Postpartum psychosis

What is postpartum psychosis?

Postpartum psychosis is a medical emergency. Women who have been diagnosed with bipolar disorder  or schizophrenia before their pregnancy have a higher risk or getting it but it can happen to any woman, even if they have not had a mental illness before.

You should get help as soon as you think you (or someone you know) might have postpartum psychosis.

It can be frightening, but most women make a full recovery with the right treatment.

What are the symptoms?

Symptoms of postpartum psychosis include:

• being severely depressed and/or being manic – extremely energetic and talkative
• quick changes of mood (up and down)
• being restless and agitated
• being very withdrawn and not talking to anyone
• being very confused
• not sleeping
• racing thoughts
• hearing voices or seeing things that aren’t there (hallucinations)
• developing unusual beliefs (delusions)
• feeling things aren’t real (like you’re in a dream world)
• feeling paranoid and suspicious of other people
• behaviour that is out of character
• feeling suicidal
• thinking about, and/or planning suicide, and sometimes thinking of taking your baby with you because of bad feelings about the world around you.

This is a list of all possible symptoms. If you have postpartum psychosis you may not have all these symptoms and they may change. You may not be able to look after yourself or your baby very well.

“A few days after my first child was born, I developed classic symptoms of postpartum psychosis. I was very excited and soon became extremely tired and anxious. I had to leave my baby with her father and spend some time in a psychiatric unit to recover."Clare, mum of two

How common is it?

Postpartum psychosis is much less common than baby blues or postnatal depression. Around 1 in 1,000 women gets postpartum psychosis.

Who is more likely to get postpartum psychosis?

Postpartum psychosis is not your fault and isn’t caused by anything you have done. Some women develop postpartum psychosis even if they have never had a mental health problem before. However, you are at greater risk of getting postpartum psychosis if you have:

• had postpartum psychosis before
• had a diagnosis of bipolar disorder or schizoaffective disorder
• had a diagnosis of schizophrenia or another psychotic illness
• a mum or sister who have had postpartum psychosis.

Can anything be done to prevent postpartum psychosis?

If you have one of the mental health conditions mentioned above, you can have treatment that may prevent you getting postpartum psychosis.

Tell your midwife as soon as possible about your condition, even if you have been well for some time.

The midwife can refer you to a mental health service (ideally a specialist perinatal mental health service) so you can talk about what can be done to prevent you becoming unwell. They will also make a plan with you to make sure you stay as well as possible and get help quickly if you do become unwell.

You should be visited regularly by a healthcare professional after you have your baby so any symptoms can be spotted quickly.

It would also be helpful to share the list of symptoms above with others in your household (for example, your partner or a parent who is helping out) so that they can be watchful too.

When to get medical help

Postpartum psychosis is a medical emergency. Some women become very unwell very quickly. If you suspect that you (or someone you know) may have postpartum psychosis, contact your GP (or your mental health team) and ask to be seen the same day, or go immediately to A&E.

If you have bipolar disorder or a schizoaffective disorder, which increase your risk of getting postpartum psychosis, make sure everyone in your healthcare team is aware of it.

“When my twins were babies, I developed psychosis. I was hearing them crying when they weren’t even in the house. The twins’ dad made me go and see a doctor and I was given antipsychotic medication.”Shamim, mum of two

How is postpartum psychosis treated?

You will normally be treated with medication. It’s essential to get treatment as soon as possible because if you get treated quickly you will usually recover well.

Most women need to be treated in hospital. Ideally, you should be offered a bed in a psychiatric mother and baby unit so your baby can stay with you. These are not available in every hospital so you may be admitted to a general psychiatric ward. If this happens your partner or family may need to look after your baby.

It can take 6-12 months or more to recover from postpartum psychosis.

Breastfeeding and medication

It is possible to breastfeed while taking some types of medications.You can talk to the doctor about the pros and cons of this.

Will I need to be referred to social services?

If you have a high risk of developing postpartum psychosis in pregnancy or you develop it after giving birth you may be referred to social services. The referral will be discussed with you (unless you are too unwell).

Sometimes women worry that this means that people think they can’t care for their baby. This isn’t usually the case. In fact, asking for help and getting treatment is a good sign and shows that you are thinking about your baby’s wellbeing. It is very rare for babies to be removed from women with postpartum psychosis.

A social services assessment will:

• check what support you have from family, friends and professionals
• make sure there is safe plan for your baby if you are too unwell to care for him or her.

You may need extra help from family members while you are unwell and during recovery. Social services may be able to help if you don’t have any support. Social workers can find a temporary carer for your baby if you need to go into hospital and there is no place available in a mother and baby unit.

More information and support

Action on Postpartum Psychosis

Association for Post Natal Illness

PANDAS Foundation UK