280: Postpartum Psychosis: Diagnosis, Treatment, Lithium, and Relapse Prevention with Dr. Veerle Bergink
September 18, 2026
AI Summary
5 min readA Treatable Emergency: What Clinicians and Patients Need to Know About Postpartum Psychosis
Postpartum psychosis is a severe psychiatric emergency that strikes in the first days after childbirth, yet it carries a strikingly good prognosis when recognized and treated correctly. Dr. Veerle Bergink, director of Mount Sinai's Women's Mental Health Center and lead investigator of the world's largest prospective cohort of first-onset postpartum psychosis, has spent two decades studying this condition. Her message is both urgent and hopeful: with timely intervention, approximately 98% of women achieve full remission—a recovery rate that includes not only the absence of psychotic and manic symptoms but also the resolution of depression. The challenge lies in diagnosis, rapid treatment, and above all, prevention of relapse.
The Clinical Picture and First Steps
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What you'll learn
- 1 (01:05) **Case Presentation: First-Onset Postpartum Psychosis** - Dr. Puder presents a detailed case of a woman with no psychiatric history who develops escalating symptoms from day 0 to day 7 postpartum, culminating in psychosis and hospitalization.
- 2 (03:13) **Initial Assessment & Triage by Dr. Bergink** - Dr. Bergink outlines her immediate approach: a very brief patient interview, then focused time with the patient and husband to explain the diagnosis, prognosis, and need for admission.
- 3 (06:37) **Neurological Soft Signs & Autoimmune Encephalitis** - The case is modified: the patient develops rigidity, tremor, and bradykinesia after starting an antipsychotic.
- 4 (08:59) **The Postpartum Immune System as a Key Biological Clue** - Dr. Bergink explains the immune system's role: pregnancy suppresses adaptive immunity to prevent rejection of the fetus, and the postpartum period is a time of intense immune reactivation.
- 5 (11:27) **Lithium Use with Autoimmune Thyroiditis** - The case is modified again: the patient has autoimmune thyroid disease. Dr. Bergink is asked if this makes her hesitant to use lithium.
- 6 (13:34) **Excellent Prognosis for Treated Postpartum Psychosis** - Dr. Bergink delivers a strongly optimistic message: both postpartum psychosis and depression are highly treatable.
- 7 (15:22) **Postpartum-Only Illness vs. Lifelong Bipolar Disorder** - Dr. Bergink discusses the long-term prognosis: more than half of women with a first-onset postpartum psychosis will not have a recurrence outside of another pregnancy.
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Show Notes
In this essential episode of the Psychiatry & Psychotherapy Podcast, Dr. David Puder sits down with internationally renowned expert Dr. Veerle Bergink, Director of Mount Sinai's Women's Mental Health Center, for an in-depth discussion of postpartum psychosis. Covering early warning signs and symptoms, differential diagnosis including anti-NMDA receptor encephalitis and thyroid issues, a highly effective acute treatment algorithm using benzodiazepines, antipsychotics, and lithium, the remarkable 98% remission rates with proper care, lithium's superior role in preventing relapse during the first postpartum year, the simple but powerful prophylaxis strategy of "baby out, lithium in" for high-risk women with bipolar disorder or prior episodes, the urgent need for mother-baby psychiatric units in the U.S., and the ongoing push to formally classify postpartum psychosis in the DSM.
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