| Condition | Postpartum Blues | Postpartum Depression | Postpartum Psychosis |
|---|---|---|---|
| Prevalence | 40%-80% | 8%-15% | 0.1%-0.2% |
| Onset | 2-3 days (resolves within 14 days) c | Typically within 4-6 weeks (can be up to 1 year) | Days to weeks |
| Symptoms | Mild depression, tearfulness, irritability | ≥2 weeks c of moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation | Delusions, hallucinations, thought disorganization, bizarre behavior |
Epidemiology
Etiology
Pathophysiology
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Clinical features
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Diagnostics
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Treatment
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Postpartum psychosis
- Risk Factors: Bipolar disorder (strongest risk factor; up to 50% recurrence), personal/family history of psychosis, primiparity; typical onset within first 1–2 weeks postpartum.
- Clinical Presentation:
- Bizarre delusions centered on the baby (e.g., infant is demonic, possessed, dead, or not theirs).
- Command auditory hallucinations to harm self or infant.
- Waxing/waning sensorium (confusion, cognitive disorganization, delirium-like picture), extreme insomnia, and severe mood lability.
- Workup: Clinical diagnosis; rule out organic mimics with TSH, CBC, CMP, and urine toxicology.
- Key Differentials:
- Postpartum blues: Onset days 2–3, resolves spontaneously within <14 days; no psychosis; functioning intact.
- Postpartum depression: Onset within 4–6 weeks; typical SIGECAPS; lacks overt psychosis or bizarre infant-related delusions.
- Immediate Management:
- Emergency psychiatric hospitalization (voluntary or involuntary). c
- regardless of whether explicit suicidal ideation (SI) is present
- Safety priority: Do not leave the mother alone with the infant under any circumstances.
- Emergency psychiatric hospitalization (voluntary or involuntary). c
- Pharmacotherapy:
- First-line: Second-generation antipsychotics (SGAs) (e.g., olanzapine, quetiapine, risperidone) + mood stabilizer (e.g., Lithium).
- Avoid antidepressant monotherapy (triggers mania/worsens psychosis).
- Benzodiazepines as needed for acute agitation and severe insomnia.
- Refractory / Severe Cases: Electroconvulsive therapy (ECT) (treatment of choice for catatonia, severe suicidality, medication refusal, or refractory disease; safe postpartum).
- Complications & Follow-up:
- High rate of infanticide (up to 4%) and maternal suicide (up to 5%).
- High recurrence risk (>50%) requiring prophylactic mood stabilizers immediately after future deliveries.