Postpartum psychosis

What is postpartum psychosis?

Postpartum psychosis is a medical emergency. Women and birthing people who have been diagnosed with bipolar disorder or schizophrenia before their pregnancy have a higher risk of getting it. But it can happen to people who have not had a mental illness before too. 

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

It can be scary, but most people recover fully with the right treatment.

What are the symptoms?

Symptoms of postpartum psychosis include:

• being severely depressed and/or manic (extremely energetic and talkative)
• quick changes of mood (up and down)
• being restless and agitated
• being very withdrawn and not speaking
• 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 others
• behaviour that is out of character
• 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 can change over time. 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

Watch people talk about their experiences of postpartum psychosis in the video below.

How common is it?

Postpartum psychosis is much less common than ‘baby blues’ or postnatal depression. Around 1 in 1,000 women and birthing people get postpartum psychosis.

Who is more likely to get postpartum psychosis?

Postpartum psychosis is not your fault. It isn’t caused by something you have done. Some people get postpartum psychosis even if they have never had a mental health problem before, but 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 has 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 about your condition as soon as you can, 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 keep you well. They will also make a plan with you to make sure you stay as well as possible and get help quickly if you need it.

You should be visited often 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, or with anyone who is helping you out, so that they can be watchful too.

Will I get postpartum psychosis again?

Sadly, there is a high risk of having postpartum psychosis again. About half of people who had postpartum psychosis will have it again after the birth of another baby. But, with planning and the right care, you should be able to get help quickly. Many women and birthing people who had postpartum psychosis go on to have more children. 

When to get medical help

Postpartum psychosis is an emergency. Some people become very unwell, very quickly. If you suspect that you or someone you know may have it, contact your GP (or your mental health team) to be seen the same day, or go straight to A&E.

If you have bipolar disorder or a schizoaffective disorder make sure your healthcare team is aware of it. Both can increase your risk of getting postpartum psychosis

“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 most likely be treated with medication. It’s vital to get help as soon as possible because if you get treated quickly you will usually recover well. 

Most people 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 on offer 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 for a while. Every effort will be made to keep mum and baby together if at all possible, though.

It can take from 6 months to over a year to recover from postpartum psychosis.

Breastfeeding and medication

You can breastfeed while taking some types of medications. You may wish to 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 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 and birthing people worry that this means people think they can’t care for their baby. This isn’t often 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 people with postpartum psychosis.

Social services 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 them.

You may need extra help from loved ones while you are unwell and during your 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 space in a mother and baby unit. This is very much a last resort, but it can happen. Find out more about how social services can help you and your baby.

Supporting someone with postpartum psychosis

It can be very distressing to see a partner, friend or loved one with postpartum psychosis. Ask for help on behalf of someone as soon as they have symptoms, because they might not know they are ill.

The organisations listed at the end of this article can help you with your worries. They are there for both people with postpartum psychosis and their loved ones.

Try to:

• support them as best you can and try to keep their home life calm
• take time to listen to them
• help with housework and cooking
• help with looking after the baby, and with night-time feeds if you can, so your loved one can get the rest they need
• get help from other people with the chores too so that you can provide emotional support
• not have too many guests
• be patient. It takes time for someone to get over postpartum psychosis
• stay healthy yourself by staying active, eating well and getting enough rest. Don’t use drugs or alcohol to cope.

You can also ask to speak to the perinatal psychiatrist or other staff involved in your relative or partner’s care, if you have any worries or questions. They will want to support and help you too. 

You might also want to try counselling or therapy to help you both recover.

More information and support

The following organisations offer further information and support if you or someone you know has postpartum psychosis:

Action on Postpartum Psychosis

Association for Post Natal Illness

PANDAS Foundation UK.