Postnatal psychosis
Postpartum psychosis is a severe mental illness that can affect a woman after she has a baby.
It causes her to have hallucinations and delusional thinking (symptoms of psychosis).
Postpartum psychosis is thought to affect around one in every 1,000 women who give birth. It's sometimes referred to as puerperal psychosis or postnatal psychosis.
Read on to find out:
What should I do if I think someone has developed postpartum psychosis?
What should I do if I think I'm having an episode?
What's the cause of postpartum psychosis?
What are the symptoms of postpartum psychosis?
Most women with postpartum psychosis will experience psychosis (a 'psychotic episode') and other symptoms very soon after giving birth, usually within the first two weeks.
Some women develop symptoms later than this – sometimes at the time they stop breastfeeding, or when their periods restart.
Psychosis
Psychosis causes people to perceive or interpret things differently from those around them. The two main symptoms are:
- hallucinations – usually hearing or seeing things that aren't there; a common hallucination is hearing voices
- delusions – thoughts or beliefs that are unlikely to be true (for example believing you've won the lottery)
The combination of hallucinations and delusional thinking can severely disrupt her perception, thinking, emotions and behaviour.
Other symptoms
A woman with postpartum psychosis may also behave in a way that is out of character, and may experience:
- a high mood (mania) – she may talk and think too much or too quickly, feel 'on top of the world', or be more sociable than normal
- a loss of inhibitions
- paranoia, feeling suspicious or fearful
- restlessness or agitation
- a low mood – she may show signs of depression and be withdrawn or tearful, with a lack of energy, loss of appetite, anxiety, irritability or trouble sleeping
- severe confusion
Her mood may change rapidly. Some affected women experience symptoms of mania and depression at the same time.
How serious can it be?
Postpartum psychosis is a serious mental illness that should be treated as a medical emergency.
If not treated immediately, the postpartum psychosis can get worse rapidly.
The illness could cause her to neglect or harm her baby or harm herself.
She may not realise she is ill, and it may be up to her partner, family or friends to spot the warning signs and take action – see What should I do if I think someone may have developed postpartum psychosis?'.
The majority of women with postpartum psychosis make a full recovery, and often very quickly provided they receive the right treatment.
Who is at risk of postpartum psychosis?
Postpartum psychosis is more likely to affect women who:
- have had postpartum psychosis before
- already have a serious mental health condition, such as bipolar disorder or schizophrenia
- have a relative who has experienced psychosis (even if the woman herself has no mental illness)
Once a woman develops postpartum psychosis, there's a high chance she will have another episode following future pregnancies.
What should I do if I think someone may have developed postpartum psychosis?
Contact your GP immediately if you think someone you know may have developed postnatal psychosis.
If this isn't possible, call NHS 111 or your local out-of-hours service.
If you think there's a danger of imminent harm, call 999 and ask for an ambulance.
What should I do if I think I'm having an episode?
If you already have a care plan because you've been assessed to be at high risk, there should be an emergency number you can call to reach a crisis team.
If you don't have a care plan, and think you're having a psychotic episode, see your GP urgently or go to A&E.
How is postpartum psychosis treated?
Postpartum psychosis is a psychiatric emergency. The woman may need to be admitted to hospital for treatment.
Ideally, she would be admitted with her baby to a specialist psychiatric unit called a mother and baby unit. For some women, this allows them to continue bonding with their baby and gives them confidence in their role as mother.
Medication
Typically, a woman with postpartum psychosis would be prescribed one or more of the following drugs:
- An antidepressant, which works by balancing mood-altering chemicals in the brain. It can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing the mother to function normally and cope better with her new baby.
- An antipsychotic (neuroleptic), which works by blocking the effect of dopamine (a chemical that transmits messages in the brain).
- A mood stabilising drug. If lithium is prescribed, regular blood tests are needed at least every three months to make sure lithium levels are not too high or low.
Doctors will weigh up the effectiveness of these medications with the risk of side effects and the risk of any harmful effects on pregnancy or breastfeeding.
What's the cause of postpartum psychosis?
We're not really sure what causes postpartum psychosis. Fluctuations in hormones and sleep patterns could play a role, and there does seem to be a genetic basis, as a woman is more likely to develop the illness if her close relative had it.
There seems to be link between postpartum psychosis and bipolar disorder.
It's important to understand that postpartum psychosis is not caused by anything the woman did, nor is it caused by stress, relationship problems or a baby being unwanted.
Can postpartum psychosis be prevented?
A woman's risk of developing postpartum psychosis should be assessed during her antenatal appointments so that if she were to develop the illness after giving birth, the signs would be spotted straight away and there would be a treatment plan to follow.
There are no specific screening tools for postpartum psychosis, but the antenatal care team should be able to identify women who are more likely to develop it and refer them to a psychiatrist for an assessment.
If you're at high risk...
If you've been assessed to be at high risk of developing postpartum psychosis, you may be offered a pre-birth planning meeting at around 32 weeks of pregnancy.
Everyone involved in your care would be invited to this meeting – your partner, family or friends, a mental health professional, midwife, obstetrician, health visitor and GP.
The aim is to make everyone aware of your risk and to agree on a plan for your care.
Studies suggest that taking certain medicines in late pregnancy could help to prevent postpartum psychosis in high-risk women. You may want to discuss this option with your care team. The risks and benefits of medication taken in pregnancy should always be carefully weighed up.
You may also be given advice on what you can do to stay as well as possible during pregnancy – for example, reducing any stress in your life, and getting as much sleep as possible.
You'll get a copy of your written care plan, which should include how you and your family can get help quickly if you were to become ill – see What should I do if I think I'm having an episode?
In the first few weeks after your baby is born, you should be regularly visited by a midwife, health visitor and mental health nurse.
What's the outlook for someone with postpartum psychosis?
With treatment, the vast majority of women with postpartum psychosis start to feel better very quickly.
Some mothers have difficulty bonding with their baby after an episode of postpartum psychosis, but this doesn't usually last long. With support from family, friends and the mental health team, most women go on to have very good relationship with their child.
About half of women who have postpartum psychosis will go on to have another episode in the future – not necessarily after having another child. In these cases, they should be able to get help quickly. With appropriate treatment, this risk can be reduced.
An episode of postpartum psychosis is sometimes followed by period of depression, anxiety and low confidence. It might take a while to come to terms with what happened.
Further advice and support
Women who have experienced or are experiencing postpartum psychosis may find the following charities and forums helpful:
The Association for Post Natal Illness
PANDAS (Pre and Postnatal Depression Advice and Support)
Postpartum psychosis can be stressful and distressing for partners, too. It can be isolating and lonely if both their baby and partner is in hospital.
If you are struggling to cope because your partner is going through an episode of postpartum psychosis or recovering from this, don't be afraid to get help yourself.
Talk to a mental health professional involved in your partner's care, or approach one of the above charities.
© Crown Copyright 2009
