What Every Woman Should Know About Postpartum Psychosis

Following the birth of her first child, Lisa Abramson temporarily lost her mind.

One morning, while her newborn daughter was still asleep, she woke up to a ringing sound. Instead of recognising it as the phone call that it was, she felt certain it was a police radio. Her house had been bugged. The police were coming for her, and she lay in the dark fearing for her life.

This was a terrifying shift in symptoms that were already pretty awful, Abramson explains to Refinery29. “Within weeks after my daughter’s arrival, I couldn't sleep. I couldn’t eat. I felt like I was living in a thick fog, and I cried all the time.” At first she convinced herself that this was just the “baby blues” and hoped that her sadness would pass soon. But when Abramson’s symptoms escalated to paranoia, the situation became truly dire. “I thought that the only way out of my crisis was to kill myself,” she says.

When Abramson told her mum and her husband that she planned to jump off the Golden Gate Bridge, they realised that she needed emergency medical help. They had her admitted to the hospital, but even then, it was still difficult for her to understand what was happening.

A doctor told Abramson's family the news: She was suffering from postpartum psychosis, a severe maternal mental health disorder. This rare illness (it occurs after approximately one out of every 1,000 births) usually comes on suddenly within weeks after the baby is born and causes hallucinations, delusions, strange beliefs, and paranoia. It can sometimes start with severe depressive symptoms and can escalate quickly, as it did in Abramson’s case. Mothers with postpartum psychosis become unhinged from reality — and in some instances, this makes them suicidal.

At the hospital, “my husband showed me information from a website, Postpartum Support International, that outlined the symptoms of postpartum psychosis, and in my delirium I thought that he had created a fake website to try to make me feel better," she says.

The doctors gave Abramson antidepressant and antipsychotic medications that helped bring her out of this psychotic state. Yet in the aftermath of this trauma, she and her family struggled to understand why having a baby had caused her brain to go haywire.

While postpartum psychosis is rare, four weeks after giving birth, a woman’s risk of becoming psychotic is 23 times higher than it is at any other period in her life. Up until now, there have been few studies on what causes this uncommon (but always terrifying and sometimes deadly) maternal mental illness. But a major new review of research from Northwestern University sheds light on the potential risk factors, causes, and treatments. Katherine Wisner, MD, the review’s lead author, says that one of the factors making postpartum psychosis so hard to diagnose and treat is that not all cases are the same — and too few women realise they’re at risk.

Ahead, we break down what every woman should know about this rare but serious diagnosis.

First, the good news: 20 to 50% of mothers affected by postpartum psychosis, experience "isolated postpartum psychosis," meaning the symptoms, once treated, dissipate immediately, and these women only need medication for a short time following the episode. But the bad news is that, like in Abramson’s case, there’s no way to predict it.

This type of postpartum psychosis is brought on by the totally normal hormonal and metabolic changes that take place after giving birth. During pregnancy, hormones such as oestrogen and progesterone rise — but once the baby is born, these hormones plummet suddenly. And for unknown reasons, some women are more sensitive to these large shifts.

For these isolated cases, drugs such as lithium often bring immediate relief, and medication can usually be stopped once the mother's mood becomes more stable, according to the new review, which was published last month in The American Journal of Psychiatry. In future pregnancies, these mothers may be able to remain medication-free during their pregnancies, though they will be monitored closely. Their doctors will typically start antipsychotic medications once the babies are born in order to help prevent another episode.

In 50 to 80% of cases, bipolar disorder is the biggest risk factor, the researchers found. Bipolar disorder, which includes symptoms such as mania, insomnia, engaging in impulsive behaviour, and racing thoughts, affects 2.6% of the population, or about six million American Adults, according to the National Institute of Mental Health. (Sadly, there is no gender breakdown of the data, so it’s hard to say how many of these are women. But other research suggests bipolar disorder is indeed more common in women than in men.)

For women who are aware of their bipolar disorder before and during pregnancy, knowing they’re at risk for postpartum psychosis can be a good thing, because it allows them and their families to at least be prepared for the possibility.

This is why it’s so important for all pregnant women to share their mental health histories with their obstetricians and midwives — and and to work with their doctors to balance the pros and cons of continuing their medications during pregnancy, Dr. Wisner says.

However, despite how relatively common it is — "Everyone knows someone with bipolar disorder," Dr. Wisner adds — many women are totally unaware they have it. That means that some women who experience postpartum psychosis don’t receive their bipolar diagnosis until after they have a psychotic episode triggered by pregnancy and birth. What Every Woman Should Know

Unless you are already diagnosed with bipolar, the best thing you can do right now is to simply be aware (and make sure your loved ones are aware) that it can happen. This increases the likelihood that you’ll get the help you need ASAP (before it turns dangerous), should it happen to you.

If you know you have bipolar disorder, on the other hand, you can ease your risk of developing postpartum psychosis by continuing to take your medication (under your doctor’s care) throughout pregnancy and while breast-feeding. This remains — quite literally — a scary pill to swallow for many mothers with mental illness, because of the question of safety.

And it’s true: There are no easy answers. There’s a huge debate in the medical community about the safety of taking antidepressant and antipsychotic medication during pregnancy and the postpartum period. Many new mothers fear that the medicine will harm the baby’s growth and development, and since there is a dearth of large, long-term studies on the topic, it’s hard to say for sure what the effects will be.

However, Dr. Wisner says you have to weigh your risks. “People think that once you’re pregnant, you’re not entitled to your body, but what happens to the mother happens to the fetus; a mentally healthy mom is critical for foetal and infant development.”

For women who experience an episode after their baby is born, the new findings from Northwestern University state that lithium, a drug that is commonly used to treat bipolar disorder, is the most effective medicine to treat postpartum psychosis — and it doesn’t harm breast-feeding babies.

The researchers cite a small small study of breast-feeding mothers who took lithium; it found that the babies were happy, healthy infants who showed no negative effects as long as their doctors monitored them. Just as important: These mothers reported feeling well, and their illness stayed in remission.

The bottom line: "Often, the risk of taking medication is less than the risk of not treating the illness,” Dr. Wisner says. She states that mothers who are not treated are at an increased risk of suicide — 5% of mothers with untreated postpartum psychosis end their lives, compared to the national suicide rate overall, which is just over 1%. In the end, Dr. Wisner says that treating postpartum psychosis with medication helps to prevent these unthinkable and heart-wrenching tragedies.

Lisa Abramson’s road to recovery included hospitalisation, medication, and psychotherapy, and today, she is a happy and healthy mother to her daughter, Lucy, age 2. "I hope that by sharing my story out loud, other mothers won’t feel ashamed about their mental health, and they will realise that there's a community of support ready to help them heal."