Postnatal psychosis

Postnatal psychosis (also known as postpartum or puerperal psychosis) is a rare mental health condition that affects a small number of women (one or two in every 1,000 mothers) in the first days or weeks after childbirth.

Postnatal psychosis is very serious as the mother may be at risk of harming herself or others, including her baby or other children. Recognising symptoms and seeking urgent professional assistance is essential.

If you’re experiencing postnatal psychosis, the earlier you’re diagnosed, the sooner you’ll able to get the right treatment and improve your mental health and wellbeing.

What causes postnatal psychosis?

While we don’t know exactly what causes postnatal psychosis, we do know that women with a history of bipolar disorder or who have experienced postnatal psychosis after previous births are at greater risk. In some cases, postnatal psychosis is the first episode of bipolar disorder, or less commonly, another psychotic condition.

My partner seemed fine for the first week after the birth, she was rushing around like a tornado and I thought she was happy and doing well. But when the rushing didn’t stop, not even for sleep, and she began to seem confused, I knew it was time to get some help.

Symptoms of postnatal psychosis

Postnatal psychosis causes marked changes in your moods, thoughts, perceptions and behaviour. Symptoms usually start within 48 hours to two weeks after giving birth, but may develop up to 12 weeks after the birth. They can be extremely distressing for both the woman and her family.

Early changes in usual behaviour include:

  • finding it hard to sleep
  • feeling full of energy or restless and irritable
  • feeling strong, powerful, unbeatable
  • having strange beliefs (e.g. people are trying to harm the baby).

This may be followed by a combination of manic or depressive symptoms including:

  • manic symptoms: these may include having lots of energy, hearing voices or seeing things that aren't there (hallucinations), believing things that are not based on reality (delusions), talking quickly, having difficulty concentrating.
  • depressed symptoms: these may include low energy, not sleeping or eating, having thoughts of self-harm or harming the baby, feeling hopeless or helpless as a mother).


Information for family and friends

If you’ve noticed worrying changes in your partner or someone close to you, keep an eye on their behaviour – you may need to help them seek support.

Things to look out for include confusion and forgetfulness, changing moods in a short space of time and having difficulty concentrating. If your loved one is experiencing postnatal psychosis, she may get confused about what’s real and what she’s imagining. This is a frightening experience, and can put her at risk of harming herself or the baby.

Treatment options

As postnatal psychosis is a serious and complex mental health condition, a specialist psychiatrist needs to be consulted and provide continuing care.

Medications

Medication is essential for treating and managing postnatal psychosis. Different medications may be used including:

  • antipsychotics – assist with both manic symptoms and psychotic symptoms (delusions or hallucinations); these are essential in the first instance
  • mood stabilisers – used to stabilise mood and help to reduce the likelihood of relapse
  • antidepressants – may also be used to reduce depressive symptoms which are part of a depressive psychosis.

If your psychiatrist prescribes mood stabilisers or antipsychotic medications (such as sodium valproate [Epilim], clozapine or lithium), make sure you talk through the benefits, risks and potential side-effects. Some medications should be avoided or used with caution if you’re breastfeeding.   

If you’ve been treated for postnatal psychosis, it’s important to discuss and review medication if you’re planning to get pregnant, during pregnancy and following the birth. Folate supplements are important if you’re taking mood stabilising medications while trying to conceive and in the first trimester of pregnancy (to reduce the small increased risk of birth defects with these medications).

You should always seek advice from a psychiatrist before changing or stopping medication. The decision to stop taking medication should be made in consultation with your psychiatrist, and always as a gradual process – you should never stop suddenly.


Hospital/mother-baby units

A woman with postnatal psychosis will almost always need to spend some time in a psychiatric hospital, especially if she, or her partner or family, feels she may be at risk of harming herself. This allows health professionals to monitor and provide treatment and ongoing support in a safe place.


Psychological treatments

As your prescribed medication begins to work and you start to recover, psychological therapies such as cognitive behaviour therapy (CBT) or interpersonal psychotherapy (IPT) can help you develop effective coping strategies. Mother-infant therapy can also help you bond with your baby.

If you’re supporting your partner or loved one as she recovers from an episode of bipolar disorder, it’s important that you take care of yourself and have your own support network to call on. Talking things through with a counsellor can be really helpful for partners and main support people.


Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a specialist treatment that can be used safely for treating acute mania, psychosis and severe depression following the birth.

There’s lots of misinformation about ECT, so we’ve put together some of the facts to help you make a decision about your own treatment, or that of your partner or loved one. 



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