A Cup of Coffee – Postpartum Depression vs. Psychosis

Welcome back! Last week, we talked about the importance of taking a vacation. If you missed that blog and would like to catch up, click HERE.

This week, I wanted to talk about the difference between Postpartum Depression (PD) and Postpartum Psychosis (PP). Several of my readers asked me to write on this topic, because they were experiencing PD and their relatives were concerned, thinking they had PP. It appears that this is a common misconception, so I’m here to hopefully clear some things up.

Ask any mom if they felt depressed following the birth of their baby, and most will admit that yes, they did suffer from post-baby blues. Some may have experienced mild depression, while others may have had a more serious experience. All of these situations are completely normal and nothing to worry about, unless, of course, the depression interferes with your quality of life, or your ability to care for yourself or your child. If this is the case, talk to your primary care doctor.

People who have never delivered a child may not understand the toll it takes on a woman’s body. You’ve spent nine months nourishing a body inside of your own, giving that child everything they need to develop, sometimes at the expense of yourself. Upon delivery, your body may be lacking nutrients, your blood count may be lower than what’s normal for you, and let’s face it, just the experience of delivering has wiped you out. Childbirth is a big deal.

You leave the hospital, sometimes the same day you deliver, and go home. Now, what do you do? You are exhausted. Just having a normal birth is hard enough on your body, but if you’ve had a C-section, you’ve also gone through a huge operation. Your muscles have been cut open, you’ve been stitched back together, and now you have this horribly painful situation going on, you are recovering from surgery, and here’s this little human, completely dependent on you for literally everything…breast milk, diaper changes, comfort, skin to skin contact, compassion, empathy, and…guess what…you need some of that as well.

Often, the people surrounding a new mother have no idea how to support her. Friends come over and coo over the baby, they may hold the baby for a bit, or even change a diaper if you’re lucky, but the minute the baby starts to cry, they hand them back to mama to “fix it”, am I right? The lucky women have supportive partners, friends, or parents that come over to help out, but at some point, the caregiving is entirely yours, regardless of how tired you may be. Just getting a shower can be a challenge, especially for new moms who aren’t sure what is “ok” to do and what isn’t. Can I leave the baby long enough to shower? What if something happens? It’s scary.

The first couple of days are surreal. Life has changed. Forever. After the first week or two, reality sets in. Oh, no…what’s happening? Slowly, the cloak of darkness starts to fall. The curtains come down. Depression sets in. “I’m tired. I’m so tired I can’t think straight”, mom’s will often say. Sleep is usually the number one thing new mothers say they can’t get enough of.

Depression, at this point in time, is expected. Being depressed can be a normal part of the process of giving birth, but what if things get even more serious beyond depression? What if you develop Postpartum Psychosis?

We need to talk about this because it’s a subject that doesn’t appear to be well understood by many. You may wonder why it doesn’t get talked about, and the answer might be because it’s fairly rare. It just doesn’t happen that often. Most people may never know a woman who has this condition, but if they do have it, it may have been so severe that it made the 11 o’clock news. Now family and friends are concerned…you are depressed…could this turn in to that??

April Dembosky, KQED writes, “Studies suggest it affects about one or two women out of every thousand who give birth; some doctors now think even more women than that are affected, but go undiagnosed. Without proper treatment, some of those women end up dying — by suicide.

This is a symptom (psychosis) that clinicians who are not trained in this field can easily miss because when they see the patient in their office with the family, they can think that the patient is normal and is probably suffering from sleep deprivation — and discharge them home.”

Growing up, my friend had a sister who experienced PP. She didn’t present with the normal post-baby blues, in fact, she was upbeat and doing really well. Almost too well. Then, one day, she started beating her child with a broom. Her husband intervened, as she screamed, “let me kill it! It’s a demon and it’s going to take our child!“. On the way to the ER, she tried to jump out of the car on the freeway. It was terrifying.

The good news is that there is treatment and this condition normally doesn’t last long, once the chemicals in the new mom’s brain get sorted out. Jennifer Payne, MD, writes, “Postpartum psychosis is typically treated with a combination of antipsychotic medication and a mood stabilizer. Benzodiazepines and antidepressants are used to treat insomnia or depression, respectively, when present.”

In all the research I conducted for this blog, I learned something that I didn’t know. Approximately 85% of all new mothers will experience depression. If a woman is going to experience postpartum psychosis, it will normally present with symptoms as early as the first 48 to 72 hours after delivery. The majority of women with psychosis develop symptoms within the first two postpartum weeks. This doesn’t mean it cannot develop after the two-week window, but it would be considered rare for it to do so.

The symptoms of PP are as follows:

  • Delusions or strange beliefs
  • Hallucinations (seeing or hearing things that aren’t there)
  • Feeling very irritated
  • Hyperactivity
  • Decreased need for or inability to sleep
  • Paranoia and suspiciousness
  • Rapid mood swings
  • Difficulty communicating at times

Knowing what to look for is half the battle. If family members are aware of the symptoms, they can catch the PP early, before the unthinkable happens. Early intervention is key.

If you are a new mom and are experiencing these symptoms, it is considered a medical emergency. Go to the ER. If you are a loved one of a new mom who is demonstrating these symptoms, intervene immediately. Don’t wait for it to clear up on its own. Time won’t help. More sleep won’t help.

The good news is that this condition is treatable, and life can return to normal. Without treatment, however, the outcome is dire. We’ve all watched the news and wondered how a mother could drown her own children, right? Postpartum Psychosis. It’s not that she’s “evil”, or “attention-seeking”, she’s ill. (Not to be confused with the Diane Down’s of this world, who shot her children because her boyfriend said he didn’t like kids and she thought she’d be able to keep him in her life if she didn’t have any children).

It’s time to stop demonizing the women who complete these acts. Once a crime has been committed, it’s too late to help her or the innocent chlld(ren), so time is of the essence.

Get help now. This video runs about 1.5 minutes. The media often confuses us. Let’s get this right. Lives depend on it.


  1. If you have postpartum depression and anxiety (hypomania??) and mild paranoia/delusions, is it PPD with psychotic features or PPP? What differentiates the two?

  2. Thank you for this very important article. I was mentally and emotionally very sick after my second baby was born. My husband had been leaving “for work” out of the country for long periods of time While I was sick. Our home was unsafe with a faulty furnace. We had no money or food and I was so ill I couldn’t get out of the home. I did ask for help but it was very limited and I was treated by family & the in laws as a lazy parent. I finally told the husband to not come back and reached out to social services for help. Somehow I managed but my babies witnessed my mood swings and crying. A lot of crying. I was never ever told I had post partm by the doctors I saw. it. To this day 27 years later I still have mild depression. I have seen counselors off and on for years to maintain my health Along with Medication. I am healthy now but I should have been given a tremendous amount of support then. Even my church turned a blind eye. How did I stay alive ?! Thank goodness I felt live in my heart for my babies and that pulled me through. If you go to the doctor tell them everything you are experiencing, you won’t lose your babies if you do. Go in your pajamas if you have to. Beg for support and threaten to not leave the office until you do. Don’t give up!
    Thank you so much for this comment…I hope someone reads it and finds hope. I wish you all the best life has to offer – Linda Tate

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