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Postpartum Psychosis

Linked to Bipolar Disorder

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Updated January 17, 2010

Frequency of Postpartum Psychosis

Experts estimate that 25-75% of all new mothers experience the "baby blues," a short-term period of mild depression following the birth of a child. Ten percent develop postpartum depression, a more serious condition that can include mood swings, uncontrollable crying, fatigue or exhaustion, feelings of guilt, inadequacy or worthlessness, lack of interest in the baby and other common signs of depression. One or two in a thousand women will develop postpartum psychosis - a very serious illness that needs quick intervention, usually including hospitalization.

One or two in a thousand may not sound like many until you know that in 2004 there were just over 4.1 million births in the United States. This translates to 4,100 to 8,200 women who experience postpartum psychosis per year. Given the rates of suicide and infanticide related to postpartum psychosis, this estimates at risk over 300 infants killed and more than 400 mothers committing suicide because of this illness each year in the US alone.

Causes and Risk Factors of Postpartum Psychosis

Although more studies are needed to determine the causes of postpartum illnesses, the evidence suggests that the sudden drop in estrogen levels that occurs immediately after the birth of a child plays a significant role, along with sleep disruptions that are inevitable before and after the birth. Many researchers conclude that postpartum psychosis is strongly related to the bipolar spectrum. Indeed, one theory is that new mothers who have psychotic episodes and dramatic mood swings are actually experiencing their first bipolar episodes, with the manic-depressive illness having been "dormant" beforehand and triggered by childbirth. In fact, for 25% of women who have bipolar disorder, the condition began with a postpartum episode (Sharma and Mazmanian).

One of the biggest risk factors for postpartum psychosis is previously diagnosed bipolar disorder or schizophrenia, along with a family history of one of these conditions. Also, women who have already experienced postpartum depression or psychosis have a 20-50% chance of having it again at future births.

Symptoms of Postpartum Psychosis

Symptoms of postpartum psychosis are consistent with those of a bipolar I psychotic episode but have some special "twists" specifically related to motherhood. They include, but are not limited to:
  • Hallucinations
  • Delusions
  • Periods of delirium or mania
  • Thoughts of harming the baby or oneself
  • Irrational feelings of guilt
  • Refusing to eat
  • Thought insertion - the notion that other beings or forces (God, aliens, the CIA, etc.) can put thoughts or ideas into one's mind
  • Insomnia - although studies are beginning to show that insomnia may be a cause rather than an effect
  • Reluctance to tell anyone about the symptoms

If you already have bipolar disorder

You should be aware - and so should your loved ones - that you have a better-than-average chance of having postpartum depression or psychosis. Prompt treatment is essential to get postpartum psychosis under control. Under no circumstances should you spend most of your time alone with your infant, as this will lead to severe disruptions in sleep that can make a bad situation even worse. Keep in contact with your psychiatrist or therapist during the first six weeks after your child's birth. Arrange ahead of time to have your husband or partner, relatives, friends or even social workers help you care for the infant and make sure you get the rest you need. If you have to choose between breast-feeding and taking your medications, choose the medications. The sooner you get treatment for postpartum illnesses, the faster they can be controlled.

References:

Sharma, A. and Mazmanian, D. (2003). "Sleep Loss and Postpartum Psychosis." Bipolar Disorders 2003, 5, 98-105.

Pregnancy-Info.net. Postpartum Psychosis. Retrieved August 22, 2006 from http://www.pregnancy-info.net/postpartum_psychosis.html

Silberner, J. (2002). "Postpartum Psychosis: Rare, Frightening and Treatable." National Public Radio. Retrieved August 18, 2006 from http://www.npr.org/programs/morning/features/2002/feb/postpartum/020218.postpartum.html

Wikipedia (2006). Postpartum depression. Retrieved August 17, 2006 from http://en.wikipedia.org/wiki/Postpartum_depression

WebMD (2005). Depression After the Birth of a Child (Postpartum Depression). Retrieved August 22, 2006 from http://www.webmd.com/content/article/62/71508

Riecher-Rössler, A. (2001). Postpartum Disorders. Retrieved August 22, 2006 from http://www.medscape.com/viewarticle/420031 (Free registration required.)

Depression After Delivery, Inc. (2004). Postpartum Depression. 8/22/06. [No longer online]

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