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Postpartum Psychosis vs. Postpartum Depression: Understanding the Key Differences

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In light of a recent tragedy, there have been conversations about postpartum psychosis, what it is, what the warning signs are, and more. Knowing the differences between PPP and PPD is essential, and this article can help.

The Lindsay Clancy tragedy is heartbreaking. As a mother, I have a hard time thinking about it. Even as a therapist, I can’t fully absorb the information because it is too devastating.

How could this happen? And many new parents and mothers worry, could this happen to me?

Not only are mothers struggling and devastated, but they are afraid. 

Many people are asking questions like, what is postpartum psychosis?
Is it just severe postpartum depression?
How do I know the difference between PPD and PPP?
And what are the warning signs of postpartum depression vs. psychosis?

This article aims to answer these questions by clarifying the signs and symptoms of both postpartum psychosis and postpartum depression, discussing the difference between psychotic and intrusive thoughts, and highlighting how you can find support if you are struggling.

I aim to dispel some myths, reduce your fear, and help you plan for a successful postpartum experience. 

What is Postpartum Psychosis? 

Postpartum Psychosis is the most severe of the postpartum mood disorders, characterized by

  • A very high or very low mood
  • Irritability
  • Loss of touch with reality 
  • Paranoia 
  • Delusions 
  • Disorganized thought processes 
  • Confusion
  • Hallucinations (including sight, sound, smell, etc.)

Those struggling with postpartum psychosis may feel that they do not need sleep, experience rapidly changing moods, believe their baby is connected to God or the Devil or may be suspicious of people’s motives.

The Action on Postpartum Psychosis (APP) reports that the prevalence is low, 1-2 in 1000 postpartum women are diagnosed, and the typical onset is within two weeks after birth.

If left untreated, there is an estimated 5% risk of suicide and a 4% risk of infanticide. This illness has a quick onset and responds well to treatment.

Risk factors for developing postpartum psychosis include: 

  • Personal or family history of bipolar disorder or psychosis 
  • History of postpartum psychosis in a previous pregnancy 
  • History of schizoaffective disorder or schizophrenia 
  • Discontinuation of psychiatric medications during pregnancy 
mom with her head in her hands wearing a yellow shirt

What is Postpartum Depression?

Postpartum Depression is a mood disorder characterized by the following:

  • Depressed mood 
  • Loss of interest or pleasure in activities previously enjoyed 
  • Fatigue 
  • Sleep disturbances 
  • Poor concentration 
  • Feelings of worthlessness, hopelessness, and guilt 

Those struggling with postpartum depression may have difficulty connecting to their baby, feel overwhelmed with caring for themselves and a child, and may experience thoughts of harming the baby or themselves. 

Postpartum depression occurs in 10 to 15% of postpartum women and can also happen in non-birthing parents. Symptoms can appear in the weeks following delivery up to a year postpartum.

Read next: Identifying Postpartum Depression in Fathers, Husbands, and Partners

Postpartum depression must be differentiated from Baby Blues: sadness experienced by up to 80% of mothers in the first two weeks after birth.

Several risk factors contribute to the possibility of developing postpartum depression: 

  • Personal or family history of depression, anxiety, or postpartum depression 
  • Premenstrual dysphoric disorder (PMDD or PMS) 
  • Inadequate support in caring for baby 
  • Financial stress 
  • Marital stress 
  • Complications in pregnancy, birth, or breastfeeding 
  • Major recent life event (ex. loss, house move, job loss) 
  • Mothers of multiples 
  • Mothers whose infants are in NICU
  • Mothers who have gone through fertility treatments
  • Women with a thyroid imbalance 
  • Women with any form of diabetes
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How are intrusive thoughts different from psychotic thoughts?

Intrusive thoughts explained

Intrusive thoughts are unwanted thoughts or mental images that can include thoughts of harm to the baby and are shared among postpartum mothers.

Read next: How to Overcome Unwanted Intrusive Thoughts in Postpartum

These thoughts are quite distressing to the individual and can lead to compulsions or avoidance of certain situations to relieve anxiety.

Intrusive thoughts differ from psychotic delusions as they are unwanted and distressing and have no connection to increased harm to the infant.

Psychotic thoughts and delusions explained

Psychotic delusions are not always harmful, though when they are, they often make sense to the individual, causing no distress, which is why it increases the risk of harm to the mother and infant.

This is not always the case, as each individual’s level of insight* can differ.

*Insight is “a patient’s capacity to understand the nature, significance, and severity of his or her illness” (Jacob, 2016).

mom with postpartum depression crying on the bed

What are the critical differences between postpartum depression and psychosis?

Some of the key differences between postpartum depression vs. postpartum psychosis are:

  • The rate of occurrence
  • Severity level
  • Risk factors
  • Treatment plan
  • State of intrusive thoughts
Postpartum Depression (PPD)Postpartum Psychosis (PPP)
Rate of occurrence?6.5-20%.089-2.6%
Medical emergency?Not typicallyYes, there is a risk to the mother and baby
Risk factors?SocialBiological
Typical treatment?Outpatient care with a care provider or therapistHospital admission for observation and treatment
Intrusive thoughts?Can occur but are accompanied by feelings of guilt or worryYes are typically not distressing to the individual, believe it’s the “right thing”

A closer look at PPD vs. PPP

Postpartum depression is more prevalent. 

Postpartum psychosis is considered rare.

Postpartum depression isn’t typically a medical emergency (unless it is accompanied by thoughts of suicide or one is an imminent threat to themself or others.)

Postpartum psychosis is more severe and considered a medical emergency due to the risks it poses to the mother and baby. The individual requires immediate medical attention, often hospitalization. 

Risk factors for depression include many more social factors, such as stress, sleep deprivation, lack of support, and more.

Risk factors for postpartum psychosis are more biological, such as a history of bipolar or psychosis.

Postpartum depression often responds well to treatment in outpatient settings with a primary care provider and psychotherapy (depending on severity).

Postpartum psychosis frequently requires admission to the hospital for observation and treatment. 

Those experiencing depression or anxiety tend to experience guilt or worry along with distressing thoughts and possibly engage in behaviors to avoid harm. 

See Also

Conversely, those experiencing postpartum psychosis are not distressed by their thoughts of harm and have a low level of insight.

mom smiling and snuggling her baby

What you can do preventatively for PPD and PPP

There are things that you can do to prepare for or improve your postpartum experience. 

Identify your supports (family, friends, partner, doctors, therapists, psychiatrists) and how they can be helpful to you (ex., cooking, cleaning, checking in on you, scheduling consistent appointments, making sure you get breaks).

Discuss any concerns with your doctor, midwives, or psychiatrist, ideally before trying to conceive, but honestly at any point. They will be able to guide you through your risks, which medications are safe to take during pregnancy, and help you develop a postpartum care plan. 

When starting or stopping any medication for a postpartum mood disorder, make yourself and your support system aware of the side effects. 

Create a sleep plan. Adequate sleep is essential for mental health and can powerfully impact your mood and thought processes.

Discuss this with your partner and whoever will support you through the evening. Consider whether and when you may be able to get sleep during the day as well. 

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Some final thoughts on postpartum depression and postpartum psychosis

Postpartum Depression and Postpartum Psychosis are separate mental health disorders; both are treatable with proper care.

While there are risk factors, about 50% of cases are those without any prior mental health concerns. It is important for women and their partners to be aware of the signs and symptoms.  

It is normal for news like Lindsay Clancy’s story to affect you. It is normal to want to know why it happened in the hopes that we can prevent it for ourselves and our loved ones.

While it is important to recognize the signs and symptoms of the different perinatal mood and anxiety disorders, it is absolutely crucial that you seek help if you are concerned about your well-being, regardless of which label you fall into. 

The bottom line is: if you are concerned about your mental health, seek help from a qualified professional. If you are struggling, please know that you do not have to struggle alone.

Both of these disorders are treatable, and you can recover and thrive in your role. Developing a perinatal mood disorder is not your fault and does not make you a bad or unfit mother. 

Make a plan for your postpartum wellness; it’s never too late.

Maternal mental health resources

A free, confidential 24/7 hotline available in English and Spanish: 1-833-943-5746 (1-833-9-HELP4MOMS)

Postpartum Support International: The organization’s purpose is to increase awareness among the public and professional communities about the emotional changes women experience during pregnancy and postpartum. They have a number of helpful resources and support groups.

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