Postpartum Psychosis Linked to Bipolar Disorder

Postpartum Psychosis Disorder
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Experts estimate that 50 to 85% of all new mothers experience the "baby blues," a common response to hormonal changes after the birth of a child that typically self-resolves within two weeks. However, an estimated 14% of new mothers will 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. Around 0.1-0.2% (that's one or two of one thousand women) will develop postpartum psychosis—a very serious illness that needs quick intervention, usually including hospitalization.

One or two of one thousand may not sound like many until you learning that in 2018 there were approximately 3.79 million births in the United States. This translates to 3,790 to 7,580 women who may experience postpartum psychosis per year. Given the rates of suicide and infanticide related to postpartum psychosis, this estimates a risk of more than 300 infants killed and approximately 380 mothers committing suicide because of this illness each year in the U.S. alone.

Causes and Risk Factors

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 considered to be on the bipolar spectrum and a prior history of depression and/or anxiety is a strong risk factor. Poor social support, young age, traumatic delivery, and financial instability are other potential causative factors.

One of the biggest risk factors for postpartum psychosis is a 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 to 50% chance of having it again at future births.

Additionally, sleep deprivation worsens mood symptoms and may increase the risk of development of a postpartum mood disorder.

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 having a history of bipolar disorder may mean that you have a higher-than-average risk of having postpartum 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 may 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 breastfeeding and taking your medications, choose the medications. The sooner you get treatment for postpartum illnesses, the faster they can be controlled.

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