The Lindsay Clancy trial has brought postpartum psychosis into the national conversation. Her defense argues that she was experiencing psychosis at the time of her children’s deaths. Testimony and records presented during the trial have also described significant mental health symptoms and efforts to seek treatment in the months before the tragedy. Prosecutors dispute that her mental illness made her not criminally responsible.
I am not writing this to analyze Lindsay Clancy, determine what she was experiencing at the time of her children’s deaths, or weigh in on her legal responsibility.
I am writing because I am a therapist who specializes in perinatal mental health, and I am seeing postpartum psychosis discussed in ways that are not always clinically accurate.
When a serious postpartum psychiatric illness becomes part of a highly publicized tragedy, accurate information matters.
So, what is postpartum psychosis?
What does it actually look like?
And what do we need to understand about it?
What Is Postpartum Psychosis?
Postpartum psychosis, sometimes abbreviated as PPP, is a serious psychiatric condition. It typically begins suddenly in the days or weeks following childbirth, but sometimes it can occur up to a year after delivery.
It affects approximately 1 to 2 people per 1,000 births.
Postpartum psychosis involves a disruption in a person’s perception of reality.
Symptoms may include:
- delusions, or firmly held beliefs that are not based in reality
- hallucinations, including hearing or seeing things others do not
- paranoia or suspiciousness
- confusion or disorientation
- severely disrupted sleep or an inability to sleep
- racing thoughts
- agitation or restlessness
- mania or unusually elevated energy
- significant depression
- rapidly changing moods
- disorganized or unusual behavior
Symptoms often emerge quickly and can change rapidly.
Postpartum psychosis is a psychiatric emergency that requires immediate evaluation and treatment.
It is also treatable.
Both of those things are important to understand.
What Are the Early Signs of Postpartum Psychosis?
One reason postpartum psychosis can be difficult to recognize is that the earliest symptoms may not initially look like psychosis.
Insomnia, anxiety, irritability, restlessness, mood changes and feeling unusually energized can occur before more obvious symptoms such as hallucinations or delusions appear.
That can make early recognition challenging, particularly during a time when disrupted sleep, exhaustion and emotional changes are already expected.
But there is an important difference between being exhausted and overwhelmed after having a baby and experiencing a rapidly changing mental state accompanied by significant confusion, unusual beliefs, extreme agitation, mania or a loss of contact with reality.
Significant and sudden changes in behavior or mental status after childbirth deserve attention.
Can Postpartum Psychosis Symptoms Come and Go?
Yes.
This is one of the most important things to understand about postpartum psychosis, particularly as people discuss what someone experiencing psychosis is “supposed” to look like.
Psychosis does not necessarily mean that a person will appear obviously disconnected from reality every moment of every day.
The presentation of postpartum psychosis can change rapidly. Symptoms may wax and wane, and periods of greater clarity or lucidity can occur.
Someone may appear coherent, organized or more like themselves during one interaction and experience significant confusion, disorganization, delusions or other psychotic symptoms at another time.
In other words, appearing “normal” at one particular moment does not, by itself, tell us what that person is experiencing across hours or days.
This is one reason postpartum psychosis requires assessment by professionals trained to recognize perinatal psychiatric illness rather than conclusions based on a snapshot of someone’s behavior.
Is Postpartum Psychosis the Same as Postpartum Depression?
No.
Postpartum psychosis and postpartum depression are not interchangeable terms.
Yet they are sometimes treated that way in news coverage and everyday conversation.
Postpartum depression is also much more common.
Postpartum Support International reports that as many as 1 in 5 mothers and 1 in 10 fathers experience depression and anxiety during the perinatal period, compared with postpartum psychosis, which occurs in approximately 1 to 2 per 1,000 births.
But the difference is not simply how often these conditions occur. Postpartum depression and postpartum psychosis are clinically distinct conditions, with different symptoms and different levels of urgency when it comes to assessment and treatment.
Postpartum depression may include :
- persistent sadness
- loss of interest or pleasure
- hopelessness
- guilt
- irritability
- changes in sleep or appetite
- difficulty concentrating
- thoughts of death or suicide.
Postpartum psychosis involves a disruption in a person’s perception of reality and may include delusions, hallucinations, severe confusion or mania.
A person experiencing postpartum psychosis may also experience significant depression. In fact, mood symptoms are common in postpartum psychosis.
But postpartum depression itself is not psychosis.
That distinction matters because the assessment, level of care, and treatment needs can be very different.
What Is the Difference Between Postpartum OCD and Postpartum Psychosis?
This may be one of the most important distinctions we can make when talking publicly about postpartum mental health.
Frightening intrusive thoughts can occur during the postpartum period, particularly with postpartum OCD.
A mother might suddenly have an unwanted image of dropping her baby, harming her baby or something terrible happening to her baby.
The thought can be graphic and terrifying.
In postpartum OCD, these thoughts are typically ego-dystonic. That means the thought is inconsistent with the person’s beliefs, values, and desires.
She does not want the thought.
She may feel horrified that her brain produced it.
She may repeatedly check on her baby, avoid situations that trigger the thought, seek reassurance or take excessive precautions because she is so afraid of something happening.
Importantly, research has not found that people experiencing these ego-dystonic intrusive thoughts in postpartum OCD have an increased risk of harming their infants.
Psychosis is different.
With postpartum psychosis, a person may experience a delusion as true or hear or see something that others do not. Insight and the ability to accurately evaluate reality may be significantly impaired.
That difference is clinically important.
It is also why we need to be careful about how we talk about frightening postpartum thoughts.
If every disclosure of an intrusive thought is treated as evidence that someone might act on it, we create more fear and shame around symptoms that people are already terrified to disclose. And shame can make it harder to ask for help.
Who Is at Risk for Postpartum Psychosis?
Research has consistently identified several important risk factors for postpartum psychosis.
One of the strongest is a previous episode of postpartum psychosis.
Bipolar disorder is another significant risk factor, particularly bipolar I disorder. A personal or family history of bipolar disorder or postpartum psychosis can also increase risk.
Research has additionally identified first birth and severe sleep disruption as factors associated with postpartum psychosis.
At the same time, not everyone who develops postpartum psychosis has an established psychiatric history before pregnancy.
This is important because understanding risk factors can help identify who may benefit from additional support, proactive care and planning during pregnancy and the postpartum period. They do not allow us to predict with certainty who will or will not experience postpartum psychosis.
Is ADHD a Risk Factor for Postpartum Psychosis?
ADHD is not currently recognized in the research as an established risk factor for postpartum psychosis.
I think this distinction is worth making because ADHD is (finally) increasingly being recognized as relevant to perinatal mental health.
Research suggests that women with ADHD may have increased vulnerability to postpartum depression and anxiety, and the transition to motherhood can create significant challenges related to executive functioning, sensory overload, sleep disruption and emotional regulation.
That does not mean ADHD should automatically be connected to postpartum psychosis.
Current research and expert consensus on postpartum psychosis consistently identify factors such as bipolar disorder, previous postpartum psychosis, family psychiatric history and other biological and reproductive factors.
ADHD has not been established as a risk factor for postpartum psychosis.
We can recognize the importance of ADHD in maternal mental health without assuming it increases the risk for every postpartum psychiatric condition.
How Serious Is Postpartum Psychosis?
Postpartum psychosis is a psychiatric emergency because psychosis can profoundly affect judgment, insight and perception of reality.
There is an increased risk of suicide associated with postpartum psychosis. Infanticide is much less common, but it can occur, particularly when severe delusions or hallucinations are involved. A recent systematic review cited an estimated infanticide rate of approximately 4% in untreated postpartum psychosis.
Statistics like this need context.
They should not be used to portray people experiencing postpartum psychosis as inherently violent or to make postpartum parents afraid to disclose psychiatric symptoms.
They tell us something different:
- Postpartum psychosis requires urgent recognition and treatment.
- The goal of identifying risk is prevention, not stigma.
Is Postpartum Psychosis Treatable?
Yes.
Postpartum psychosis is a psychiatric emergency, and it is treatable.
Treatment often requires hospitalization so the person can receive specialized psychiatric care, medication and support.
With appropriate treatment, people can and do recover from postpartum psychosis.
That is an important part of this conversation. A diagnosis of postpartum psychosis does not mean that tragedy is inevitable. Early recognition and access to appropriate care matter.
Why Accurate Conversations About Postpartum Psychosis Matter
When postpartum psychosis enters the public conversation because of a tragedy, it can be easy for the illness itself to become associated with the tragedy.
That is why accurate information matters.
We need people to understand that postpartum psychosis is not postpartum depression. We need to understand that frightening intrusive thoughts are not the same as psychosis. We need families to know that symptoms can change quickly and may not always be obvious. And we need people experiencing postpartum mental health symptoms to feel safe asking for help without shame or fear of being judged.
Postpartum psychosis is serious. It is a psychiatric emergency. And it is treatable.
People can and do recover.
The more accurately we understand postpartum psychosis, the better able we are to recognize when someone needs help, connect them with appropriate care and support families through recovery.
If You or Someone You Love Needs Support
If you or someone you love is struggling during pregnancy or the postpartum period, you do not have to figure out what is happening on your own.
For maternal mental health support, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262). The hotline is free, confidential, available 24/7, and in English and Spanish.
If you or someone you love is experiencing a mental health crisis or needs immediate support, call or text 988, the Suicide & Crisis Lifeline, or call 911 or go to the nearest emergency department.
National Crisis Text Line: Text HOME to 741741 from anywhere in the USA, anytime, about any type of crisis.
For more information and resources on Perinatal Mood and Anxiety Disorders, go to Postpartum Support International.
Research & Sources
Alford, A. Y., Riggins, A. D., Chopak-Foss, J., et al. (2025). A systematic review of postpartum psychosis resulting in infanticide: Missed opportunities in screening, diagnosis, and treatment. Archives of Women’s Mental Health, 28(2), 297–308. https://doi.org/10.1007/s00737-024-01508-3
Bergink, V., Akbarian, S., Byatt, N., et al. (2025). Postpartum psychosis and bipolar disorder: Review of neurobiology and expert consensus statement on classification. Biological Psychiatry, 99(9), 740–747. https://doi.org/10.1016/j.biopsych.2025.10.016
Jairaj, C., Seneviratne, G., Bergink, V., Sommer, I. E., & Dazzan, P. (2023). Postpartum psychosis: A proposed treatment algorithm. Journal of Psychopharmacology, 37(10), 960–970. https://doi.org/10.1177/02698811231181573
Osborne, L. M. (2018). Recognizing and managing postpartum psychosis: A clinical guide for obstetric providers. Obstetrics and Gynecology Clinics of North America, 45(3), 455–468. https://doi.org/10.1016/j.ogc.2018.04.005
Perry, A., Gordon-Smith, K., Jones, L., & Jones, I. (2021). Phenomenology, epidemiology and aetiology of postpartum psychosis: A review. Brain Sciences, 11(1), 47. https://doi.org/10.3390/brainsci11010047
Perry, A., Gordon-Smith, K., Lewis, K. J. S., et al. (2024). Perinatal sleep disruption and postpartum psychosis in bipolar disorder: Findings from the UK BDRN Pregnancy Study. Journal of Affective Disorders, 346, 21–27. https://doi.org/10.1016/j.jad.2023.11.005
Weingarten, S. J., & Osborne, L. M. (2024). Review of the assessment and management of perinatal mood and anxiety disorders. Focus, 22(1), 16–24. https://doi.org/10.1176/appi.focus.20230023
This article is for educational purposes and is not a substitute for individual medical or mental health assessment.
Jacqueline V. Cohen, LPC, ADHD-CCSP, is a licensed therapist who specializes in the intersection of perinatal mental health and adult ADHD. To learn more about her work, visit her website. You may also contact her by email.
