What is Postpartum Psychosis?

Postpartum psychosis, also known as puerperal psychosis or postnatal psychosis, is a serious mental illness that can affect women in the days or weeks after they give birth. Its onset can be extremely sudden, with symptoms varying and changing rapidly.

Postpartum psychosis is usually a temporary mental health condition and is extremely treatable, however, symptoms can be severe, and it is classified as a medical emergency. It is therefore essential that professional help is sought immediately.

Postpartum psychosis is extremely rare compared to other postnatal illnesses, such as postpartum depression or anxiety. It occurs in approximately 0.1%-0.2% of births or around 1-2 out of every 1,000 new mothers.

During pregnancy and following birth, new mothers experience significant physical, emotional and hormonal changes. Rapidly changing hormone levels can affect a new mother’s mental and emotional state and, although all new mothers will experience these changes to some degree, in some situations, the impact can be much more serious.

Understanding and recognising the difference between postpartum blues, postpartum depression and postpartum psychosis is crucial for preventing long-lasting harm to both the mother and the baby.

Although all these conditions occur after birth, postpartum blues typically only last a few days or weeks and go away naturally as hormone levels stabilise. Many new mothers will experience postpartum blues on some level.

Symptoms may include crying frequently, feeling low and anxious and mood swings. Also known as “baby blues” symptoms should abate on their own, usually within 10 days.

Postpartum depression is also much more common than postpartum psychosis, with around 1 in 10 women being affected within a year of giving birth. Symptoms of postnatal depression may be similar to depressions and are likely to present as feelings of sadness, anxiety, withdrawal, lack of appetite and negative thoughts.

If your symptoms last longer than two weeks, you are likely experiencing postpartum depression.

Postpartum psychosis is a severe illness and is classified as a medical emergency. The onset is usually more sudden than other conditions. Research suggests that postpartum psychosis has a 5% suicide rate and a 4% infanticide rate.

Symptoms can progress rapidly and if it is left untreated, the health and wellbeing of both the mother and the baby can be in jeopardy.

Postpartum psychosis can affect anyone; however, some women may be at higher risk than others.

Those who may be at higher risk include:

• Those who have previously experienced postpartum psychosis.
• Those who have a close family member who experienced postpartum psychosis.
• Those who have previously received a diagnosis of schizophrenia or bipolar disorder.
• Those who experience a traumatic pregnancy or birth.

According to the NHS, the most severe symptoms of postpartum psychosis can last between 2 to 12 weeks. However, it can take up to 12 months for the individual to recover completely.

What are the signs and symptoms?

A mother who is experiencing symptoms of postpartum psychosis may not understand or realise that they are ill. It is usually their partner, family members or friends that notice the symptoms. Symptoms usually begin within two weeks of giving birth, although in some cases, symptoms can present within hours of the birth.

Some symptoms are less severe than others and, in many cases, the new mother will first experience early symptoms that are less severe. However, symptoms can escalate rapidly and if left untreated, the illness can advance quickly with symptoms changing from hour to hour and day to day.

Early intervention is key, and it is recommended that all expectant mothers and their families are aware of the signs and symptoms.

The most common signs and symptoms of postpartum psychosis include:

• Hallucinations – This is not only limited to visual hallucinations but can also include hearing, smelling or feeling things that do not exist in reality.
• Delusions – Having thoughts or beliefs that are not true. Some examples of delusions include feeling like you are being followed or someone is spying on you and feeling that you are very powerful and can control things such as the weather or other people’s behaviour.
• Mania – Also known as experiencing a manic mood. This can include talking or thinking rapidly, disorganised thinking, restlessness, confusion, overexcitement and feeling high.
• Lack of inhibitions.
• Severe mood swings or rapid changes in mood.
• A low mood – This includes showing signs of depression, being tearful, anxious or withdrawn, loss of appetite and difficulties sleeping.
• Feelings of paranoia, suspicion or fear.
• Feeling suicidal.
• Exhibiting severe confusion.
• Feeling that you are living in a dream world.
• Being restless and agitated.
• Being unable to sleep or feeling like you do not need to sleep.

How to prevent postpartum psychosis

Postpartum psychosis is an illness that is not caused by the new mother or anyone around them. It is extremely difficult to predict and prevent. Although one definitive cause has not been identified, it is thought that genetics, family history, hormonal changes, physical changes and the disrupted sleep patterns of new mothers may all be factors.

Anyone who has previously experienced postpartum psychosis or is deemed as being high risk should receive specialist care during their pregnancy and after the birth.

It is thought that people who have previously experienced postpartum psychosis have a 50% chance of developing the condition again. Women with bipolar disorder or schizophrenia may have a 10%-50% chance of developing postpartum psychosis after giving birth.

Although it may not always be possible to prevent postpartum psychosis from developing, the expectant mother and the relevant healthcare professionals can take some important steps to dramatically reduce the likelihood or ensure that they have rapid access to support and treatment, if they begin to develop symptoms.

It is important to make your doctor or midwife aware of any factors that may make you more susceptible to postpartum psychosis or any other postnatal mental illness.

If you currently take medication for a mental illness such as bipolar disorder, it can be beneficial to inform your doctor you are planning to have a baby before you become pregnant.

This will allow your doctor to adjust your medication accordingly. If your pregnancy was unplanned or you were unable to inform your doctor in advance, inform them as soon as possible.

If you are currently on medication and are planning to become pregnant, you have several options available to you.

• Continue taking your medication at the same dosage.
• Change your medication to one that may be safer during pregnancy.
• Reduce the dosage of your medication.
• Stop all medication.

You should not make this decision alone. If you have a higher risk of developing postpartum psychosis, stopping or limiting your medication may increase the likelihood of you developing psychosis. Seek advice from your doctor and consider all options carefully.

Your GP or midwife can then create a plan with you to ensure you receive the care and support you need and help prevent you from becoming unwell. You should also be referred to a mental health service or a perinatal mental health service, where you can access preventative treatments.

A healthcare professional, such as a midwife or health visitor, should also arrange more frequent visits or appointments with you after the birth. This will enable them to check that you are not experiencing any symptoms of postpartum psychosis and offer you additional support following the birth.

Even if a mother is not deemed as high risk, they should ensure that they, and those around them, are aware of the signs and symptoms of postpartum psychosis so that early intervention is more likely, if they develop the condition.

If you suspect that you or another person is experiencing postpartum psychosis, contact your GP immediately, call 111 or go straight to A&E.

For more information about accessing help if you or someone you know is experiencing symptoms of postpartum psychosis, Action on Postpartum Psychosis (APP) has developed a guide on accessing help and encouraging recovery.

Recovery from postpartum psychosis

If a new mother is displaying symptoms of postpartum psychosis, a referral needs to be made to a specialist mental health service as soon as possible.

Because of the severity of the illness and the potential danger to both the mother and the baby, treatment usually occurs in the form of in-patient psychiatric care. Where possible, the treatment will take place in a mother and baby unit (MBU). If this is not possible, the mother will be initially treated on a general psychiatric ward, before being moved to an MBU as soon as possible.

There are several treatments for postpartum psychosis and the doctor will consider a variety of factors before deciding which one is best for you. Factors to consider may include whether you are breastfeeding and any treatments that have succeeded or failed previously.

Treatments may include:

Medication

You may be prescribed one or more of the following medications:

• Antipsychotics – These can help to reduce any manic or psychotic symptoms you are experiencing such as hallucinations, delusions and mania.
• Antidepressants – To help ease symptoms of depression.
• Mood stabilisers – To help stabilise your mood and reduce the likelihood of symptoms reoccurring.

Not all medications used to treat postpartum psychosis are compatible with breastfeeding. If you want to breastfeed your baby, inform the medical professionals and they will prescribe the relevant medication.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is rarely used as a treatment for postpartum psychosis. It is usually only recommended when all other treatment has failed, or symptoms are so severe that they could be imminently life-threatening. It involves electrical currents being passed through the brain and is done under general anaesthetic.

Psychological therapy

Once your symptoms reduce and you start to recover from the psychosis, you may be offered psychotherapy, such as Cognitive Behavioural Therapy (CBT). This can provide you with some much-needed support and help you deal with the effects of your postpartum psychosis.

The therapist can help you develop strategies to deal with the effects of your illness. Family or relationship therapy may also be recommended. For more information about CBT, consult our knowledge base.

The most severe symptoms of postpartum psychosis usually last up to 12 weeks. Following this, many women find that they experience a period of depression or anxiety, a lack of self-confidence or difficulty bonding with their baby. Although these symptoms can last for 6-12 months, with the right support, most women make a full recovery.

Once you and your baby return home, you should continue to receive support from your community mental health service, GP and health visitor. You may be referred to social services or be assigned a social worker, but do not view this negatively. Your social worker will ensure you are receiving the right support from your friends and family and healthcare professionals.

Joining a support group can also be very beneficial. Many women who have experienced postpartum psychosis feel alone, or that no one understands their experience. Some do not want to talk to friends or loved ones through fear of being judged. Sharing your experiences with someone who has experienced something similar may be extremely helpful.

PANDAS Foundation offers a variety of support networks for anyone experiencing perinatal illness or mental health difficulties. You can attend an in-person support group, chat online or call the free helpline. For more information visit their website.

Once the mother is back in their home environment, their partner, family members or friends can all follow steps to aid recovery further.

This could include:

• Helping with childcare, night feeds and other responsibilities.
• Providing emotional and physical support.
• Ensuring the mother gets as much rest and sleep as possible.
• Taking time to listen.
• Showing trust, especially if the mother is experiencing low self-confidence.
• Ensuring the home is a calm and stress-free environment.

If you experienced postpartum psychosis after a previous pregnancy, there is a 1 in 2 chance you will experience it again. Being more aware of the symptoms and informing your doctor of your pregnancy as soon as possible can reduce the risk.

A perinatal psychiatrist will be assigned to you and you should have a pre-birth planning meeting that involves everyone involved in your care or personal life, including your doctor, midwife, health visitor, mental health workers, your partner, family members or friends.

Your care plan will also include information on how to access help quickly if you begin to experience signs of postpartum psychosis again.