Postpartum psychosis

Symptoms of postpartum psychosis

Symptoms usually start suddenly within the first two weeks after giving birth. More rarely, they can develop several weeks after the baby is born.

Symptoms can include:

• hallucinations
• delusions – thoughts or beliefs that are unlikely to be true
• a manic mood – talking and thinking too much or too quickly, feeling "high" or "on top of the world"
• a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping
• loss of inhibitions
• feeling suspicious or fearful
• restlessness
• feeling very confused
• behaving in a way that's out of character 

When to get medical help

Postpartum psychosis is a serious mental illness that should be treated as a medical emergency. If not treated immediately, you can get rapidly worse and could neglect or harm your baby or yourself.

See a GP immediately if you think you, or someone you know, may have developed symptoms of postpartum psychosis.

You can call 111 if you can't speak to a GP or don't know what to do next.

Or call your crisis team if you already have a care plan because you've been assessed as being high risk.

Go to A&E or call 999 if you think you, or someone you know, may be in danger of imminent harm.

Be aware that if you have postpartum psychosis, you may not realise you're ill. Your partner, family or friends may spot the signs and have to take action.

Treating postpartum psychosis

Most women need to be treated in hospital. Ideally, this would be with your baby in a specialist psychiatric unit called a mother and baby unit (MBU). But you may be admitted to a general psychiatric ward until an MBU is available.

Medication

You may be prescribed one or more of the following:

• antidepressants – to help ease systems of depression
• antipsychotics – to help with manic and psychotic symptoms, such as delusions or hallucinations 
• mood stabilisers (for example, lithium) – to stabilise your mood and prevent symptoms recurring 

Psychological therapy

As you move forward with your recovery, your GP may refer you to a therapist for cognitive behavioural therapy (CBT). CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.

Electroconvulsive therapy (ECT)

ECT is used only very rarely. You may have this therapy if your symptoms are particularly severe – for example, if you have severe depression or mania.

Most women with postpartum psychosis make a full recovery as long as they receive the right treatment.

Causes

We're not really sure what causes postpartum psychosis, but you're more at risk if you:

• have a family history of mental health illness, particularly postpartum psychosis (even if you have no history of mental illness)
• already have a diagnosis of bipolar disorder or schizophrenia
• you have a traumatic birth or pregnancy
• you developed postpartum psychosis after a previous pregnancy

Reducing the risk of postpartum psychosis

If you're at high risk of developing postpartum psychosis, you should have specialist care during pregnancy and be seen by a psychiatrist.

You should have a pre-birth planning meeting at around 32 weeks of pregnancy with everyone involved in your care. This includes your partner, family or friends, mental health professionals, your midwife, obstetrician, health visitor and GP. 

This is to make sure that everyone is aware of your risk of postpartum psychosis. You should all agree on a plan for your care during pregnancy and after you've given birth.

You'll get a written copy of your care plan explaining how you and your family can get help quickly if you become ill. 

In the first few weeks after your baby is born, you should have regular home visits from a midwife, health visitor and mental health nurse.

Recovering from postpartum psychosis

The most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to recover from the condition. But with treatment, most women with postpartum psychosis do make a full recovery.

An episode of postpartum psychosis is sometimes followed by a period of depression, anxiety and low confidence. It might take a while for you to come to terms with what happened. 

Some mothers have difficulty bonding with their baby after an episode of postpartum psychosis, or feel some sadness at missing out on time with their baby. With support from your partner, family, friends and the mental health team, you can overcome these feelings.

Many women who've had postpartum psychosis go on to have more children. About half of women will have another episode after a future pregnancy. But you should be able to get help quickly with the right care.

Support for postpartum psychosis

Postpartum psychosis can have a big impact on your life, but support is available.

It might help to speak to others who've had the same condition, or connect with a charity.

You may find the following links useful:

• Action on Postpartum Psychosis (APP) and APP forum
• Association for Post Natal Illness
• Mind: what is postpartum psychosis?
• PANDAS Foundation UK
• Royal College of Psychiatrists: postpartum psychosis

Supporting people with their recovery

People with postpartum psychosis will need support to help them with their recovery.

You can help your partner, relative or friend by:

• being calm and supportive
• taking time to listen
• helping with housework and cooking
• helping with childcare and night-time feeds
• letting them get as much sleep as possible
• helping with shopping and household chores
• keeping the home as calm and quiet as possible
• not having too many visitors

Support for partners, relatives and friends

Postpartum psychosis can be distressing for partners, relatives and friends, too. 

If your partner, relative or friend is going through an episode of postpartum psychosis or recovering, don't be afraid to get help yourself.

Talk to a mental health professional or approach one of the charities listed.