Author: Dr. Kevin R. Kurian

If you or someone you love is having thoughts of self-harm, harming a child, experiencing hallucinations, paranoia, or feels disconnected from reality, call or text 988 immediately or seek emergency medical care. Help is available.

As a psychologist and father, I have seen the profound joy that comes with welcoming a new child into the world. I have also seen the heartbreak that can occur when postpartum mental health conditions go unrecognized or untreated.

Recently, the case of Lindsay Clancy has drawn national attention and sparked important conversations about postpartum depression and postpartum psychosis. While the legal questions surrounding her case remain the responsibility of the courts, the public discussion has highlighted an important truth: severe postpartum mental health conditions are real, they can be devastating, and they deserve compassion rather than stigma.

One misconception I encounter is that postpartum depression and postpartum psychosis are the same condition. They are not.

Postpartum depression is relatively common and may include persistent sadness, anxiety, hopelessness, guilt, difficulty bonding with a baby, sleep disturbances, and loss of interest in previously enjoyable activities.

Key risk factors [1]:

• History of depression/anxiety, especially untreated antenatal depression or anxiety (the strongest predictor)
• Prior postpartum depression (~40% relapse risk in subsequent pregnancies)
• Depression during current pregnancy (OR ~2.4), history of depression (OR ~3.1)
• Gestational diabetes, low social support, marital difficulties, intimate partner violence, adverse birth outcomes, genetic predisposition
• Course: Most recover within months, but ~20% remain depressed beyond 1 year and 13% beyond 2 years

Postpartum psychosis, by contrast, is rare but constitutes a psychiatric emergency. It can involve hallucinations, delusions, severe confusion, paranoia, dramatic mood changes, and a loss of contact with reality. Experts estimate that postpartum psychosis affects approximately 1 to 2 out of every 1,000 births.

Key risk factors and high-risk groups [2]:

• Bipolar disorder (especially type I): markedly elevated risk of 7–17% (nearly 1 in 5 deliveries)
• Prior postpartum psychosis: overall relapse ~31% (95% CI 22–42); in women with both bipolar disorder and prior postpartum psychosis, rates as high as 41–87%

I have personally worked with mothers who were ultimately found not guilty by reason of insanity after acts of infanticide. The pain, grief, and devastation involved are among the worst psychological suffering I have ever witnessed. These are not stories of “bad mothers.” They are stories of severe mental illness, tragedy, and families forever changed.

That is why early intervention matters.

In many cases, mental health support should begin during pregnancy, not after delivery. Pregnancy and the postpartum period involve significant hormonal, physical, emotional, and lifestyle changes. For some women, this period may also involve difficult decisions regarding psychiatric medications. Women who have successfully managed depression, anxiety, bipolar disorder, or other conditions with medication may choose to reduce or discontinue treatment because of concerns about pregnancy or breastfeeding. Those decisions should always be discussed with qualified healthcare providers, but they can create periods of increased vulnerability that deserve careful monitoring and support.

Psychotherapy during pregnancy provides a safe place to process fears, manage stress, develop coping strategies, strengthen support systems, and identify warning signs before they become crises.

For fathers, partners, grandparents, and close friends, your role is incredibly important. If a new mother seems withdrawn, overwhelmed, unusually fearful, unable to sleep, persistently depressed, or begins saying things that seem out of character or disconnected from reality, do not dismiss it as simply being tired. Reach out. Listen without judgment. Encourage professional help. Offer practical support.

Most importantly, remember this: seeking help is a sign of strength, not failure.

At Insight Carolinas, we understand that pregnancy and the postpartum period can be emotionally complex. Whether someone is experiencing depression, anxiety, intrusive thoughts, relationship stress, or difficulty adjusting to parenthood, therapy can provide support, treatment, and hope.

No mother should have to suffer in silence.

If you or someone you love is experiencing a mental health crisis, call or text 988 immediately. If the situation is an emergency or there is concern for immediate safety, call 911 or go to the nearest emergency department. Early intervention can save lives.

To speak with one of our staff to schedule an outpatient appointment, click the link below:
https://insightcarolinas.com/referrals/

References

[1] Stewart, D. E., & Vigod, S. (2016). Postpartum depression. The New England Journal of Medicine, 375(22), 2177-2186. https://doi.org/10.1056/NEJMcp1607649

[2] American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum (ACOG Clinical Practice Guideline No. 4). Obstetrics & Gynecology, 141(6), 1232-1261. https://doi.org/10.1097/AOG.0000000000005200

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