Postpartum psychosis vs depression: Warning signs new mothers and families should never ignore

The ongoing trial of Lindsay Clancy, who is accused of killing her three children in 2023 and has pleaded not guilty by reason of insanity, has brought renewed attention to one of the most severe complications of childbirth: postpartum psychosis. The case is particularly complex, with experts disagreeing over whether Clancy was experiencing acute psychosis at the time.

From a doctor’s perspective, such cases mustn't create fear around motherhood, but instead encourage families to recognise when postpartum emotional changes require medical attention.

Are postpartum depression and postpartum psychosis the same?

No. Postpartum depression is rather common and may occur within several weeks or months after delivery. Women feel persistent sadness, anxiety, irritation, guilt, hopelessness, lack of interest, inability to bond with the baby, change in sleeping or eating habits, and difficulties coping with daily routines. The mother may have suicidal or homicidal thoughts toward her baby, which needs to be assessed by a specialist.

Postpartum psychosis, on the other hand, is much rarer but is considered to be a mental crisis and requires immediate treatment. The symptoms include hallucinations, delusions, severe confusion, paranoia, disorganised behavior, extreme agitation, or unusual euphoria/low mood. Women become unaware that they are ill and start believing in some scary or unrealistic ideas.

Postpartum psychiatric disorders exist on a spectrum, with postpartum psychosis being the most severe. A woman may lose insight and become unable to recognise or control her thoughts or actions, potentially putting herself or her vulnerable infant at risk.

It should not simply be attributed to sleep deprivation or postpartum blues. Psychosis can be associated with underlying psychiatric vulnerabilities, which is why mental health screening should begin during pregnancy and continue after delivery. A personal or family history of bipolar disorder, psychosis or schizophrenia should be specifically assessed to identify women who may need closer monitoring and support.

What should families watch for?

Family members shouldn’t just ignore these symptoms as 'new mother stress'. Signs to look out for include several days without proper sleep, intense confusion, experiencing visions or hearing voices others don’t hear, delusions, extremely suspicious behaviour, rapid mood swings, erratic behaviour and speech, and suicidal or homicidal thoughts, especially involving the baby.

In cases of possible postpartum psychosis, it’s important that the mother is not left alone with the baby and that immediate psychiatric/emergency treatment is obtained.

Treatment can make a difference

Postpartum depression is normally managed through psychotherapy, social and family support, and medication if necessary. However, postpartum psychosis needs psychiatric care immediately, and hospitalisation together with proper medication and constant monitoring.

The main thing to remember is that the mental health of mothers should receive the same amount of attention as their physical health following delivery. Screening for any problems, talking about them and involving family members can assist in detecting the problem early. Seeking professional help does not mean that you are a bad mother.

(The author is a consultant obstetrician & gynaecologist, Manipal Hospital, Vathur)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.