Posted by: jedwardswright | March 18, 2011

Postpartum Depression, Part 2: Postpartum Psychosis

I only have vague memories of a child a few years younger than myself, but our parents were longtime friends, dating back to the time our fathers went to university together. It was still a shock to find out that the woman I had been hearing about in the news was once that little girl.

She seemed to be the epitome of success. The daughter of a doctor and a psychologist, she herself was an attractive physician with a thriving practice in psychotherapy. She and her husband, a computer executive with a recent promotion, lived in a desirable neighborhood of upscale homes and had a healthy six-month-old boy.

All these advantages – a life that was eminently enviable and expertise in dealing with mental illness – did not save her.  Early one morning, she drove her Mercedes-Benz to a subway station, where she jumped in front of a train with her infant son in her arms. The baby died instantly. Eight days later, she joined him.[i]

If suicide is incredibly difficult to understand, infanticide is almost impossible. How could a woman kill her adorable, helpless child within a year or two of his birth?

Surely this is the greatest fear of a woman suffering from postpartum depression. Involuntary thoughts of harming her baby are sometimes part of PPD, and usually, these thoughts never translate into action. Instead these mothers are horrified and feel overwhelming guilt for even imagining such a terrible thing.

Women who actually commit such dreadful acts are usually in the grip of an even more severe condition: postpartum psychosis.  This illness does not inevitably have such a tragic result (only a 5 % incidence rate), but when infanticide does occur, postpartum psychosis is usually suspected.

The symptoms of PPP usually begin suddenly within three weeks of giving birth. These may include:

  • Hallucinations
  • Delusions
  • Illogical thoughts
  • Insomnia
  • Refusing to eat
  • Extreme feelings of anxiety and agitation
  • Periods of delirium or mania
  • Suicidal or homicidal thoughts

Women with a personal or family history of psychosis, bipolar disorder or schizophrenia are at greater risk of developing postpartum psychosis, but it can also occur in women with no previous psychiatric problems (as in the case above). Once a woman has had PPP, she has a significantly higher risk of experiencing it again following any subsequent births.[ii]

It is absolutely critical that postpartum psychosis is treated promptly with antipsychotic, antidepressant or antianxiety medication. In some cases short-term hospitalization is required, and counseling may also be beneficial. Postpartum depression may still follow after treatment for postpartum psychosis. Since the woman suffering from PPP may not be capable of recognizing or responding to her need for medical attention, a spouse or other family member may need to initiate professional care. In the case of the woman described above, it was reported that she discontinued her antidepressant medications out of concern for her nursing son.

Both postpartum depression and postpartum psychosis respond well to treatment, and most women will recover completely from either condition. Many new mothers never tell their physicians about their difficulties, so education is essential. In my opinion, all prenatal classes should include information about the potential for mental health issues after giving birth, so that every woman at risk can recognize the symptoms and be prepared to consult with her doctor.

Hopefully, the heartbroken family who experienced the doubly tragic loss described at the top of this post is comforted to know that their pain has translated into greater awareness of postpartum depression and psychosis. Certainly, their most fervent desire would be for no one else to ever experience the devastation that they have had to endure.

Spread the word.  Postpartum depression is much more than the “baby blues,” and there is effective medical treatment available.




  1. So, so, incredibly heartbreaking. There are no words. I hope this helps others.

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