It’s one of the most extreme postnatal issues and yet it’s rarely spoken about. Here’s what you need to know
What is postpartum psychosis?
Postpartum psychosis, or puerperal psychosis, is a rare but serious and potentially life-threatening mental health issue. It takes the form of severe depression or mania or both.
For the small number of women who experience postpartum psychosis, it occurs in the first three months after birth, usually within the first 2 weeks (NICE, 2014).
"Postpartum psychosis is a medical emergency yet as the mother herself probably won't recognise the problem, others will need to get help for her."
What are the signs and symptoms of postpartum psychosis?
Postpartum psychosis symptoms usually arrive suddenly and quickly within the first month after birth. Symptoms then disappear again by the three-month mark (NICE, 2014). Many women report symptoms appearing within three days of having their babies (Heron et al, 2008).
Early symptoms of postpartum 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 sociable than usual.
Depression – low mood, tearful, trouble sleeping.
Severe mood swings.
(NHS Choices, 2017; APP, 2017)
Who is at risk of postpartum psychosis?
For most women, postpartum psychosis will appear with no warning. It’s rare, affecting between one and two women per 1,000 births (NICE, 2014). Those at high risk are women who have:
already experienced postpartum psychosis
a close female relative who’s suffered from postpartum psychosis
bipolar disorder, especially if they have stopped medication during pregnancy.
(Essali, et al, 2013; NICE, 2014; Action on Postpartum Psychosis, 2017; MIND, 2017)
Postpartum psychosis is also more common among those who have a traumatic pregnancy or birth. It’s more likely to happen in first pregnancies (MIND, 2017).
Can postpartum psychosis be avoided?
Postpartum 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, 2017).
Women who are assessed as high risk for postpartum psychosis should receive specialist care during pregnancy (NHS Choices, 2017). For those women, preventive drug therapy may help to prevent postpartum psychosis. Drug therapy might include mood stabilisers, anti-psychotics or hormone therapy (Essali et al, 2013).
What should you do if you or someone you know shows symptoms of postpartum psychosis?
Postpartum psychosis should be treated as a medical emergency (NHS Choices, 2017). It’s unlikely that a woman herself will recognise the symptoms, so it’s mostly up to partners, friends and family to get help for her.
If you do suspect a case of postpartum 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 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).
How is postpartum psychosis treated?
In-patient psychiatric care
Most women with postpartum 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 postpartum 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)
Electrical currents are passed through the brain to relieve the symptoms of postpartum psychosis. This is done under general anaesthetic. Electroconvulsive therapy is only used rarely for women who have severe symptoms or don’t respond to other treatment (NHS Choices, 2017; MIND, 2017).
Your GP might suggest you have Cognitive Behavioural Therapy (CBT) once you’re in recovery from postpartum psychosis (NHS Choices, 2017).
What about future pregnancies
If you suffer from postpartum psychosis with your first pregnancy, there is no reason why you can’t go on to have more children. There is a chance that you will get another episode. About 50% of women who have had postpartum psychosis experience it again if they have another baby (AAP, 2018).
With a future pregnancy, you’ll be more prepared to get the support you need. You won’t necessarily be able to avoid another bout but you can get help from the start to make it as easy to deal with as possible.
The key thing is planning. Ask your midwife or GP to refer you to a perinatal psychiatrist. You should get the help you need more quickly, meaning that you can recover more quickly too.
What is the outlook for postpartum psychosis?
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.
Some women find it difficult to bond with their baby for a little while afterwards (NHS Choices, 2017). But with the right treatment, women who have postpartum psychosis will make a full recovery within six to 12 months (NHS Choices, 2017).
This page was last reviewed in June 2018
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
You might find attending one of our Early Days groups 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.
For more information and help on postpartum psychosis, visit Action On Postpartum Psychosis.
Action on Postpartum Psychosis. (2018) Available from: https://www.app-network.org/what-is-pp/faq/ [Accessed 2nd January 2018].
Essali A, Alabed S, Guul A, Essali N. (2013) Preventive interventions for postnatal psychosis. Cochrane Database of Systematic Reviews 2013 Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009991.pub2/ful [Accessed 1st December 2017].
Heron J, McGuinness M, Blackmore ER, Craddock N, Jones I. (2008) Early postpartum symptoms in puerperal psychosis British Journal of Obstetrics & Gynaecology; 115(3):348-353. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18190371 [Accessed 2nd January 2018].
MIND. (2017) Postnatal depression and perinatal mental health pages. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postpartum-psychosis/#.Wc0VHIokqRs [Accessed 1st December 2017].
NHS Choices. (2017) Postpartum psychosis pages. Available from: http://www.nhs.uk/conditions/postpartum-psychosis/Pages/Introduction.aspx#Symptoms [Accessed 1st December 2017].
NICE (National Institute for Health and Care Excellence). (2014) Antenatal and postnatal mental health. CG192. Available from: https://www.nice.org.uk/guidance/cg192/evidence/full-guideline-pdf-193396861 [Accessed 1st December 2017].