Professionals are calling for changes to how postpartum psychosis is classified, arguing the mental health crisis affecting new mums deserves recognition rather than a footnote in diagnostic manuals.
Postpartum psychosis strikes roughly one in every 500 to 1,000 new mothers, typically within the first two weeks after giving birth. The condition is characterised by severe symptoms including mania, delusions, hallucinations and confusion. Left untreated, it carries the risk of suicide and harm to the infant, yet when promptly identified and treated, most women recover fully within a year.
Despite its distinct characteristics, postpartum psychosis currently lacks its own diagnostic category in the Diagnostic and Statistical Manual (DSM-5) or the International Classification of Disease (ICD). The panel say that this contributes to missed diagnoses and delayed treatment, with potentially tragic consequences.
The researchers emphasise that postpartum psychosis appears to fall within the bipolar disorder spectrum. About half of women who experience it will go on to develop bipolar disorder and women with existing bipolar disorder face exceptionally high risk of postpartum psychosis. The condition responds remarkably well to lithium and electroconvulsive therapy, the same treatments used for severe mood disorders.
What makes postpartum psychosis particularly distinctive is its timing and triggers. The dramatic hormonal, immune system and brain changes that occur after childbirth appear to spark the illness in genetically vulnerable women. Recent genetic studies have found the condition has an estimated heritability of 55%, comparable to bipolar disorder, with some unique genetic contributions alongside overlapping risk factors.
The panel recommends classifying postpartum psychosis within the bipolar disorders chapter of the diagnostic manual, noting that proper classification would improve detection by healthcare providers and enable more appropriate treatment planning. They emphasise that the condition is also preventable in high-risk women through careful monitoring and prophylactic medication immediately after delivery.
With suicide identified as a leading cause of maternal mortality and postpartum psychosis carrying the highest risk, the experts argue that formal recognition of this condition could save lives and prevent the heartbreak of families torn apart by a treatable illness.
Veerle Bergink, Director of the Women’s Mental Health Center at Mount Sinai and first author of the paper said: ‘The postpartum time period is characterised by profound endocrine, immune, neuroanatomical and physiological changes in the brain that strongly suggest a biological basis for the illness.
‘Genetic studies have shown a unique risk architecture that’s partly shared with, but distinct from, bipolar disorder. And epidemiologic studies show an enormous peak in incidence and prevalence of the condition.
‘The scientific evidence we present in our consensus statement justifies our recommendation that postpartum psychosis be classified as a distinct mental illness. The lack of accurate diagnosis and subsequent misinformed treatment has contributed to increased morbidity and mortality. Only by proper classification of the illness will we be able to improve patient outcomes. The time is now to make the change so we can help these women and save lives.’
The full research can be read here.
Photo: Nathan Dumlao/Unsplash
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