What is postpartum psychosis and how is it different from postpartum depression?

A mother in Massachusetts who was accused of killing her three children may have been suffering from postpartum psychosis, as her husband asks the public to forgive her for strangling their children to death.

Lindsay Clancy, 32, has been accused of strangling her two older children – Cora, five, and Dawson, three – while her third child, eight-month-old Callan, was pronounced dead on Friday at Boston Children’s Hospital after he was hospitalised.

She is facing two counts of homicide, three counts of strangulation, and three counts of assault and battery with a deadly weapon. Investigators are said to be looking into the possibility that Clancy was suffering from postpartum psychosis – a serious mental illness impacting new mothers.

What is postpartum psychosis?

Postpartum psychosis (PPP) is a rare condition that occurs in up to four new mothers out of every 1,000 births, but its symptoms are severe.

People with PPP may experience symptoms within one to two weeks after childbirth. According to Postpartum Support International, these symptoms include feeling confused, experiencing hallucinations, paranoia, making attempts to harm yourself or your baby, or experiencing rapid mood swings within several minutes.

Among those who develop PPP, research suggests there is approximately a five per cent suicide rate and a four per cent infanticide rate associated with the illness.

What causes postpartum psychosis?

Experts suggest that chances for developing PPP are higher with a personal or family history of bipolar disorder or previous episodes of psychosis. About one-third of people with PPP have a previously diagnosed mental health condition, according to the Cleveland Clinic.

How is postpartum psychosis treated?

Because PPP is a mental health emergency, many experts suggest inpatient mental healthcare as best to treat this condition. Other treatment methods include medication and therapy.

How is postpartum psychosis different from postpartum depression?

Postpartum depression, which refers to the time after childbirth, is a type of mood disorder that occurs after pregnancy and can range from being mild to severe. PPD is a type of perinatal depression, which refers to the period of time before and after the birth of a child. Prenatal depression – meaning depression during pregnancy – is also a type of perinatal depression.

What are the symptoms of postpartum depression?

The “baby blues” and other mood swings are normal and common among new mothers. However, these feelings typically last about 10 days, according to the Cleveland Clinic, and are less severe than symptoms similar to those of depression.

If these feelings of sadness, guilt, or intense mood swings continue for more than two weeks, new mothers may be experiencing PPD.

According to the March of Dimes, a non-profit organisation dedicated to the health and safety of mothers and babies, signs and symptoms of PPD may include feeling depressed most of the day every day; feeling shame, guilt or like a failure; feeling panicked or scared a lot of the time; or having severe mood swings.

Some women with postpartum depression also experience changes in their everyday lives, including feelings of fatigue, changes in eating habits, gaining or losing weight, having trouble sleeping or sleeping too much, and having trouble concentrating or making decisions.

PPD can even influence how mothers think about themselves or how they connect with their baby. These signs can include having trouble bonding with your baby, thinking about hurting yourself or your baby, and even thoughts of suicide.

What causes postpartum depression?

While there is no single cause of PPD, research has shown that changing hormone levels after pregnancy can have an effect on your emotions and moods. During pregnancy, the body has higher levels of oestrogen and progesterone hormones. But in the first 24 hours after childbirth, hormone levels quickly drop back to normal levels, according to the US Office on Women’s Health. Levels of thyroid hormones may also drop after giving birth.

Other possible causes of PPD can include a personal or family history of depression. Women who have experienced PPD with a previous pregnancy are also at greater risk of developing it.

What treatments are available for postpartum depression?

Treatment for PPD may vary depending on the severity of symptoms, but those who think they have it should discuss the best treatment options for them with their health care provider.

These treatments may include talk therapy or cognitive behavioural therapy, which are commonly recommended treatments for depression. A therapist or psychologist will help to develop strategies for coping with feelings of depression,  and learn how to respond to situations in a positive way.

Some people may also be prescribed medication to treat their PPD, such as antidepressants. These are medicines used to treat many kinds of depression, and can help relieve symptoms of PPD. Some antidepressants can also be taken while breastfeeding, but mothers who are nursing should consult with their doctors about which medicines are right based on their symptoms and if they’re breastfeeding.

If you are experiencing feelings of distress and isolation, or are struggling to cope, the Samaritans offers support; you can speak to someone for free over the phone, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch.

If you are based in the USA, and you or someone you know needs mental health assistance right now, call National Suicide Prevention Helpline on 1-800-273-TALK (8255). The Helpline is a free, confidential crisis hotline that is available to everyone 24 hours a day, seven days a week.

If you are in another country, you can go to www.befrienders.org to find a helpline near you.