Postpartum psychosis (PPP) is a mental health emergency. This condition affects a person’s sense of reality, causing hallucinations, delusions, paranoia or other behavior changes. In severe cases, people with PPP may attempt to harm themselves or their newborn. This condition is treatable, and early treatment increases the odds of a good outcome.
Postpartum psychosis (PPP) is a reversible — but severe — mental health condition that affects people after they give birth. This condition is rare, but it’s also dangerous.
IMPORTANT: People with postpartum psychosis have a much higher risk of harming themselves, dying by suicide or harming their children. Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, it’s important to seek immediate help. If you believe someone is a danger to themselves or others, you should immediately dial 911 (or your local emergency services number).
Postpartum psychosis can affect anyone who recently gave birth. While it usually happens within several days of giving birth, it can happen up to six weeks after.
It can happen to anyone who gives birth, but the odds of having it are higher for people with certain mental health conditions. While experts don’t know if these conditions contribute to or cause PPP, they do know that there’s a link (see below under Causes and Symptoms for more about these conditions).
Postpartum psychosis is a rare condition. 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 in between 12 million and 352.3 million births.
The two main symptoms of psychosis affect a person’s sense of reality and how they understand the world around them. They are:
Other symptoms that are common with postpartum psychosis include:
Researchers organize the symptoms of PPP into three types:
The depressive subtype of PPP is the most common, making up about 41% of cases. It’s 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 with this type include:
This 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.
This subtype makes up about 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.
Experts don’t know why postpartum psychosis happens but suspect it involves a combination of factors, including:
A mental health provider can diagnose postpartum psychosis based on your symptoms (either by observation or what you describe) and a physical and neurological exam. Other tests are possible, but these are to rule out other conditions or underlying causes of psychosis. These tests can’t diagnose PPP itself.
Some of the most common tests include:
Your healthcare provider may also use specialized screening tools or questionnaires. These are lists of questions or symptom checklists. Depending on the results of these tools, your provider can determine if you’re likely to have a condition.
Postpartum psychosis is treatable, and a few different approaches may work. Unfortunately, the rarity of this condition means there's limited available research on how to treat it. Some methods are in widespread use, but more research is necessary for experts to understand how best to treat this condition.
Because PPP is a mental health emergency, people with this condition need inpatient mental healthcare. This kind of care means trained medical professionals are with them at all times to make sure they’re safe and as comfortable as possible.
Because PPP disrupts a person’s sense of reality, many people who have it are completely unaware that they have a mental health or medical issue. Further complicating this is the fact that delusions and hallucinations may actually make them afraid to seek help.
For those reasons, inpatient mental healthcare for PPP is almost always involuntary. That means the person with PPP is rarely the one who chooses to receive care. Instead, family members, friends or other loved ones must decide to have their loved one hospitalized. This is only an option when there’s reason to believe a person could be a danger to themselves or others.
The possible treatment methods include:
Many different medication types can help PPP. The types include:
Electroconvulsive therapy (ECT) is a safe and highly effective method for treating conditions that involve psychosis. This treatment uses a mild electrical current, passed through your brain, to induce a mild seizure. The effects of that seizure cause changes in brain activity that reduce or resolve the effects of PPP.
ECT often has a negative reputation because of frightening portrayals in books, TV shows and movies. But ECT happens under general anesthesia, so the person receiving it is asleep and won’t feel any pain or discomfort during the procedure.
Once the person is asleep, healthcare providers will place electrodes on the person’s head and pass an electrical current through their scalp and skull and into a specific part of their brain. These seizures usually last less than two minutes, and a provider can use an injectable medication to stop a longer seizure. Most people wake up within 15 minutes after an ECT procedure and can be up and walking around after half an hour.
The possible complications and side effects depend on many factors, especially the treatments you receive and the symptoms you have. Because of this, your healthcare provider is the best person to tell you the most likely risks, complications or side effects that you can or should expect.
Because PPP disrupts your ability to tell what’s real and what isn’t, most people aren’t aware that they have a medical issue. That means this isn’t a condition you can take care of or manage on your own. It’s also very rare for people with PPP to recognize the symptoms, even early on. In almost all cases, others close to the person with PPP will notice the symptoms and act to seek care.
If you have a history of PPP or have conditions like bipolar disorder or schizophrenia (or have a family history of these conditions), it’s important to talk to your healthcare provider about what you can do to plan ahead in case you develop PPP. You also should have a conversation with those closest to you, such as a partner, family member, close friends, etc. These discussions give you a chance to make them aware of your situation and to understand what you want in case you’re unable to make decisions or act for the safety of yourself or your newborn.
The recovery timeline for PPP depends on many factors, including the specific treatment or medication. Your healthcare provider is the best person to tell you what’s most likely to happen in your case, and can provide information and guidance that’s relevant to you.
PPP happens unpredictably and for reasons that experts don’t fully understand. Because of that, there’s no way to prevent it entirely. But some approaches can reduce the chance of developing it. These are especially important for people who have:
For people who meet any of those criteria, some treatments may reduce the risk of developing it. Lithium, which also treats PPP, is the most common medication used to lower the risk of another occurrence later in life. Other medications may also help reduce the risk of developing it. Your healthcare provider is the best person to explain the options and why they recommend them.
Postpartum psychosis (PPP) is a condition that disrupts your sense of reality. The hallucinations and delusions it causes can cause intense fear and anxiety. Unfortunately, the symptoms of this disease mean it’s very rare for you to be aware that you have the symptoms of this mental health condition.
For those around someone with PPP, this condition can also be a source of great anxiety and worry. However, loved ones can also play a very important — if not critical — role in keeping a person with PPP and their children safe (see below to learn more about what you can do to help someone with PPP).
PPP is a temporary condition. With treatment, people who have it can recover relatively quickly within a few weeks. Without treatment, PPP can last for weeks or even months. This condition also becomes more severe and more dangerous the longer it goes untreated, so it’s vital that family members or loved ones recognize the symptoms and help get treatment for a person with PPP.
PPP is a mental health emergency because it affects a person’s sense of reality. The disruptions can be so severe that a person may even attempt suicide or try to harm their child.
With treatment, this condition is reversible and many people who have it go on to have children in the future without a recurrence of PPP. However, most people who have PPP do later develop bipolar disorder. Fortunately, that condition is better understood, and there are multiple methods and approaches for its treatment.
People with PPP can't recognize their symptoms or understand that they have a mental health condition. That means they don’t believe they need medical care or treatment, and they may misunderstand attempts to help them as a sign that someone is trying to hurt them.
If you notice a loved one showing signs of PPP, there are things you can do to try to help them.
Postpartum mood changes are very common but can vary from person to person. Some examples in addition to postpartum psychosis include postpartum anxiety, postpartum blues and postpartum depression, including:
A note from Cleveland Clinic
Postpartum psychosis (PPP) is a condition that affects people who just gave birth. This condition is especially severe and dangerous because it disrupts a person’s sense of reality. That puts people with PPP at risk of dying by suicide or harming their children. Fortunately, PPP is a condition that’s treatable and reversible. Many people with this condition ultimately recover, and many have children again in the future without a recurrence of PPP.
Because people with PPP can’t recognize that they have this condition, family and loved ones are the most likely to spot the symptoms of this condition. If you suspect a loved one has PPP, don’t hesitate to get medical help for them by any means necessary. While it may be frightening or worrying to see a loved one experiencing this condition, you can act to keep them and their newborn safe, giving them a chance to recover and return to their life as it was before (with the addition of a new family member, of course).
Last reviewed by a Cleveland Clinic medical professional on 09/13/2022.
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