Women who develop postpartum psychosis often see or hear things that are not really there. These hallucinations may be frightening, upsetting, or disorienting. They may come and go, or they may persist. Hallucinations are one of the major signs that distinguishes postpartum psychosis from postpartum depression, and it requires immediate medical intervention. Confusion also distinguishes postpartum psychosis from postpartum depression. Even healthy new mothers may seem exhausted and mentally foggy, but these symptoms should not evolve into true confusion or bewilderment. A woman with postpartum psychosis may seem puzzled by what’s going on around her unable to understand what others are saying to her. Along with hallucinations and confusion, delusions – strange but strongly held beliefs that a rational person would know to be false – are one of the chief symptoms that distinguishes postpartum psychosis from postpartum depression. Delusions also require immediate medical treatment. They may not cause a woman to hurt herself or someone else, but in some cases, they do lead to violence. These delusions, perhaps in combination with hallucinations, may make a woman paranoid or suspicious. Someone with postpartum psychosis may think her friends and family members are lying to her or trying to hurt her; she may feel that she is being watched or followed. Mood swings are a common symptom for women with postpartum depression and anxiety, and they also play a role in postpartum psychosis. Women who develop postpartum psychosis tend to move quickly from one emotional state to another; they may suddenly find themselves overwhelmingly sad, distressed, irritated, or angry, and they may or may not be able to pinpoint any reason for the abrupt shift in mood. Difficulty sleeping is also characteristic of all the postpartum psychiatric conditions, but it may be especially pronounced in women with postpartum psychosis. They may develop persistent insomnia, or they may feel that they do not need to sleep at all. This symptom can be especially difficult to detect because most new mothers, even perfectly healthy ones, struggle with sleep. Newborns do not sleep reliably, and they must eat frequently, which can disrupt their mothers’ sleeping patterns. For women with postpartum psychosis, though, difficulties with sleep persist even when they are given the opportunity to rest (as when a spouse, partner, friend, or relative agrees to care for the baby temporarily). Postpartum psychosis can make a woman seem manic, agitated, or unusually energetic. She may not be able to sit still or calm down. Women with postpartum psychosis sometimes articulate the sense that they are “going crazy” or “losing their minds.” Do not dismiss these feelings; get help. Technically, postpartum psychosis can develop at up to six months postpartum, but almost all cases occur during the first four weeks. If you are a new mother yourself, or if your wife or partner recently gave birth, pay particular attention to mental and psychological symptoms during this early period. Women with a history of bipolar disorder have a much higher incidence of postpartum psychosis, as do women who have had postpartum psychosis before. Family history may also play a role: if a new mother has a family history of mental illness, her risk of developing postpartum psychosis increases. Be particularly vigilant in these cases. Note, however, that half of all women who develop postpartum psychosis have none of these risk factors. The disorder sometimes occurs for no discernible reason at all.
Watch for hallucinations. Take confusion seriously. Look for delusions. Pay attention to mood swings. Monitor sleep patterns. Note any hyperactivity. Take feelings of “craziness” seriously. Be especially vigilant during the first few weeks after delivery. Consider risk factors.