Postpartum psychosis: what it is, symptoms and treatment

Postpartum psychosis is a serious mental illness that can affect someone soon after having a baby. It is sometimes called puerperal psychosis or postnatal psychosis. The NHS says it affects around 1 in 1,000 mothers after giving birth and should not be confused with the baby blues, which are normal mood changes that usually last only a few days. Psychosis means losing touch with reality, with hallucinations, delusions or confused thinking.

It is an illness, it is treatable, and the NHS says most people recover fully with the right treatment. The challenge is recognising it quickly, because it can get worse rapidly and the person may not realise they are unwell.

The NHS says symptoms usually start suddenly within the first 2 weeks after giving birth, often within hours or days, and more rarely they can develop several weeks after the baby is born. They can include a mix of the following.

• Hallucinations: hearing, seeing, smelling or feeling things that are not there.

• Delusions: suspicions, fears, thoughts or beliefs that are unlikely to be true.

• Mania: feeling very high or overactive, talking and thinking too much or too quickly, restlessness or losing normal inhibitions.

• Low mood: signs of depression, being withdrawn or tearful, lacking energy, loss of appetite, anxiety, agitation or trouble sleeping.

• Sometimes a mixture of manic and low mood, or rapidly changing moods.

• Feeling very confused.

The NHS says to see a GP immediately if you think you, or someone you know, may have developed symptoms of postpartum psychosis, and to request an urgent assessment on the same day. You can call NHS 111 if you cannot speak to a GP or do not know what to do next, and your midwife or health visitor may also be able to help you access care. If you already have a care plan because you have been assessed as being at high risk, call your crisis team. Go to A&E or call 999 if you think you or someone you know may be in danger of imminent harm.

Because the person may not recognise they are ill, the NHS says partners, family or friends may need to take the lead and take action.

The NHS says the most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to recover completely, but with treatment and the right support most people make a full recovery. An episode may be followed by a period of depression, anxiety and low confidence. Some mothers have difficulty bonding with their baby after an episode, or feel sadness at missing out on time with their baby. With support from partner, family, friends and the mental health team, these feelings can be overcome.

Many people who have had postpartum psychosis go on to have more children. The NHS says there is about a 1 in 2 chance of another episode after a future pregnancy, but you should be able to get help quickly with the right care and the risks can be reduced with appropriate interventions.

The NHS says treatment usually happens in hospital, ideally with the baby in a specialist psychiatric unit called a mother and baby unit (MBU), although you may be admitted to a general psychiatric ward until an MBU is available.

The NHS says it is not clear what causes postpartum psychosis, but you are more at risk if you already have a diagnosis of bipolar disorder or schizophrenia, have a family history of mental illness, particularly postpartum psychosis (even if you have no history of mental illness yourself), or developed postpartum psychosis after a previous pregnancy.

Because the NHS says it can develop suddenly, it helps for new parents and their families to know the warning signs.

The NHS says if you are at high risk you should have specialist care during or before pregnancy and be seen by a perinatal psychiatrist. A pre-birth planning meeting at around 32 weeks of pregnancy should bring together everyone involved, including your partner, family or friends, mental health professionals, midwife, obstetrician, health visitor and GP. You should get a written care plan explaining how you and your family can get help quickly, and in the first few weeks after birth you should have regular home visits from a midwife, health visitor and mental health nurse.

Postpartum psychosis is treated through NHS emergency, crisis and perinatal mental health services, including mother and baby units, and this is not something to arrange through a private appointment while waiting. Private perinatal psychiatrists can offer planning and ongoing support in some areas, but acute admission is arranged through the NHS pathway described above.