Management of postpartum psychosis

As postpartum psychosis is a serious mental health condition, it is very important to seek help immediately – so that timely and appropriate management can stabilise the woman’s energy, thinking, behaviour and moods.

Treatment will almost always require admission to a psychiatric hospital.  This will allow the woman to be in a safe environment where she can be closely monitored by health professionals. Some hospitals have mother and baby units, which enable the baby to stay with the mother and where both mother and baby can be monitored by health professionals. This allows the mother to remain close to her baby, ensure the needs of the baby are being met and encourages ongoing close contact between them.

Medical treatment

Medication is necessary for the treatment and management of postpartum psychosis, in order to address the chemical imbalance that is leading to the range of extreme symptoms that the woman is likely to be experiencing.

Use of medications requires ongoing monitoring – both in terms of the impact on the mother herself and her infant. For this reason being in a hospital setting provides this opportunity for close monitoring whilst the woman stabilises.

A specialist psychiatrist should be consulted when prescribing medications for puerperal psychosis. There are three different types of medications that may be used to treat the range of symptoms:

  • Mood stabilisers – work to stabilise mood and help reduce the likelihood of the symptoms reoccurring (relapse). The most common mood stabiliser is lithium. Other types of mood stabilisers (which are also used to manage epilepsy) that may be used are sodium valporate, carbamazapine and lamotrigine.
  • Antidepressants – are used to treat the symptoms of depression that are part of the ‘depression’ part of the disorder.
  • Antipsychotics – assist with both manic and psychotic symptoms such as delusions or hallucinations.

It is also important to note, that medications should not be prescribed, changed or stopped without discussion with a specialist psychiatrist who is best placed to assess the risks and benefits of the range of treatments for the mother and her baby.

If breastfeeding, it is important to discuss this with the specialist health professional as some particular medications (sodium valporate and clozapine) are not recommended and others (such as lithium) should be used cautiously, and their impact on the mother and baby (if breastfeeding need to be monitored closely).

I expressed for a while in hospital in the false hope of breastfeeding when I returned home. All milk was tipped down the sink as it was considered unsafe. The reality was that I would be on anti-psychotics and mood stabilisers for many months to come and my baby would develop a happy bottle feeding routine with my mother and husband. When I returned home I was able to share in her feeding routine at a pace that suited my very gradual recovery.

As sleep, together with medications is also an important part of treatment and recovery for puerperal psychosis, the advantages and disadvantages of breastfeeding need to be discussed with your health professional so that you can make a decision about breastfeeding that best meets the needs of the mother, family and infant.

Electroconvulsive therapy

Electroconvulsive Therapy (ECT) is a specialist treatment that may be essential in the treatment of postpartum psychosis.  By stimulating the neurones in the brain via an electric current, ECT is an effective way of specifically treating the symptoms of mania, psychosis (bizarre thinking) and severe depression.

The only thing that got me out of it was the ECT. I know they had to sedate me to get me to sleep and calm me down but I do feel that they over medicated me and should have just done ECT straight away. I know it’s seen as controversial but I think the stigma around it needs to be removed and people need to understand more about it so they’re not scared of it.

This treatment is provided in major hospital settings and the woman is closely monitored to evaluate the impacts of the treatment on the woman’s recovery from postpartum psychosis. Whether the mother and baby are cared for together or separately will depend upon how severe here condition is, the specific needs of the mother and family members and the availability of mother and baby unit beds. 

There are safe and effective treatments for postpartum psychosis, and getting help as soon as possible can help reduce the impacts of this serious mental health condition on the mother, her partner, the infant and other members of the family.  

Recovery and future pregnancies

Recovery can be slow, and take time.

It is recommended that recovery requires a low stimulus environment, with minimum stress and maximum sleep. Hence whilst an extensive network is essential to provide the necessary medical, emotional and practical  support – too many visitors can be overwhelming.

If you remain on medication over time and are considering becoming pregnant again, it is vital to discuss this with a specialist. If you are taking mood stabilisers, it is also recommended that high levels of folate are taken prior to becoming pregnant and in the first trimester of pregnancy to reduce the small chance of increased birth defects associated with these medications.

Developing a relapse prevention plan with a specialist is strongly advised to help you and your family identify and prepare should the condition reoccur.

I developed I developed an “Advanced Agreement” which provides a basis for responding early to potential relapse. It details my treatment preferences and is shared with my medical team.

Such a Plan, may also contain information including:

  • Your early warning signs – e.g. sleeplessness, elevated mood, very active/busy, skipping meals, being overly suspicious, feeling agitated
  • Your vulnerable periods – such as returning to work
  • Your self-care strategies – good sleep, daily exercise, eating well, working part time, socialising with friends, taking holiday
  • Identifying your sources of help and assistance in advance – this is likely to include additional social supports as well as appointments with specialists throughout pregnancy to monitor your mood and identify and possible symptoms.

A tailored relapse prevention and early response plan shared with the treatment team can provide assurance and an important safety net – for the whole family.