Postpartum refers to the time after childbirth. Postpartum mothers may experience mental health changes or challenges after giving birth, including mood disorders such as postpartum depression and postpartum psychosis.
Postpartum depression is a type of depression that happens after having a baby. It affects up to 15% of women, involving emotional highs and lows, frequent crying, fatigue, guilt, and anxiety. A postpartum mother may have trouble caring for their baby or themselves.
Postpartum psychosis (PPP) is a mental health emergency that affects a postpartum mother’s sense of reality, causing hallucinations, delusions, paranoia, or other behavior changes. In severe cases, postpartum mothers with PPP may attempt to harm themselves or their newborn.
Postpartum depression is common. A mother who has just given birth may experience baby blues, which affects between 50% and 75% of women after delivery. Up to 15% of them will develop postpartum depression. Postpartum psychosis is rare, as experts estimate that it affects between 0.089 and 2.6 out of every 1,000 births. In the United States, that means it happens in between 320 and 9,400 births each year. Globally, that means it happens between 12 million and 352.3 million births.
A mother can experience postpartum depression for up to one year after their baby is born. However, this doesn’t mean that they will feel cured in one year.
Symptoms of postpartum depression can include:
· Feeling sad, worthless, hopeless, or guilty
· Worrying excessively or feeling on edge
· Loss of interest in hobbies or things you once enjoyed
· Changes in appetite or not eating
· Loss of energy and motivation
· Trouble sleeping or wanting to sleep all the time
· Crying for no reason or excessively
· Difficulty thinking or focusing
· Thoughts of suicide or wishing you were dead
· Lack of interest in your baby or feeling anxious around your baby
· Thoughts of hurting your baby or feeling like you don’t want your baby
It is believed that hormonal changes are linked to postpartum depression; however, more research is needed to determine the link between the rapid drop in hormones after delivery and depression. The levels of estrogen and progesterone increase tenfold during pregnancy but drop sharply after delivery. When a mother is three days postpartum, levels of these hormones drop back to pre-pregnancy levels.
In addition to these chemical changes, the social and psychological changes associated with having a baby increase the risk of postpartum depression. Examples of these changes include physical bodily changes, lack of sleep, worries about parenting, or changes to relationships.
Experts don’t know why postpartum psychosis happens, but suspect it involves a combination of factors, including:
· History of mental health conditions
· Number of pregnancies
· Family history of mental health conditions, especially PPP
· Sleep deprivation
· Hormone changes
· Other medical conditions
Hallucinations and delusions are the two main symptoms of postpartum psychosis. However, there are several other common symptoms, including:
· Mood changes, such as mania and hypomania or depression
· Depersonalization
· Disorganized thinking or behavior
· Insomnia
· Irritability of agitation
· Thoughts of self-harm or harming others, especially their newborn
Researchers have organized the symptoms of PPP into three types: depressive, manic, and atypical/mixed.
The depressive subtype of PPP is the most common, making up about 41% of cases. It is also the most dangerous. Research shows that depressive symptoms and psychosis are almost always a factor in cases that involve self-harm or harm to a child, especially hallucinations or delusions that command a person to harm their child or themselves. The rate of harm to a child is about 4.5% with this subtype, about four or five times greater than with the other subtypes. The rate of dying by suicide is about 5%. Symptoms that are most likely experienced with this type include:
· Anxiety or panic
· Delusions and hallucinations
· Depression
· Feelings of guilt
· Loss of appetite
· Loss of enjoyment related to things they usually enjoy
· Thoughts of self-harm, suicide, or harming their child
The manic subtype is the next most common of the types, affecting about 34% of cases. The risk of self-harm or harm to children is lower but still possible, happening in about 1% of cases. Symptoms can include:
· Agitation or irritability
· Disruptive or aggressive behavior
· Talking more or faster than usual, or both
· Needing less sleep
· Delusions of greatness or importance, such as believing your child to be a holy or religious figure
The atypical/mixed subtype makes up to 25% of cases. This can mix the symptoms of manic and depressive subtypes. It can also involve symptoms where a person seems much less aware or completely unaware of the world around them. Symptoms can include:
· Disorganized speaking or behavior
· Disorientation or confusion
· Disturbance of consciousness, where a person doesn’t appear to be awake or isn’t aware of activities or things taking place nearby
· Hallucinations or delusions
· Inappropriate comments, behaviors, or emotional displays
· Catatonia or mutism
There isn’t a specific test that diagnoses postpartum depression. A healthcare provider will evaluate you at your postpartum visit, which may include discussing your health history, how you have felt since delivery, a physical exam, a pelvic exam, and lab tests. They may also perform a postpartum depression screening or ask a series of questions to assess if you have postpartum depression.
Postpartum psychosis can be diagnosed by a mental health provider who can determine either by observation or what you describe whether you have the condition or not. They may also perform physical and neurological exams and order blood, urine, or imaging tests.
Postpartum depression is treated differently depending on the type and severity of symptoms. Treatment options include anti-anxiety or antidepressant medications, psychotherapy or cognitive behavioral therapy, and support group participation.
Treatment for postpartum psychosis may include medications to treat depression, anxiety, and psychosis. You may also be admitted to a treatment center for several days until you’re stable. To find out more about our mental health services or to schedule a virtual appointment, call (718) 670-5316 to speak with our intake coordinator or call (718) 670-5562 to reach the clinic
All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.