t have the insight to know that right at this moment.”

The condition can cause a profound and sometimes dangerous disconnect from reality. “If they were not experiencing postpartum psychosis, these are mothers who would tell you they love their baby. It’s the psychosis that doesn’t allow them to be in touch with reality. They see the world differently, but in their delusion it makes sense,” says Dr. Andrea Diaz Stransky, M.D., psychiatrist at Duke Psychiatry & Behavioral Sciences, and assistant professor of psychiatry and behavioral sciences at the Duke University School of Medicine. “Psychosis, in some ways, is like having a dream while you’re awake. In your dreams, you might make choices that are bizarre and not in touch with reality.”

What is the difference between postpartum depression and psychosis?

When there’s breaking news around postpartum mental health, you may hear “postpartum depression” used as a blanket term for any mental health condition affecting a new parent who has given birth. Experts say this is inaccurate — postpartum depression and postpartum psychosis are both PMADs, but they’re different conditions with unique symptoms and treatments.

Of course, some symptoms may overlap. “There is often a mood component with psychosis, and it can sometimes look like depression because there’s a little bit of social withdrawal, but it’s not the same as PPD,” Stransky says. What differentiates psychosis from depression is that it causes hallucinations and delusions.

And because they’re two distinct conditions, you don’t have to have one as a prerequisite to the other. “You don’t have to have postpartum depression to have postpartum psychosis; they’re different,” Garrett says.

Postpartum psychosis symptoms

According to Postpartum Support International, postpartum psychosis symptoms can include:

• Decreased need for or inability to sleep
• Delusions or strange beliefs
• Difficulty communicating at times
• Feeling very irritated
• Hallucinations
• Hyperactivity
• Paranoia and suspiciousness
• Rapid mood swings

Some people experiencing postpartum psychosis may conceal their symptoms, making it harder to tell they are struggling. “When a patient has a little bit of insight into their psychosis, they’re able to appear like they are in touch with reality and tuck away those delusions where they’re not as obvious. This can make it really hard for families,” says Stransky. “If you have any suspicions or something is off, it’s really helpful to talk to their OB-GYN or primary care doctor.”

Postpartum psychosis risk factors

Just like having depression before pregnancy puts you at higher risk for developing postpartum depression, according to Postpartum Support International, a personal history of bipolar disorder can put you at risk for experiencing postpartum psychosis.

“Postpartum psychosis may occur as an isolated episode, or most commonly, in association with bipolar disorder,” says Dr. Yardana Kaufman, M.D., reproductive psychiatrist at Zucker Hillside Hospital’s Perinatal Psychiatry Center, and assistant professor of psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra University and Northwell Health. “Symptom onset usually occurs within the first two to six weeks after delivery.”

This is especially true if your bipolar disorder developed when you were young, Stransky says, or have had other mental health crises that required you to be hospitalized. Postpartum psychosis can also run in families.

“There definitely is a genetic component, so if you have a mother or sister who has experienced it or other perinatal mood conditions, that definitely increases your risk,” says Stransky.

How long does postpartum psychosis last?

Unfortunately, postpartum psychosis will not go away with time. “It absolutely requires treatment, ideally going to the emergency room for care,” says Stransky. “It does not self-resolve. You can get it under control in one to two weeks, but there are times when you’ll need to take medications for mood stability long-term.”

Postpartum psychosis treatment

If someone you care about is exhibiting signs of postpartum psychosis, Garrett says they should be taken to the emergency room immediately. “The reason is because they’re at a higher risk of hurting themselves or others. Next steps tend to be medication and therapy. This is a really treatable condition with the right medications.”

“Patients will get medications for sleep, then oftentimes they’ll be started on a mood stabilizer which we’ll choose based on side effects. Sometimes we use antipsychotic medications for their mood stabilizing components,” Stransky explains. “We also try to help the patient leverage their social supports to get more sleep at night. Often they will require an inpatient psychiatric hospitalization, which is followed by intensive outpatient treatment.”

Stransky adds that having postpartum psychosis can make a person more likely to develop bipolar disorder, which may require ongoing treatment with medication and therapy. For those who don’t, once they achieve stability, they “will no longer need the medications or high levels of care,” Stransky says.

If you have experienced postpartum psychosis before and are thinking about having another baby, Stransky and Garrett recommend establishing a relationship with a psychologist and psychiatrist that specialize in perinatal mental health ahead of time, and working with them to remain on any mood stabilizing medications throughout pregnancy. Having the right care team in place before and after you give birth ensures you’ll have the support you need.

Postpartum psychosis sounds scary — and for the person living with it, it must be terrifying — but if we can set aside stigma and help new parents when they need it, they can find treatment and make a full recovery.

If you or someone you know is experiencing psychosis while pregnant or postpartum, treat it as an emergency and dial 911 or take them to your nearest ER. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, visit Postpartum Support International, call their HelpLine at 800-944-4773, or text “Help” to 800-944-4773.

Experts:

Dr. Jill Garrett, PsyD, PMH-C, psychologist at Baptist Health Jacksonville and program director of maternal mental health program The Motherhood Space

Dr. Andrea Diaz Stransky, M.D., psychiatrist at Duke Psychiatry & Behavioral Sciences, and assistant professor of psychiatry and behavioral sciences at the Duke University School of Medicine

Dr. Yardana Kaufman, M.D., reproductive psychiatrist at Zucker Hillside Hospital's Perinatal Psychiatry Center, and assistant professor of psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra University and Northwell Health