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Postpartum psychosis is a serious psychiatric emergency, but it’s a topic that is often misunderstood, especially when news coverage focuses on the most tragic cases.

In this episode, Allison Egidi talks with Laudy Burgos, a clinical social worker who specializes in perinatal mood disorders and serves in leadership roles with Postpartum Support International. Together, they take a closer look at what postpartum psychosis actually is, how it differs from postpartum depression and anxiety, and what families need to know about recognizing the signs.

Laudy explains that postpartum psychosis involves a loss of connection with reality and can include hallucinations, delusions, paranoia, severe confusion, dramatic changes in behavior, agitation, rapid speech, and unusual or impulsive behavior. Symptoms can wax and wane, which can sometimes make the condition difficult for loved ones to recognize.

The conversation also covers:
— How postpartum psychosis differs from postpartum depression and anxiety
— The signs and symptoms family members and partners should watch for
— Why a significant change from someone’s usual behavior can be an important warning sign
— How sleep and insomnia can factor into postpartum psychosis
— The difference between being sleep-deprived because you’re caring for a newborn and being unable to sleep even when you have the opportunity
— Risk factors, including bipolar disorder, a previous experience with postpartum psychosis, and a family history of bipolar disorder or psychosis
— When postpartum psychosis typically begins after childbirth
— Why someone experiencing psychosis may not recognize that anything is wrong
— What partners and loved ones should do if they are concerned
— Why postpartum psychosis should be treated as a psychiatric emergency
— What hospitalization and treatment can look like
— The importance of ongoing support, sleep, therapy, medication management, and family support during recovery
— Why the tragic cases that make the news do not represent the majority of people who experience postpartum psychosis
— The importance of talking about postpartum psychosis with both urgency and compassion
— Resources available through Postpartum Support International and the National Maternal Mental Health Hotline

Most importantly, Laudy emphasizes that postpartum psychosis is an illness, not a choice or a reflection of someone’s ability to be a good mother. With early detection and appropriate treatment, recovery is possible.

Important: Postpartum psychosis is a medical and psychiatric emergency. If you believe someone may be experiencing postpartum psychosis, seek immediate professional help. In the episode, Laudy recommends contacting a psychiatrist who understands this emergency when possible, or going to the nearest emergency room/calling 911 if necessary to get someone to care safely.

Resources mentioned in this episode:
— Postpartum Support International
— National Maternal Mental Health Hotline: 1-833-TLC-MAMA (1-833-852-6262)
— Postpartum Support International Helpline: 1-800-944-4773
— Connect with Laudy at her website or on LinkedIn

Chapter Markers:
00:00 Introduction: Why We’re Talking About Postpartum Psychosis
01:47 Meet Laudy Burgos, LCSW
02:55 What Is Postpartum Psychosis?
05:09 Signs and Symptoms to Watch For
08:26 Can Postpartum Psychosis Come and Go?
09:32 When Does Postpartum Psychosis Begin?
11:17 Who Is at Risk for Postpartum Psychosis?
13:04 How Common Is Postpartum Psychosis?
14:56 The Connection Between Sleep and Postpartum Psychosis
16:16 Does Someone Know They’re Experiencing Psychosis?
17:38 What Should Loved Ones Do?
19:41 Postpartum Psychosis, News Coverage and Tragedy
22:18 What Does Treatment and Recovery Look Like?
23:46 What Expecting Parents Should Know
24:36 Postpartum Mental Health Resources

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Scroll down for a full transcript of this episode.

259. Understanding Postpartum Psychosis with Laudy Burgos
Allison Egidi: Hey there, Allison here. Welcome back to How Long ‘Til Bedtime. Postpartum Psychosis is a topic I will admit I was fairly naive about until the last few months, since it has been such a huge part of our news cycle. And I definitely found myself with more questions than answers as I watched these news stories.

So, when Postpartum Support International reached out to ask if I wanted to have a guest on my podcast to help educate our community on this important topic, I jumped at the opportunity. Laudy Burgos is a licensed clinical social worker who specializes in the treatment of perinatal mood disorders. She is an associate director of social work in the Women’s and Children’s Division at Mount Sinai Hospital, serves as a New York State co-coordinator for Postpartum Support International and is the vice chair of PSI’s Board of Directors. Laudy also teaches at the Icon School of Medicine at Mount Sinai, Columbia University, and NYU. I really appreciated her helping me better understand postpartum psychosis, and I hope that you will also find this episode informative.

Thank you so much for joining me today to help educate my community, but also me on postpartum psychosis. But before we dive in, I always like to start by asking my guests what inspired you to pursue your vocation?

Laudy Burgos: Thank you for having me, Allison. I think for me, social work has always been about people and connection. And I’ve always been drawn to understanding people’s stories even when I was young, before I even went to college. And you know, and just not this just their stories, but what they’ve been through, what has shaped them, and also how we can support them during some of the difficult moments in their lives.

AE: Love that. Has your whole career been in social work?

LB: Yes, can you believe it’s almost going to be three decades? I you know, I knew I wanted to do social work and so I got my bachelor’s in social work and then right after that I went into my masters. So this is what I’ve done all my life.

AE: Amazing. Well, we’ve talked about postpartum depression and anxiety a lot on this podcast, but we’ve never discussed postpartum psychosis. So let’s start with the most basic question of what exactly is postpartum psychosis and how is it different from postpartum anxiety or depression?

LB: Sure. no, I’m glad so much that we are talking about this, especially now. So, postpartum psychosis is a very serious psychiatric emergency. I like to think of it it like the same way like when someone gets a heart attack or a stroke, right? It’s and it typically begins suddenly. Often we see it within a few days to a few weeks after childbirth. and the key difference is that with postpartum psychosis is a person really loses touch with reality. I have a colleague and friend who experienced postpartum psychosis, and she literally describes it as I lost my mind for that period of time. And usually when people have psychosis, they experience hallucinations, delusions, severe confusion at times, paranoia. And you usually see their behavior is dramatic, dramatically altered.

And so because judgment and perception of reality can become impaired, there can be a risk of harm not only to themselves but to their baby. And postpartum depression anxiety are a little different because they are severe and debilitating, that can be it can be really hard to function, but the person generally remains grounded in reality.

So although they have these uncomfortable symptoms, and they may even have intrusive thoughts. They may even have thoughts that don’t feel great. But these thoughts, while incredibly upsetting, the parent doesn’t have a desire to act on them. And they’re disturbing to the parent. So usually we don’t worry that they’re going to do something.

AE: And so when you describe the signs and symptoms of postpartum psychosis, what might a family member, a friend, a partner be looking for? Because obviously it sounds like if if the person is disconnected from reality, they’re going to have a hard time self-identifying that they have a problem. Whereas sometimes with postpartum anxiety or depression, they can identify that they have an issue. Am I thinking about that correctly?

LB: Yes, absolutely. No, you hit it right on the nose. and you know, people have this idea, I think, that when someone has postpartum psychosis, they’re always confused and erratic, but it’s just not true. Someone with postpartum psychosis can wax and the symptoms can wax and wane. There’s a great psychiatrist that I love and she always talks about that in her presentation and I think that’s key because and this is why sometimes people don’t pick up on it, right? If you see your friend and she’s acting quote unquote normal that day, right?
You’re not going to pick up on it, but it could be that later in the day there are symptoms.

So usually people notice that the person is extremely confused, they’re not making sense, or they’re behaving very differently, and that’s key to me. I always tell partners and families and like other supports that you know what you behave like, you know, my family and knows how I am. And if there is behavior that just seems like, huh, this is not like Allison, right? Pay attention to that. Usually people with postpartum psychosis, moms with postpartum psychosis, become unusually suspicious or paranoid. or they say things, right, that are not based in reality. And they may believe someone is trying to hurt them or their baby. they also have these grandiose, sometimes even religious sort of thoughts that the baby is somehow evil or possessed or special or sent by God. Or they may be receiving messages or signs that other people don’t see. And so I always say really pay attention to that. Some moms may even hear voices or see things that aren’t there.

And then there’s other symptoms, right? That we may not catch right away. They may be extremely energetic or agitated or unable to sleep even when the baby is sleeping. You may also see with some people very rapid speech, their thoughts are racing, and then impulsive behavior that is not typical of that person, but also one of the things that people often discuss is this like dramatic shift in mood that they would be really down one moment and look upset and depressed and then all of a sudden they’re very energetic and talking nonstop with like pressured speech. So I basically tell families to pay attention to a significant change in the person that you know basically.

AE: And once you have it or it kicks in, c does it come and go or are you in it until you’re medically treated to get out of it?

LB: Yeah, so once you have it, like I said, you may have moments where you’re not displaying those symptoms, but again, it waxes and wanes. And so there are women that without treatment will get better, but usually the majority of women will need treatment. And when I say treatment, I mean most people need to be hospitalized so they can just stabilize them. Usually requires medication and then some sort of other therapeutic support, whether that’s individual or group. But we definitely always tell people it’s an emergency, you need to speak to a psychiatrist. Like I said, can you not treat it and get better? Sometimes, but for the most part people need treatment for it to completely go.

AE: And you mentioned that it it often kicks in fairly quickly after birth. Is it how big is that window? Because I know a lot of times they’ll say with postpartum depression and anxiety, it’s much bigger than the first few months. Is that not the case with postpartum psychosis? Or it varies?

LB: So usually it can vary, but usually we see symptoms within the first day or two to maybe a few weeks, three to four weeks after childbirth. But you know, then again, like I shared before, some of these symptoms can start very subtly. So sometimes I’ve had families that say, I didn’t notice. I don’t think it started early for her. I think it started late. And I tell them it could be that the symptoms were subtle or that mom was trying really hard to sort of contain them because sometimes some women, right, they behave this way and they see people’s reaction, and then they may have moments where they think, my god, yeah, like why am I doing this, or why am I having these thoughts? And they come in and out of that, and then they may try really hard not to show that, right? And they try to really keep this control so that people don’t think, quote unquote, they’re crazy, right?

I’ve had families say that I’ve had moms say that but sometimes the symptoms are there and you just don’t catch them now is it possible that sometimes a month or two later it starts absolutely I mean hormonally right and just in terms of situational stuff that’s going around or you know around you something may just break you so it’s possible but usually you see it pretty early.

AE: And are there women who are more at risk of developing postpartum psychosis?

LB: Yes, absolutely. So one of the strongest risk factors we always talk about is having bipolar disorder. And so women who have experienced postpartum psychosis, you know, who usually when you talk to them, you’ll see they have been diagnosed with bipolar disorder or during, you know, whatever assessment is made through their psychosis, they’ll say, you know, she has bipolar disorder and it was not diagnosed.

The other thing is women who have experienced postpartum psychosis in a previous pregnancy are also at a much greater risk of experiencing it again. Other things we look at is a family history of bipolar disorder or psychosis. So even if you didn’t have it, but like your mother, your grandmother, your sister had it, we look at that, that puts you at risk. The other thing I always talk about is discontinuing medication during pregnancy, you know, many moms feel a little uncomfortable taking medication during pregnancy. And we always explain to them, right, the risks and benefits and sort of like, you know, putting in a balance, okay, if you take versus not take anything we take can have an effect or a side effect. But we usually say that it is better to be on medication because if your mental health deteriorates, that’s bad for your baby.

AE: And how many women do you think are impacted by postpartum psychosis as compared to postpartum depression or anxiety? What are the numbers we’re looking at?

LB: Yeah, so one to two of a thousand women will experience postpartum psychosis.

AE: Okay, so it’s a lot less.

LB: Yes. So it’s interesting, Allison, because it is a lot less. and at one point the way we train people at PSI and other organizations is we always used to refer to it as this is rare. And even though it’s less frequent, it’s one to two of a thousand, right? As opposed to, you know, depression and anxiety. Still happens. I mean that’s still a lot. So we no longer say it’s rare, but I’d like to say obviously it happens less frequently.

AE: Right. I agree. I would not say one and two out of a thousand is rare, but I’m envisioning as someone who had postpartum anxiety and just I think since then some better awareness of my own natural anxiety that I have thought many times as this has become s such a hot discussion in the news and everything that like, I bet if I were still in my child bearing years, I would suddenly have new anxiety about what are my chances of having this. And so I think it’s somewhat reassuring to people that it’s not as significant as anxiety or depression.

LB: Correct. This is not something, you know, I work in a hospital and most of our moms that we see postpartum, we would start seeing some of the baby blues, right? Or if they were pregnant and had depression or anxiety, we may start seeing that. but this is very different. This is not something we see all the time. Maybe we have a couple of cases a year. So it is a little different.

AE: So, with postpartum psychosis, I think one of the things we’ve been hearing is that there’s a lot of insomnia or struggle to sleep. So, can you talk a little bit about that and how common that is as a symptom and just what role being sleep-deprived plays in a woman’s experience with postpartum psychosis?

LB: Yeah, no, that’s an excellent question, and it comes up a lot. Sleep is something we pay very close attention to. And I do this when I assess a mom, I ask about this all the time, even if I’m not concerned about postpartum psychosis. Of course, most new parents are sleep deprived, right? And so lack of sleep alone doesn’t mean someone is developing postpartum psychosis. What’s concerning to us is when a mother has the opportunity to sleep, but simply can’t.

So instead of being exhausted, which she should be, right? If she hasn’t been sleeping, she’s been up caring for her baby, instead she becomes kind of like more energized and restless and agitated and confused. So again, it’s not the lack of sleep when you’re caring for your baby, it’s more that when you are able to sleep, you still can’t sleep.

AE: Okay. And how aware would you say the person struggling with postpartum psychosis is that they are struggling? Or are they so disconnected from reality that they don’t appreciate that they are in a really bad place? Like what’s kind of the percentage? Sounds like some people realize something might be off and they’re trying to cover it up or not let people see it. And then are some people really unaware that they are not acting like themselves?

LB: Yeah, and I think that’s one of the challenges, especially when you have, you know, a therapist that’s trying to evaluate them, is that a woman may not recognize that what she’s experiencing isn’t real. To her those thoughts and those beliefs and those fears may feel completely real and normal. So we can’t always rely on her to recognize that something is wrong and ask for help. And like I said before, are there women when they sort of go in and out of it that realize yes and that’s and then they try really hard to hide it. But not always. Some women may not recognize it and that’s why partners, family members, and also healthcare providers play such an important role in in identifying it.

AE: And if you are one of these partners or loved ones who suspects that someone is struggling with postpartum psychosis, what do you recommend they do? Because I suspect there’d be some pushback if they were to tell the person struggling, hey, we should get help. What do you suggest that the partner or loved one do?

LB: Yeah, it’s very difficult, Allison, and you’re absolutely right. women don’t always respond well to that, right? And it’s no I mean it makes sense, right? You have a new baby, you want to take care of your baby, you want to be this like perfect mom. So all of a sudden to hear like something’s wrong with you, especially if you don’t recognize it or that’s not your reality, can be really hard. So what I say is if you are able to, I tell the family member, if it’s someone right that has insurance, that has access to a psychiatrist that has some resources where they can call a psychiatrist and get the person seen within a day or two, that’s ideal. But some people may not have that same access, right?

And sometimes, you know, scope of practice is really important. You don’t want to just go anywhere, you want to go someone to someone who is going to know how to treat this emergency, this psychiatric emergency. So, in the absence of that, right, of having someone that you can make an appointment with, I really just tell them to take them to the nearest emergency room or call 911 if you can safely get there, right? Because the mother may become really agitated. So it’s not the best, right? I think calling an ambulance can be very traumatic for all those involved. But if that’s the only way you can get her there safely, that’s what you have to do. I’ve definitely had families that are able to take their loved one to their emergency room, they convince them or you know or whatever they do to get them there, they’ve done that. But really it’s an emergency, so they have to get them help right away.

AE: And I think postpartum psychosis often makes the news when something incredibly tragic has occurred. And I’m for all of our education, including my own, what do you want the public to kind of know about the treatment versus this thought that it appears it causes these really tragic events? Like what is the reality here on how many people get treatment and there is no tragedy involved and it’s just a very scary situation versus these really extreme tragic events.

LB: I’m glad that you brought that up because I think that, you know, all like when it happens in the news, a tragedy and then they sensationalize certain things, it can be it really creates a lot of fear, you know, and ultimately we’re not really educating people. But what I really wish people understood that these tragic cases that we hear about in the news really don’t represent the majority of women who experience postpartum psychosis. I mean it’s awful.

It’s disturbing, but you know, there are many women who experience postpartum psychosis, and fortunately, right, it doesn’t end in in a tragic way like some of these cases. Those stories, understandably, you know, get a lot of attention, but they can also create fear and stigma around an illness that is treatable. There are mothers, these are mothers experiencing, you know, a serious medical and psychiatric emergency. But they’re not bad mothers, right? And they did not choose to become ill.

And when someone is experiencing psychosis, their perception of reality can be profoundly altered. So I really wish people understood that. That when moms are behaving this way, they really are not aware. It’s like something takes over their body and do things that they wouldn’t normally do. So you know, I also wish we would talk more about recovery because with early detection and with the appropriate treatment, women can and do recover. They go back to their families and their careers and their lives.

And we need to talk about postpartum psychosis with urgency, Allison, but also with compassion and make sure that families know that help and recovery are possible. And with the right treatment, people do get better and go back to their lives.

AE: And how long is the treatment process typically? So you said they often are going to be hospitalized. And then what does it look like from kind of that moment on?

LB: You know, first, like I said before, because it’s a medical emergency, usually you need to stabilize the person, right? So the treatment usually begins in the hospital where the mom can be kept safe and you can stabilize her. And then treatment may include medications for sure, such as antipsychotics or mood stabilizers. And depending on the severity of the symptoms, right, there may be other things, but usually typically that is medication with individual therapy. Sometimes some of these places have group therapy because we know that peer support and social support is so important.

And then once you get over that little hump, right? That emergency and you are more stable, then recovery continues after she leaves the hospital. And that includes, you know, seeing a psychiatrist regularly for the medication management. It includes therapy. It may include a support group and lots of support from the family. It’s really important during that time that we make sure that they are able to sleep, that they get some rest. So that support from the family becomes really paramount.

AE: That’s really helpful. Well, what do you want expecting parents to know as it relates to postpartum psychosis? Like what do you think the overall message you wish all expecting parents knew would be?

LB: I would say, you know, we have this little slogan in PSI that says, You are not alone, you are not to blame, and with treatment you’re going to get better. And I think that sort of summarizes what I would want them to know that this is really not their fault and that they don’t have to feel this way forever. And if they receive treatment within a few months, they’re going to feel better and be able to go back to mothering their child and being with their family and enjoying their lives.

AE: Well, I really appreciate you taking some time today to help us better understand postpartum psychosis and thank you for the work that you do supporting moms and families. And we will link to Postpartum Support International in the show notes. But there are there any other resources that you think parents should know about?

LB: Yeah, there is a national maternal mental health line that you can reach at 1-833-TLC-MAMA, which is 1-833-852-6262. It’s a hotline, so they respond very quickly. but you know they can also call the PSI helpline and also text. Some people like texting, so that’s fine too. So if they text HELP to 1-800-944-4773. They will get help. And then the PSI helpline is 1-800-944-4773. They can talk to someone who is going to put them in touch with someone in their state, maybe even in their county, who can get them, you know, help them access resources.

AE: Okay, great. We will link to that in the show notes as well. Well, thanks again for your time and thanks to everyone for listening.

LB: Thank you for having me.