Originally published by A Voice For Choice Advocacy on October 15, 2026.

EDITOR’S SUMMARY: The weeks following childbirth bring profound physical and emotional changes. For a small number of mothers, they also bring a sudden break from reality. Postpartum psychosis is a rare psychiatric emergency that can be mistaken for postpartum depression, yet the widely used Edinburgh Postnatal Depression Scale was designed to screen for depression, not psychosis. Researchers are still investigating why some women are particularly vulnerable during this period. Because a mother experiencing psychosis may not recognize the change, the people around her, from partners to pediatricians, are frequently the first to see it. Treatment is urgent and often means a hospital stay. Food, sunlight and movement can help rebuild strength alongside it.

In the hours following childbirth, a woman’s body begins a transformation unlike anything it has experienced before. The placenta, which has sustained the pregnancy for months, is delivered. Hormone levels that rose steadily to support the growing baby begin to fall rapidly. The immune system, which spent nine months adapting to the presence of a genetically distinct fetus, starts shifting again. Sleep becomes fragmented. The body’s stress-response system recalibrates. And somewhere in the middle of all of this, a mother is expected to recover from childbirth while learning how to keep a newborn alive.

For most women, these changes unfold without becoming a lasting psychological illness. But in other cases, the transition into motherhood triggers a downward spiral: persistent sadness, emotional numbness or a feeling of being disconnected from a baby they expected to love immediately. What looks from the outside like a difficult adjustment can reflect a much deeper disruption occurring within the brain and body.

Maternal mental health disorders are among the most common complications associated with pregnancy and childbirth, affecting as many as one in five new mothers. Over the last decade, there has been an almost 65% jump in mothers who reported their mental well-being as fair to poor. Yet a mood disorder can be difficult to recognize during a period when almost everything about a woman’s life has changed at once. You may be healing from a vaginal delivery or C-section, waking repeatedly through the night, recovering from blood loss and trying to meet the demands of a baby who cannot yet communicate what it needs. For many mothers, breastfeeding can add another layer of stress. Up to 40% experience breastfeeding difficulties, including an improper latch, cracked nipples, engorgement and other physical challenges. When breastfeeding does not go as planned, the emotional impact can be significant. And nearly 60% of women are unable to meet their personal breastfeeding goals.

When you struggle under those conditions, you may interpret your symptoms as a personal failure rather than a medical problem. You may be afraid to tell someone you’re having frightening thoughts, worried that people will think you’re a bad mother, or simply assume that exhaustion is part of the job. But postpartum mental illness is not a reflection of how much you love your baby or how well you’re coping. Even when pregnancy and delivery go smoothly, the biological and psychological changes surrounding childbirth can affect mental health. They can contribute to depression or anxiety, or they can precipitate a far more serious psychiatric condition.

When Postpartum Distress Becomes Something More

Postpartum depression (PPD) is one such condition. Symptoms can develop gradually and may appear weeks or even months after delivery. You may cry frequently, lose interest in activities you once enjoyed, feel worthless or inadequate, experience intense irritability or rage, withdraw from loved ones or struggle to connect emotionally with your baby. Appetite can change, and some women experience physical symptoms such as headaches, stomach problems or muscle pain.

Postpartum anxiety can occur alongside depression or on its own. You may feel constantly on edge, worry excessively about your baby’s health or safety, have difficulty relaxing even when the baby is asleep, or become so focused on a particular task or fear that you lose track of everything around you. Postpartum obsessive-compulsive symptoms can also involve frightening, intrusive thoughts that are deeply distressing. These conditions warrant medical attention, yet up to 50% of women with postpartum depression go undiagnosed and untreated. Equally important is recognizing a separate, rarer psychiatric emergency that can emerge after childbirth: postpartum psychosis (PPP).

It can develop suddenly, most often within the first two weeks after childbirth, and may involve mania (an unusually elevated or irritable mood, increased energy and activity, and a reduced need for sleep), severe insomnia, confusion, paranoia, delusions, agitation, disorganized behavior—action that lacks a clear goal or logical pattern—or a profound loss of contact with reality. The early signs aren’t always dramatic. You may become unusually energetic, intensely irritable, talk much more than normal or behave in ways that are completely out of character. Your thoughts may begin racing. As the illness progresses, you may become confused or disoriented, hear or see things others don’t, or become convinced that people around you are trying to cause harm.

Sarah, an elementary school teacher trained in Mental Health First Aid, recognized the signs of postpartum psychosis in herself just seven days after giving birth. Believing she could manage the illness on her own, she gathered her educational credentials and highlighted information about psychosis in her training manual to show her family that she understood what was happening. The following morning, she became profoundly confused, convinced she had died and gone to heaven and asking, “Did we have a miscarriage?”

A close link to bipolar disorder helps explain why some women are especially vulnerable. According to a review published in the Journal of Women’s Health, 72% to 88% of women who develop postpartum psychosis immediately after childbirth have bipolar illness or schizoaffective disorder. PPP affects approximately one to two women per 1,000 births. The strongest known risk factors are bipolar disorder and a previous occurrence of PPP. Yet about half of women experiencing a first episode of psychosis have no previous psychiatric diagnosis. At the same time, researchers increasingly acknowledge PPP as a distinct postpartum syndrome, with its own timing, biological features and clinical presentation.

Given this close association with bipolar-spectrum disorders, an international expert consensus recommends placing PPP within the bipolar disorders chapter of the Diagnostic and Statistical Manual of Mental Disorders, although it still has no standalone classification. Clinicians may instead diagnose a woman with a condition such as brief psychotic disorder. Limited coverage in medical textbooks may also mean that some clinicians receive little training on PPP and may not know to look for it.

Understanding this connection is important because PPP can require a different treatment approach than depression. Still, misdiagnosis is common, and in some cases PPP is not even considered until multiple antidepressant trials fail to produce meaningful improvement. In women with underlying bipolar disorder, antidepressants alone can sometimes trigger or worsen mania or severe mood instability.

This concern extends to women with first-onset postpartum depression who may not yet have a bipolar diagnosis. A case report involving three women, “A cautionary note on the use of antidepressants in postpartum depression,” published in Bipolar Disorders, advises clinicians to be careful when prescribing antidepressants for first-onset PPD in women with a family history of bipolar disorder, because depression may sometimes be the first visible sign of an underlying bipolar-spectrum illness.

What May Be Happening in the Brain and Body

Researchers believe PPP results from multiple interacting vulnerabilities rather than a single hormonal imbalance. During pregnancy, estrogen and progesterone rise to extraordinarily high levels, then fall rapidly after delivery. Severe sleep loss on top of that can accelerate mania in people vulnerable to bipolar illness. Childbirth also brings inflammatory and immune changes associated with tissue healing and recovery. Studies have identified changes in tryptophan metabolism during the postpartum period, including differences in women experiencing postpartum psychosis or severe depression. Tryptophan is an amino acid used to produce serotonin, a neurotransmitter involved in mood regulation.

Scientists are also investigating the body’s stress-response system, including the hypothalamic-pituitary-adrenal axis. Early findings suggest that changes in stress-hormone regulation and immune activity may contribute to PPP in susceptible women, although the precise relationship remains uncertain.

One of the most promising areas of postpartum mental health research involves neuroactive steroids, natural or synthetic compounds that rapidly change how brain cells communicate. Progesterone is converted into several of them, including allopregnanolone, which acts on gamma-aminobutyric acid type A (GABA-A) receptors. During pregnancy, the body gradually adapts to higher levels of neuroactive steroids. Then, after delivery, progesterone and allopregnanolone levels drop sharply. Researchers have proposed that this abrupt neurochemical transition may be particularly difficult for some women to navigate. This may help explain why certain postpartum mood disorders emerge so quickly after childbirth.

Brexanolone, a medication chemically identical to allopregnanolone, targets this pathway directly. A small, uncontrolled pilot study, “Open-label study of the efficacy, safety and tolerability of Brexanolone in the treatment of adult women with postpartum psychosis,” published in General Hospital Psychiatry, gave 10 women with PPP a continuous 60-hour IV infusion of brexanolone. They saw reductions in psychotic, manic and depressive symptoms within days.

Why Postpartum Psychosis Gets Missed

One of the challenges of postpartum mental health care is that the most commonly used screening tools are not designed to identify PPP. The Edinburgh Postnatal Depression Scale, for example, is widely used to screen for depression and anxiety during pregnancy and after birth. It can help identify women who need a more comprehensive evaluation, but it is not a diagnostic test and is not designed to identify psychosis. The 10-item questionnaire also relies on honest self-reporting. That can be a problem when a mother is frightened by her own thoughts or worried that telling someone the truth will make her appear to be a bad parent. Symptoms can change rapidly, and a single screening with one clinician may miss depression, mania or psychosis that develops weeks or months later.

Similarly, the Mood Disorder Questionnaire can help clinicians identify a history suggestive of bipolar disorder, but it is not a psychosis screening tool. It focuses on symptoms such as racing thoughts and hyperactive behavior rather than delusions or hallucinations. This means a woman with emerging PPP may pass through several points of the medical system without anyone asking the questions that would reveal what is actually happening. Screening tools are valuable, but they are only one part of care: a positive screen needs follow-up, and a negative screen does not necessarily mean that a woman is safe, particularly when symptoms are changing rapidly or involve mania, psychosis or a loss of insight.

As one maternal mental health expert, Robert Trestman, MD, PhD, put it, “Screening, even when conducted, is still not treatment.” He notes that fewer than one in four positive screens lead to treatment. Barriers include limited clinician training, insurance gaps, inadequate referral networks and fragmentation between psychiatric and obstetric care. Fear of losing custody, stigma and concerns about medication can create additional barriers, leaving some women without the attention they need.

Because symptoms such as hallucinations, delusions or severe confusion can impair your ability to recognize that your thoughts or perceptions have changed, another person’s observation can be one of the most important tools for recognizing PPP. Marium’s story demonstrates why. A medical student who had previously recognized postpartum psychosis in someone else, she developed the illness herself after giving birth. Nine days after delivery, she began speaking rapidly and failed to recognize her own baby. By the following day, she was critically ill. “Nobody understood at first when I suddenly started speaking in a rush,” she recalls. A psychiatrist eventually realized what was happening, and with treatment and substantial support from her husband and in-laws, she recovered.

Postpartum psychiatric assessment should not always rely on what the mother is able—or willing—to report. A simple question to family members such as “Is this how she normally behaves?” can sometimes reveal much more than a checklist. Instead of asking mothers, “How are you feeling?” clinicians may need to ask, “What have the people around you noticed?” The American College of Obstetricians and Gynecologists encourages patients’ support systems to contact a medical practice when they have concerns. When PPP is suspected, a sudden change in behavior or thinking should prompt immediate professional evaluation.

Pediatric visits offer another chance to notice changes. New parents often see their pediatrician far more often than their own doctors—up to eight times during their baby’s first year, which puts pediatricians in a position to notice maternal exhaustion, changes in bonding or other concerning symptoms. Yet a 2019 survey of American Academy of Pediatrics members found that only about half of pediatricians (53.9%) conduct formal screening for maternal depression.

The case of Lindsay Clancy illustrates the stakes. Clancy, a labor and delivery nurse, saw multiple health care professionals and received psychiatric treatment in the period before her three children died in January 2023 and she attempted suicide. She is charged with murder and pleaded not guilty. Her defense argues she was experiencing postpartum psychosis and did not know what she was doing was wrong, while prosecutors say she knew. Her trial ended in a mistrial in September 2026 when jurors could not agree on whether she was criminally responsible. A judge subsequently denied a defense request for acquittal, while the question of a retrial remains unresolved. Another hearing is scheduled for November 2. Psychiatrist Veerle Bergink, an expert in PPP who was not involved in Clancy’s care or trial, told NPR the case fits a familiar pattern of postpartum psychosis going undiagnosed and untreated. Whatever the outcome of her case, it has focused attention on how easily warning signs can go unconnected.

Other women’s experiences show how easily the pieces can remain disconnected. Meghan Cliffel developed postpartum psychosis about eight months after the birth of her second child. What initially felt like simply “not feeling like herself” after returning to work rapidly progressed into paranoia, hallucinations and a profound break from reality. Her husband spotted the dramatic change and called 911, leading to a psychiatric hospitalization. Yet Cliffel says she was not told that she had experienced PPP until about two months later, when she sought out a reproductive psychiatrist herself.

Haley Ashcom’s story followed a different path. After giving birth to her first child, she initially struggled with insomnia and anxiety and was diagnosed with postpartum depression. She later describes what she believes were intrusive thoughts turning into voices that grew increasingly disturbing and violent. She sought hospital care, but her symptoms continued until she admitted herself to a psychiatric hospital, where she was diagnosed with postpartum psychosis.

These stories show how a rapidly changing illness can be difficult to recognize when symptoms initially resemble more familiar postpartum problems. Initiatives like Massachusetts’ Child Psychiatry Access Program for Moms offer a model for what more collaborative care could look like. The statewide program gives obstetricians, pediatricians, primary-care clinicians and other frontline providers free, real-time access to psychiatric consultation, care coordination and referrals for pregnant and postpartum patients with complex mental health needs. Providers can call for help navigating treatment, finding specialized care or responding to a patient experiencing severe psychiatric symptoms, including psychosis. And the model is spreading. Perinatal psychiatry access programs are present in more than half of U.S. states and aim to close the gap that can leave mothers without appropriate care.

Mental illness does not always fit neatly into one appointment, one specialty or one diagnosis. When providers can communicate and connect the dots, warning signs are less likely to slip through the cracks. According to 2022 data from the Centers for Disease Control and Prevention, mental health conditions accounted for 27.7% of pregnancy-related deaths with known causes, and 85.7% of pregnancy-related deaths with a preventability determination were considered preventable. Better systems of recognition, coordination and prompt intervention can save lives.

Treating Postpartum Psychosis

Once PPP is recognized, treatment needs to move quickly. It requires more than a prescription and sending you home. PPP is a psychiatric emergency, and women experiencing it generally require immediate assessment and, often, hospitalization in a setting where both mother and baby can be kept safe.

A Mother and Baby Unit (MBU) is a dedicated inpatient facility that allows mothers to stay with their babies while they receive psychiatric treatment. While this model of care is standard in countries such as the United Kingdom, it remains extremely rare in the United States. Maintaining the mother-baby bond can make a huge difference. In a 2010 survey of women with PPP conducted by the UK charity Action on Postpartum Psychosis, 70% of those treated in MBUs said they felt fully recovered after 12 months, versus 40% in the comparison group. The charity also cites UK maternal death enquiries showing fewer suicides among women admitted to MBUs than to general psychiatric wards. By contrast, it says, separation from their babies on general wards can be traumatic and may make mothers unwilling to return for care. A 2022 UK paper, “Effectiveness and Cost-Effectiveness of Psychiatric Mother and Baby Units: Quasi-Experimental Study,” found women were more satisfied with MBU care than with other acute care, though it found no significant difference in readmission within a year.

Treatment for PPP typically involves antipsychotic medication, with mood stabilizers such as lithium playing an important role, particularly when bipolar-spectrum illness is suspected. Benzodiazepines may also be used short-term to manage severe agitation, anxiety or insomnia. The goal is not simply to suppress symptoms but to prevent a dangerous escalation of the illness by restoring sleep and stabilizing mood and thinking.

These medications can be lifesaving, but their use also requires careful attention to side effects, drug interactions and the risks of combining treatments. Antipsychotics can cause sedation, weight gain, metabolic changes and movement-related problems. Lithium has a narrow range between therapeutic and toxic blood levels, requiring regular monitoring of lithium levels, kidney function and thyroid function. Dehydration and certain medications can increase the risk of lithium toxicity. Benzodiazepines may cause excessive sedation and, with prolonged use, physical dependence. Because some psychiatric medications also pass into breast milk, treatment decisions may require additional consideration of infant exposure and monitoring. These risks highlight the importance of individualized care, ongoing assessment and adjusting treatment as needed, rather than assuming that more medication necessarily means better care.

The urgency of that stabilization becomes clearer when you consider what severe psychosis can feel like from the inside. Kay, a survivor whose postpartum illness included psychosis and severe suicidal thoughts, describes feeling as though “there were dozens of voices in my head talking to me and shouting at me constantly,” telling her to harm herself and warning her about perceived threats. At one point, she bargained with the voices, promising to wait until after a planned family vacation to Disney World. After returning home, her condition deteriorated further. She thought the television was talking to her and felt terrified of ordinary sounds and people. Kay was eventually hospitalized.

Kay ultimately left her teaching job because she no longer felt safe caring for a classroom of children. “I was somehow able to function at school to a good degree,” she recalls. “I never entertained thoughts of harming any of my students, and I loved them all very much.” Kay’s story shows how someone experiencing psychosis may continue functioning in some areas while becoming increasingly disconnected from reality in others.

Sleep deserves particular attention because it can be both an early warning sign and a significant aggravator of mania and PPP. During an acute episode, protecting a mother’s ability to get sustained, restorative sleep should be part of treatment rather than an optional lifestyle recommendation. For women who do not respond adequately to medication, or whose condition requires a rapid response, electroconvulsive therapy (ECT) can be vital. ECT can produce rapid improvement in severe mood episodes and psychosis and is particularly useful when symptoms are critical, medications have not worked or waiting weeks for a response is not safe.

What a mother needs in this moment is compassion, not judgment, alongside prompt medical care. Throughout treatment, a supportive and involved family can be lifesaving. Family members may help ensure the immediate physical safety of both the newborn and the mother, coordinate medical appointments, support treatment adherence and manage daily needs. Postpartum psychosis is frightening, but it is an illness—not a failure of motherhood. The most revealing warning sign may be the simplest one: you suddenly don’t seem like yourself.

Supporting Postpartum Brain Health

When it comes to mental health, nutrition is an essential part of the picture, yet one that can easily be overlooked during the postpartum period. Pregnancy and breastfeeding place substantial nutritional demands on the body, while sleep deprivation, a disrupted appetite and the demands of caring for a newborn can make it difficult to eat consistently. Research has linked deficiencies in vitamin D, iron, folate and zinc, along with low intake of carbohydrates and vegetables, to PPD. While most of the research on nutrition and postpartum mental health focuses on depression rather than psychosis, addressing nutritional deficiencies can still be an important part of supporting overall recovery alongside psychiatric treatment.

Vitamin D is particularly crucial because it plays a role in immune function, inflammation and brain health. It is involved not only in calcium regulation but also in neuropsychiatric regulation, including serotonin production and inflammatory pathways. Some studies have found an association between low vitamin D levels and PPD, although supplementation appears to be most helpful when someone is actually deficient. If you’re concerned about your vitamin D status, a blood test can help determine whether supplementation is appropriate.

Getting regular, adequate sun on your skin is one of the best ways to support vitamin D production. But sunlight does more than help your body make vitamin D. Natural light entering the eyes helps regulate the brain’s circadian clock, influencing the release of hormones and neurotransmitters involved in mood, alertness and sleep. Daytime light also suppresses melatonin production, helping anchor your sleep-wake cycle. Some research has found that ultraviolet and certain visible wavelengths of light can influence the release of beta-endorphins—natural, opioid-like hormones that elevate mood and relieve pain.

Omega-3 fatty acids are another important consideration. Fatty fish such as wild salmon provide eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), while plant foods such as flaxseeds and walnuts provide another type of omega-3 called alpha-linolenic acid (ALA). EPA and DHA have been studied more extensively than ALA for their potential effects on mood and mental health, although findings on their therapeutic benefits remain mixed.

These fatty acids play important roles in brain and retinal health and in cellular signaling, including pathways involving serotonin. During pregnancy, maternal levels of these fatty acids can decline as the developing baby draws on them for growth. Some studies suggest that omega-3 supplementation may help reduce depressive symptoms in certain women. If you eat fish regularly, choosing lower-mercury options such as salmon, sardines and trout can provide omega-3s while limiting mercury exposure.

Folate (vitamin B9) also deserves attention, as a severe deficiency can contribute to neurological and psychiatric symptoms. It plays a role in producing several neurotransmitters—serotonin, dopamine and norepinephrine—all of which are essential for normal neurologic function and mood regulation. Correcting a true deficiency is important, but extra folate isn’t necessarily beneficial. It also helps to distinguish between naturally occurring folate in food and supplemental forms such as methylfolate, an isolated, concentrated form used in some prenatal and nutritional supplements. While supplemental methylfolate may be appropriate in certain circumstances, an MTHFR gene variation alone does not necessarily mean it is needed. If you’re experiencing anxiety, insomnia or mood changes, you should discuss your regimen with a professional rather than increase your dose on your own, especially if an underlying bipolar-spectrum condition may not have been recognized.

Zinc is highly concentrated in the brain and plays a key role in neurotransmitter regulation, immune health and inflammation. Levels can naturally decline during pregnancy, and several studies have shown that lower maternal zinc levels during the prenatal and postpartum period are associated with a greater likelihood of depressive symptoms. Oysters are by far the richest food source of zinc, and they are safe to eat after birth when fully cooked. If oysters aren’t on your menu, pumpkin seeds, beef, cheese and other zinc-rich foods can help replenish your supply.

Vitamin B12 is another nutrient vital for brain and nervous-system function. Research has found associations between low B12 levels and depressive symptoms, while severe deficiency can directly alter your mental state and cause cognitive changes, paranoia and other psychiatric symptoms that may resemble or worsen other mental health conditions. Because the deficiency is a potentially reversible contributor to neuropsychiatric symptoms, clinicians may consider checking B12 and other nutritional or metabolic factors when evaluating someone with new symptoms, including psychosis. Foods such as beef liver, fortified nutritional yeast, eggs and yogurt can help provide the B12 your body needs.

Like folate, iron plays an important role in brain function and is involved in the production of dopamine, serotonin and norepinephrine. When iron shortage progresses to anemia, reduced oxygen delivery to the body’s tissues can contribute to fatigue, difficulty concentrating and cognitive changes. Iron deficiency has also been associated with mood and psychiatric symptoms, some of which may improve when an underlying deficiency is corrected. If you’re experiencing significant fatigue or mood symptoms during the postpartum period, checking your iron status can help identify a potentially treatable contributor. For rich food sources, try red meat, lentils, spinach or tofu.

Vitamin A plays a role in brain development and neuronal function, with research suggesting it also influences learning, memory and the growth of new neurons. Its link to psychosis is less clear, and more is not necessarily better. Preformed vitamin A, found in supplements and animal foods such as liver, fish and eggs, can build up in the body, and excessive intake can cause toxicity. High doses during pregnancy can also increase the risk of birth defects. Foods such as carrots, sweet potatoes and spinach provide beta-carotene, which the body converts to vitamin A as needed. Beta-carotene is generally considered much less likely to cause toxicity.

An emerging area of research is metabolic psychiatry: the idea that changes in the body’s metabolism may influence brain function and psychiatric symptoms. A 2026 case report describes a 22-year-old woman who developed postpartum mania, hallucinations, delusions and severely reduced sleep. She achieved remission after receiving standard psychiatric medications, including lithium, olanzapine and a benzodiazepine, alongside a strict ketogenic diet. This eating pattern is high in fat and very low in carbohydrates, causing the body to produce ketones for energy. Because several treatments were used simultaneously in a single patient, the report cannot establish to what extent the diet contributed to her recovery. At Stanford Medicine, researchers are investigating whether ketogenic metabolic therapy may benefit conditions such as bipolar disorder and schizophrenia. As they explain:

“Ketogenic therapy significantly reduces inflammation in the brain—which is strongly associated with depression, anxiety, schizophrenia and bipolar disorder—by regulating immune signaling and reducing oxidative stress, among other probable mechanisms.”

Beyond individual nutrients, the overall quality and consistency of your diet matter. High-fiber foods foster a diverse gut microbiome, and research has increasingly found that the gut and brain communicate through pathways that influence mood and stress responses. Foods such as quinoa, rolled oats, leafy greens, nuts, seeds, avocado, broccoli and colorful peppers provide fiber along with vitamins and minerals such as B vitamins and magnesium that support overall brain and nervous-system function. During the postpartum period, simply making regular meals a priority can be valuable when exhaustion and the demands of caring for a newborn make eating easy to neglect.

The opposite dietary pattern deserves attention, too. Diets high in ultra-processed foods, added sugars and sugar-sweetened beverages have been associated with a greater risk of depression in observational research. That doesn’t mean that eating sugar causes PPD, but consistently replacing nutrient-dense foods with highly processed snacks can make it harder to meet your body’s nutritional needs. Extreme blood sugar imbalances, which are linked to diabetes, can trigger confusion, delirium or even psychotic features. Medical studies show that correcting glucose levels often resolves these episodes. Building meals around protein, healthy fats, fiber-rich carbohydrates, fruits and vegetables can provide more consistent energy and a broader range of nutrients during a physically demanding time.

While moderate caffeine intake is generally considered compatible with pregnancy and breastfeeding, it can interfere with sleep and may worsen anxiety, agitation or racing thoughts. These effects can be particularly concerning for someone who is vulnerable to mania or psychosis. Caffeine can also affect lithium levels, so people taking lithium should discuss significant changes in caffeine consumption with their clinician. Heavy use of highly caffeinated or stimulant-containing drinks is best avoided.

Movement is another part of postpartum recovery that can reinforce both physical and mental health. Regular physical activity is associated with a lower risk of PPD and can support mood, sleep and overall well-being. A 2025 systematic review and meta-analysis, “Impact of Postpartum Physical Activity on Maternal Depression and Anxiety,” published in the British Journal of Sports Medicine, found that as little as 80 minutes of moderate-intensity exercise per week was associated with “moderate reductions in severity of postpartum depressive symptoms.” The researchers also found a dose-response relationship: “greater exercise volume was associated with a greater reduction in the severity of depressive symptoms.” Exercise doesn’t have to mean going to a gym or following a structured workout. Even a daily walk, gentle stretching or dancing at home can be a practical way to build movement into your day.

One mother, Alexandra, described PPD as a daily fight for survival. She was surprised when her mental health specialist said that exercise was “non-negotiable,” along with sleep and social support. After just one week of a 30-minute walk with her baby after lunch each day, Alexandra began to notice a difference:

“Maybe it was the fresh air, maybe it was the people that nodded hello, maybe it was the time to myself to think without looking around and seeing energy-sapping piles of laundry and dusty furniture. Whatever the reason, I began to look forward to my daily walk. Before the month was out, I had increased my walks from 30 minutes to an hour. I felt good and I felt something new: hope.”

If you are concerned for yourself or someone you love, contact your doctor or a mental health professional, or seek emergency psychiatric care. You can also call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for free support any time, every day. If there is an immediate risk of harm to you or your baby, call 911 or go to the nearest emergency department. For mental health crisis support, call or text 988.

Professional treatment is essential, but recovery also involves supporting your body through an extraordinary physiological transition. Protecting uninterrupted sleep, reducing overwhelming demands, eating regular, nourishing meals, engaging in gentle movement and staying connected to supportive people can become part of the broader foundation of recovery. These measures are not substitutes for psychiatric treatment, but they can support wellness alongside it. You don’t have to carry this alone. Know the signs. Trust the changes you notice. Speak up early. And when postpartum psychosis is suspected, treat it as the emergency it is.

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