Postnatal psychosis is one of the most serious postnatal mental health conditions, yet it’s rarely spoken about. Here’s what you need to know.
What is postnatal psychosis?
Postnatal psychosis, which is also called puerperal or postpartum psychosis, is a rare but serious and potentially life-threatening mental health disorder. It takes the form of severe depression or mania (high mood) or both. This condition only affects birthing women and is rare, affecting one to two women per 1,000 births (NICE, 2014).
When does postnatal psychosis start?
Postnatal psychosis symptoms usually arrive suddenly and severely within the first month after birth. Many women report that symptoms appear within three days of having their babies (Heron et al, 2008).
What are the symptoms of postnatal psychosis?
Early symptoms of postnatal psychosis can include:
Feeling excited, elated or high.
Not needing to sleep or being unable to sleep.
Feeling active or energetic.
Feeling very chatty.
(Heron et al, 2008)
More advanced symptoms can include:
Delusions (possibly about the baby) – having thoughts or beliefs that are unlikely to be true, and that other people don’t share.
Hallucinations – sensing smells, visions or voices that don’t exist outside the mind.
Mania – talking quickly, disorganised thinking, restlessness, confusion, appearing ‘high’.
Loss of inhibitions.
Behaving out of character – more talkative, active, suspicious, fearful, giggly or more sociable than usual.
Depression – low mood, tearful, trouble sleeping.
Severe mood swings.
(NHS, 2020; APP, no date)
Who is at risk of postnatal psychosis?
For most women, postnatal psychosis will appear with no warning. Postnatal psychosis is not caused by anything a woman or her partner has done or thought. The exact cause is unknown but genes, changes in hormone levels and disrupted sleep patterns are likely to be involved (APP, no date).
Some women will have a higher chance of having postnatal psychosis, including those who have:
already experienced postnatal psychosis
a close female relative who’s suffered from postnatal psychosis
bipolar disorder, especially if they have stopped medication during pregnancy.
(Essali, et al, 2013; NICE, 2014; MIND, 2020; Action on Postpartum Psychosis, no date)
Women who are assessed as high risk for postnatal psychosis should receive specialist care during pregnancy and the early postnatal period (NHS, 2020). For those women, preventive drug therapy may help to prevent postnatal psychosis (Essali et al, 2013).
How long does postnatal psychosis last?
The most severe symptoms last between two and 12 weeks. What often follows is a period of anxiety, depression or a lack of self-confidence. With the right treatment, women who have postnatal psychosis will make a full recovery within six to 12 months (NHS, 2020).
What is the impact of postnatal psychosis?
Rapid medical intervention and treatment for postnatal psychosis is important. This is because postnatal psychosis is associated with an increased risk of maternal suicide and harm or death of the baby (Gilden et al, 2020a).
Having postnatal psychosis can affect the attachment between mother and baby (Gilden et al, 2020b) and also impact on other family bonds, such as the couple relationship, the bond between father and infant (Holford et al, 2018), as well as affecting siblings. It is important that a family affected by postnatal psychosis receives long-term support (Darwin et al, 2021).
Support and treatment
As we mentioned earlier, postnatal psychosis should be treated as a medical emergency (NHS, 2020). It’s unlikely that a woman herself will recognise the symptoms, so it’s mostly up to partners, friends and family to get help.
If you do suspect a case of postnatal psychosis:
See a GP immediately, or call 111.
Go to A&E or call 999 if you or someone you know is in imminent danger.
Women should then receive a referral to a specialist perinatal mental health service for assessment. This should happen within four hours of any symptoms starting suddenly (NICE, 2014).
Women who have already been assessed as being at high risk of perinatal mental health issues will have a care plan in place. A care plan will let the woman, her friends and family know how to get help quickly if symptoms appear (Heron et al, 2008).
In-patient psychiatric care
Most women with postnatal psychosis will need in-patient psychiatric care. This is either because their symptoms are so severe that they might harm themselves or others. Or because specialist perinatal teams in their area cannot care for them safely at home.
Where possible, in-patient care will be at specialist mother and baby units (MBUs) (NICE, 2014). These units make sure mothers and babies can stay together during treatment.
If specialist mother and baby units aren’t available, the mother will go to a general psychiatric unit while family care for the baby (NICE, 2014). The mother will stay in the general unit until a place in a specialist unit is available or they are well enough to go home.
Women suffering from postnatal psychosis can be prescribed:
anti-depressants to ease depression symptoms
anti-psychotics to help with hallucinations, mania and delusions
mood stabilisers to help prevent reoccurrence of symptoms.
Electroconvulsive therapy (ECT)
ECT is sometimes used when other treatments have failed or the situation is life threatening (NHS, 2020). With ECT, electrical currents are passed through the brain to relieve the symptoms of postnatal psychosis. This is done under general anaesthetic.
Electroconvulsive therapy is only used rarely, and for women who have severe symptoms or don’t respond to other treatment (MIND, 2020; NHS, 2020).
Once you start to recover from postnatal psychosis, your GP might suggest you have cognitive behavioural therapy (CBT) (NHS, 2020).
Can postnatal psychosis come back after future pregnancies?
About half of women who have had postnatal psychosis will experience it again if they have another baby (AAP, 2018). However, in a future pregnancy, you’ll be more prepared to get the support you need. You won’t necessarily be able to avoid another episode but you should get the help you need more quickly, meaning that you can recover more quickly too.
The key thing is planning. Speak to your midwife or GP, ideally before you conceive again to discuss the options and, if needed, they can refer you to a perinatal psychiatrist.
This page was last reviewed in January 2022.
Experiencing mental health symptoms can be overwhelming but help is available. So speak to a trusted healthcare professional, such as a midwife, health visitor, or GP. If you feel at risk of harming yourself or others then call 999, attend an emergency departmenthealth care setting, or call the Samaritans on 116 123.
For more information and help with postnatal psychosis, visit Action On Postpartum Psychosis.
Our support line offers practical and emotional support with feeding your baby: 0300 330 0700.
You might find attending one of our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
APP. (no date) Frequently asked questions. Available at: https://www.app-network.org/what-is-pp/faq/ [Accessed 25th January 2022]
Darwin Z, Domoney J, Iles J, Bristow F, McLeish J, Sethna V. (2021) Involving and supporting partners and other family members in specialist perinatal mental health services. Available at: https://www.england.nhs.uk/publication/involving-and-supporting-partner… [Accessed 25th January 2022]
Essali A, Alabed S, Guul A, Essali N. (2013) Preventive interventions for postnatal psychosis. Cochrane Database Syst Rev. (6):CD009991. Available at: https://doi.org/10.1002/14651858.CD009991.pub2
Gilden J, Kamperman AM, Munk-Olsen T, Hoogendijk WJ, Kushner SA, Bergink V. (2020a) Long-term outcomes of postpartum psychosis: a systematic review and meta-analysis. J Clin Psychiatry. 81(2):19r12906. Available at: https://doi.org/10.4088/JCP.19r12906
Gilden J, Molenaar NM, Smit AK, Hoogendijk WJ, Rommel AS, Kamperman AM, Bergink V. (2020b) Mother-to-infant bonding in women with postpartum psychosis and severe postpartum depression: a clinical cohort study. J Clin Med. 9(7):2291. Available at: https://doi.org/10.3390/jcm9072291
Heron J, McGuinness M, Blackmore ER, Craddock N, Jones I. (2008) Early postpartum symptoms in puerperal psychosis. BJOG. 115(3):348-353. Available at: https://doi.org/10.1111/j.1471-0528.2007.01563.x
Holford N, Channon S, Heron J, Jones I. (2018) The impact of postpartum psychosis on partners. BMC Pregnancy Childbirth. 18(1):1-10. Available at: https://doi.org/10.1186/s12884-018-2055-z
MIND. (2020) Postnatal depression and perinatal mental health pages. Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postpartum-psychosis/#.Wc0VHIokqRs [Accessed 25th January 2022]
NICE. (2014) Antenatal and postnatal mental health. CG192. Available at: https://www.nice.org.uk/guidance/cg192 [Accessed 25th January 2022]