Postpartum Psychosis: What New Mothers and Families Should Know

Postpartum psychosis is a severe mental illness. It can happen to any woman, and often occurs "out of the blue." It can be a frightening experience for a mother, her partner, and her friends and family. It can last several weeks or longer — but you will usually recover fully.

It starts suddenly, in the days or weeks after having a baby. About 1 in every 1,000 women (0.1%) who have a baby will experience postpartum psychosis.

What are the symptoms?

Symptoms vary, and can change rapidly — sometimes from hour to hour, and from one day to the next. They can include high mood, depression, confusion, hallucinations, and delusions. It is a psychiatric emergency, and you should seek help as quickly as possible.

Women with postpartum psychosis can present with some of the following symptoms:

• Feeling "high," "manic," or "on top of the world"
• Low mood and tearfulness
• Anxiety or irritability
• Rapid changes in mood
• Severe confusion or altered behaviour
• Being restless and agitated
• Racing thoughts
• Behaviour that is out of character
• Being more talkative, active, and sociable than usual
• Being very withdrawn and not talking to people
• Finding it hard to sleep, or not wanting to sleep
• Losing your inhibitions, and doing things you usually would not do
• Feeling paranoid, suspicious, or fearful
• Delusions — odd thoughts or beliefs that are unlikely to be true. For example, you might believe you are here to save the world, that your baby is possessed, or that people are out to get you
• Hallucinations — seeing, hearing, feeling, or smelling things that aren't really there

During a postpartum psychosis, you may not understand that you are ill. Your symptoms can make it hard for you to properly look after yourself or your baby. However, your partner, family, or friends will usually know that something is wrong and that help is needed.

It is not your fault

Postpartum psychosis is not your fault. It is not caused by anything you or your partner have thought or done. It is not caused by relationship problems, stress, or doubts about your pregnancy.

Several things seem to play a part in postpartum psychosis. Your family history and genetic factors are important — you are more likely to have postpartum psychosis if a close relative has had it. Hormone levels and disturbed sleep patterns may also be involved.

What raises the risk?

Risk increases if you have bipolar disorder, schizophrenia, a depressive disorder, or a previous postpartum psychosis yourself, or a history of postpartum psychosis in a close relative. Ask your psychiatrist about how these risk factors might apply to you.

Planning a pregnancy, if you're at higher risk

Let your psychiatrist know that you want to get pregnant before you start trying for a baby. You can discuss with them any medications you are taking. They can advise you on how to stay as well as possible before becoming pregnant. Your pregnancy may not be planned — many pregnancies aren't. In that case, let your doctor know as soon as possible.

Already pregnant, and haven't discussed your mental health history with anyone?

It's important that everyone involved in your care knows about any mental illness you have had in the past, especially your obstetrician. They need to know you are pregnant and at higher risk of postpartum psychosis, so that they can arrange the care and support you need, and help you make a plan.

What can you do to reduce the risk?

Have a look at the things that seem to trigger your episodes of illness, and do whatever you can to deal with them. Can you reduce other stressful things going on in your life? Try to get as much sleep and rest as you can in late pregnancy and after the birth. This can be difficult with a new baby, so ask your partner or family to take some of the night-time feeds.

Medication decisions during pregnancy and postpartum

If you have bipolar disorder, the risk of postpartum psychosis may be higher if you stop medication. It is generally advised to continue medication, even during pregnancy and after delivery — although there are no absolutely right or wrong answers here, and there are risks involved with all the options, including:

• Staying on all, or some, of your current medication
• Switching to other medications that may be safer in pregnancy and breastfeeding

If your psychiatrist feels the risk of psychosis in the postpartum period is present, they may advise starting medication in late pregnancy or after delivery, to reduce the risk of becoming ill again.

If you have been well for many years and your psychiatrist feels it is safe to discontinue medication during pregnancy, they may do so if they don't suspect any risk. Talk these options over with your psychiatrist — this will help you decide what is best for you and your baby.

What to talk about with a psychiatrist when planning a pregnancy

• Your risk of developing postpartum psychosis
• The risks and benefits of medication in pregnancy and after birth
• Preventive strategies
• How to care for yourself during pregnancy

You should be under the regular supervision and continuing care of your psychiatrist and obstetrician throughout. Discuss the risks and benefits of taking medication during pregnancy and lactation, and any side effects, with your psychiatrist. Report signs of relapse as soon as you or your family notice them, and keep your required visits to the radiologist to make sure your baby is healthy.

Admission is required in case of relapse

If you start to have symptoms of postpartum psychosis, you need to be seen urgently. Most women with postpartum psychosis need to be treated in hospital, where the necessary treatment will be started. You may also be offered electroconvulsive therapy, which is considered safe and effective.

Supporting a partner through postpartum psychosis

It is very stressful when your partner has postpartum psychosis. Here are a few things that can help:

• Ask for help as soon as your partner first has symptoms — this is particularly important if she does not understand that she is ill
• Keep home life as calm and organised as possible, and take time to prepare for when mum and baby return home
• Once your partner and baby are home, try to be as calm and supportive as you can, and take time to listen
• Help with housework, cooking, looking after the baby, and night-time feeds as much as possible
• Let your partner get as much rest and sleep as possible
• Let other family members and friends help with shopping and cooking — this frees up more of your own time to spend with your partner and baby
• Try not to have too many friends and relatives visiting, and keep your home as calm and quiet as possible

It can be very stressful and tiring when your partner is recovering from postpartum psychosis. Stay healthy by exercising, eating well, and getting enough rest — don't use drugs or alcohol to cope. Be patient; it takes time for someone to get over an episode of postpartum psychosis. In the long term, talking about your experiences can help your recovery, and counselling or couple therapy may be helpful for some couples.

How long does recovery take?

It can take 6 to 12 months or more to recover from postpartum psychosis. The most severe symptoms tend to last 2 to 12 weeks. You are likely to recover fully, but you may have another episode in the future.

After a postpartum psychosis, you may feel depressed, anxious, and have little social confidence. It can take time to come to terms with what has happened, and it's normal to feel some sadness about missing out on parts of early motherhood. It can take time to rebuild confidence in relationships and friendships, but most women get back to feeling like their usual selves again.

Will it happen again after a future pregnancy?

Many women who have had postpartum psychosis go on to have more children, but there is a high risk of having another episode — about 1 in 2 (50%) of women who have had postpartum psychosis will have it again after the birth of another baby. With the right care, if you have another episode, you should be able to get help quickly.

Am I likely to have an episode of psychiatric illness at other times?

Over half of women with postpartum psychosis will have a further episode of illness not related to childbirth. Avoiding having further babies does not guarantee that you will stay well.

Postpartum psychosis is frightening, but it is treatable, and most women recover fully. If you notice any of the symptoms above in yourself or someone you love, don't wait — reach out to your psychiatrist or obstetrician right away. For a broader look at emotional wellbeing through pregnancy, see Pregnancy and Your Mental Health: What to Expect, and When to Ask for Help, or read about Bipolar Disorder in Pregnancy and Postpartum.