What to know about postpartum psychosis, which can affect a new mom’s sense of reality

A key question in a Massachusetts murder trial is whether postpartum psychosis drove a mother to kill her three children.

On Monday, a jury heard opening statements in the trial of Lindsay Clancy, a former labor and delivery nurse at Massachusetts General Hospital. Both sides agree she strangled her children aged 5 and younger in 2023. But they disagree over whether she should be held criminally responsible.

Clancy and her ex-husband, Patrick Clancy, filed lawsuits accusing her medical providers of failing to properly diagnose and treat her condition.

Here’s what to know about the disorder.

Postpartum psychosis is rare and dangerous

It’s estimated to afflict only 1 to 2 per 1,000 women after delivery. Experts at the Cleveland Clinic describe it as a mental health emergency affecting someone’s sense of reality.

It can happen to anyone after giving birth, but the chances are higher for people with certain mental health conditions. In a journal article on the subject in 2023, researchers at the Medical University of Lublin in Poland said about half of people with postpartum psychosis have a previous history of psychiatric problems and the most common risk factor associated with the condition is bipolar affective disorder, which causes extreme mood swings.

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EDITOR’S NOTE: This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.

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Though most people with postpartum psychosis don’t harm their children, mothers with severe cases may try to do so, and also may try to harm themselves.

Experts say it’s important to seek immediate help if you or your partner or family member show signs of postpartum psychosis.

Signs of postpartum psychosis

Postpartum psychosis usually happens within several days of giving birth but can occur up to six weeks afterwards.

Symptoms may include hallucinations, delusions, paranoia or other behavior changes.

A woman may also have mood changes, such as mania or depression, disorganized thinking or behavior, insomnia, irritability or agitation.

It’s not the same as postpartum depression or baby blues

Postpartum depression is a mood disorder that can also be dangerous but is much more common. One 2024 study found that U.S. rates reached 19% in 2021. Baby blues is a lot milder and affects about 8 in 10 new moms shortly after delivery.

With baby blues, crying jags and feelings of sadness aren’t enough to interfere with normal life and moms should still be able to care for themselves and their babies.

If sadness lingers for more than two weeks, that can be a sign of postpartum depression. Other signs include intense feelings of despair, anxiety, loss of interest, feelings of guilt and worthlessness, low energy and decreased concentration and appetite. Moms may worry constantly about their babies, be unable to sleep, or stop showering for days. They may even have thoughts of harming themselves.

Postpartum psychosis is the most severe postpartum psychiatric illness.

Treatment for postpartum psychosis

Moms with the condition need inpatient mental healthcare, which can include involuntary hospitalization. Treatments include medications or electroconvulsive therapy, a procedure done under anesthesia in which small electric currents pass through the brain, intentionally causing a brief seizure.

Experts say getting help early increases the odds of a good outcome.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.