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ACUTE TREATMENT OF POSTPARTUM PSYCHOSIS: AN UPDATE FROM THE MASSACHUSETTS GENERAL HOSPITAL POSTPARTUM PSYCHOSIS PROJECT

Lee Cohen — Peri Barest1, Lily Cork1, Samantha Pegg2, Hannah Yoon3, Rachel Vanderkruik1, Marlene Freeman1 1Massachusetts General Hospital, Ammon-Pinizzotto Center for Women’s Mental Health, 2Massachusetts General Hospital, Dauten Family Center for Bipolar Treatment Innovation, 3Lewis Katz School of Medicine, Temple University

2026 ASCP Annual Meeting

Objective

Postpartum psychosis (PP) is among the most severe perinatal psychiatric illnesses and has significant effects on pregnant women and their families. There are effective, evidence-based treatments, particularly psychopharmacologic treatments. However, it is unclear how evidence-based psychopharmacologic interventions are applied in real-world clinical practice. The present study examined psychiatric interventions received by patients via selfreport from the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3), an international cohort of over 450 participants, for both the acute treatment period 3 months postepisode and subsequent treatment across the 2-year postpartum period, including pharmacologic methods, variation by diagnosis, and duration of treatment.

Methods

Data are retrospectively collected from women who experienced PP within 6 months of delivery within the past 10 years from the time of interview. Subjects report data during a onetime structured clinical interview administered by phone, which includes the Mini International Neuropsychiatric Interview for Psychotic Disorders Studies, the MGHP3© Questionnaire, assessment of treatment received, and other relevant history. Descriptive statistics were conducted to report on clinical characteristics and treatment received.

Results

As of February 4, 2025, 453 participants were enrolled in MGHP3. N=346 participants were included in this analysis, after excluding individuals who withdrew, were lost to follow-up, or who had missing treatment responses. Most participants received treatment with psychiatric medications, including the frequent use of atypical antipsychotics (83.4%) and SSRIs (49.2%). Lithium (25.1%), lamotrigine (12.4%), and valproic acid (7.8%) were the most commonly used non-antipsychotic mood stabilizers. Most participants reported taking psychiatric medications for at least 1 year postpartum, and many discontinued psychiatric medications within 2 years after childbirth. Inpatient hospitalization and psychotherapy were also commonly utilized.

Conclusions

Findings highlight variable use of evidence-based care for PP in community settings and a need for closer alignment with the most strongly supported evidence-based treatments. Concerning findings include the variable rates of hospitalization, the underutilization of lithium treatment, the most researched efficacious medication for PP, and the use of valproic acid in this population despite its known risk of teratogenicity and recommendations to avoid in reproductive-aged women. Additional research is needed to assess the prospective treatment of PP, the real-world effectiveness of commonly utilized medications, and associated adherence and tolerability. The understanding of barriers to evidence-based psychopharmacologic therapy is a major priority for the field.