From Blues to Breakdown: A Psychiatric Reappraisal of Postpartum Psychosis with Real-World Cases

Abstract

Background: Postpartum psychiatric illnesses, from the ubiquitous but generally self-limited baby blues to the comparatively unusual but potentially fatal postpartum psychosis, remain under-recognized in maternal mental illness. Despite growing attention, underdiagnosis, stigma, and absence of standardized diagnostic classification remain a threat to early detection and treatment. Aim and Objective: The purpose of this research is to critically assess current literature on the etiology, risk factors, prevention, and treatment of postpartum psychiatric disorders, with two model clinical vignettes. The aim is to discuss the multifaceted etiology, pathways, and management of these disorders, and to ask: Why is postpartum psychosis yet to be officially recognized considering its disastrous outcomes? Methods: The narrative review with systematic elements consisted of 10 peer-reviewed papers of different geographical and methodological backgrounds. Two clinical cases from practice were included to provide context and enhance the scope of the evidence. Inclusion criteria were papers on postpartum blues, depression, or psychosis in women up to one year postpartum. Exclusion criteria were literature that was not in English and non-clinical outcome studies. Results: Five studies were initially synthesized, followed by Case 1, a 35-year-old woman with postpartum depression. The other five studies were examined before Case 2, a 32-year-old woman with recurrent postpartum psychosis. The common risk factors were primiparity, bipolar disorder, immune dysregulation, and psychosocial stress. Lithium and antipsychotics were always indicated for postpartum psychosis, and SSRIs and psychosocial interventions were helpful for depression. Case 1 presented early-onset depressive symptoms like refusal to eat, tearfulness, and somatic complaints on Day 3 postpartum. Case 2, with a history of a previous psychotic episode following the death of her first child, presented relapse symptoms of hallucinations and disorganized thinking following the second delivery, again on Day 3 postpartum. Conclusion: Postpartum psychiatric disorders are multifactorial, recurrent, and underdiagnosed. There is an urgent need for early screening, Diagnostic and Statistical Manual of Mental Disorders (DSM) reclassification of postpartum psychosis, and integrated maternal mental health services.