The highly publicized trial of Lindsay Clancy, a Massachusetts mother charged with murder in the 2023 deaths of her three children, has put a spotlight on a condition called postpartum psychosis.
While Ms. Clancy was not formally diagnosed with postpartum psychosis, her defense lawyers have argued that she was in the midst of a psychiatric crisis and had heard voices that ordered her to kill her children and herself.
One in eight new mothers will experience postpartum depression, with symptoms like extreme sadness, insomnia and social withdrawal that can emerge in the first year after giving birth.
Postpartum psychosis is considerably rarer — it affects between one and two women per 1,000 births worldwide. Some experts say the number may be higher, though, as women are often misdiagnosed.
“The consequences of missing a diagnosis of postpartum psychosis can be serious. Both the mom and children are at high risk of harm,” said Wendy Davis, the executive director of the nonprofit Postpartum Support International.
Here is what to know about the condition and how to get help.
What is postpartum psychosis? And what are the signs?
Postpartum psychosis is characterized by hallucinations and delusions that cause women to disconnect from reality. The symptoms can vary: Some women might be high-energy, talking faster than usual or staying awake for days. Others might feel depressed and disconnected from their baby.
Symptoms often come and go. A woman might see or hear something that isn’t there, only to appear completely normal a few minutes later.
“When they’re lucid, they’re desperately trying to find a way to get help, to get better, to not hurt anybody,” Dr. Davis said.
In some cases, a woman with postpartum psychosis may have thoughts of harming herself or her baby. These can include what are known as command hallucinations, where a woman hears powerful voices that instruct her to perform a specific action. In rare cases, when women do not receive proper treatment, they may act on these thoughts.
“These delusions take over their mind and their body,” said Dr. Margaret Spinelli, a clinical professor of psychiatry at Columbia University who has evaluated over 30 women who were on trial for killing their children while experiencing postpartum psychosis. “They are like puppets.”
Many new mothers without mental illness will have intrusive thoughts about accidentally harming their babies. This is normal, and it might even help parents stay alert to potential dangers, said Dr. Giles Berrisford, a consultant psychiatrist who provides inpatient perinatal care in Abu Dhabi. But if the thoughts become debilitating, or a woman reports hearing a voice telling her to act on them, they warrant immediate medical attention, experts said.
Experts are divided on how to categorize the condition in the Diagnostic and Statistical Manual of Mental Disorders, the world’s most influential psychiatric manual. It has not yet been added as a distinct diagnosis. Some experts say this makes misdiagnosis common, which can have dangerous consequences.
What causes it?
Postpartum psychosis is believed to be triggered by a combination of the hormonal and immunological changes that accompany childbirth, as well as genetics and environmental factors like sleep deprivation.
Research shows that women with a personal or family history of bipolar disorder are at much higher risk of developing postpartum psychosis. It can be the first presentation of bipolar disorder that endures beyond the postpartum period.
But some research suggests about two-thirds of women with postpartum psychosis have no prior psychiatric history. That is why it’s important for family and friends to pay attention to the behaviors of new mothers, especially in the first weeks after giving birth, experts said.
How is it treated?
Postpartum psychosis requires emergency care. With proper treatment, women can recover fully. One study of women with postpartum psychosis found that nearly all participants achieved remission.
In the majority of cases, psychiatric hospitalization is required to protect the health of both the mother and the baby. In the United States, this could happen in a general psychiatric ward or in one of five inpatient units that specialize in perinatal mental health care — in California, North Carolina, Arkansas, Louisiana and New York. Infants can visit those units but cannot stay overnight. Intensive outpatient treatment or partial hospitalization are also options.
One of the first goals of treatment in any type of specialized facility is to help new mothers catch up on sleep, as doctors believe that sleep deprivation can trigger psychosis. Most women also receive medication, often a combination of benzodiazepines, antipsychotics and lithium. Research has shown that electroconvulsive therapy, or ECT, can effectively treat severe cases.
The typical length of stay for mothers receiving specialized inpatient treatment is less than two weeks. Experts said that is often too early for women to truly become stable and can sometimes leave them without the support needed to sort through medication side effects.
“What we see happening over and over again is that patients who get discharged too early before they’re fully recovered — they easily relapse,” said Dr. Veerle Bergink, the director of Mount Sinai’s Women’s Mental Health Center.
Many experts consider mother-and-baby units (MBUs), which allow mothers and babies to remain together under careful supervision, the gold standard of care for postpartum psychosis. Women can stay for months if needed in these inpatient wards, which are found in Britain, France, Australia and other parts of the world.
There are resources to support families affected by postpartum psychosis, including an international help line and charities like Action Against Postpartum Psychosis.
Dr. Davis said there are three things she tells any woman experiencing postpartum psychosis: “You’re not alone, you’re not to blame, and with help you will get well.”
If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. Go here for resources outside the United States.