Postpartum Psychosis Symptoms and Treatment

There are many symptoms that occur in postpartum psychosis. These may include: ·

• feeling ‘high’, ‘manic’ or ‘on top of the world’
• low mood and tearfulness
• anxiety or irritability 
• rapid changes in mood
• severe confusion
• 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• being very withdrawn and not talking to people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
• feeling paranoid, suspicious, fearful
• feeling as if you’re in a dream world

delusions: these are odd thoughts or beliefs that are unlikely to be true. For example, you might believe you have won the lottery. You may think your baby is possessed by the devil. You might think people are out to get you.

hallucinations: this means you see, hear, feel or smell things that aren’t really there.

If you, your partner or family think that you have symptoms of postpartum psychosis, you need to be seen urgently. If you have been told during pregnancy that you have a high risk of postpartum psychosis, you may have a care plan. This should include emergency contact numbers for your mental health team or local crisis service.

You may not have this type of plan, or you may not have had any mental illness before. In that case you should see your GP urgently (the same day) or attend your local A&E department. If you are told you do not have postpartum psychosis but your symptoms worsen, you should make sure you are seen again.

Most women with postpartum psychosis need to be treated in hospital. Ideally you should be offered a bed in a Mother & Baby Unit (MBU). This is a specialist psychiatric unit where mothers with mental illness are admitted with their babies. You will be supported in caring for your baby whilst you have the care and treatment you need.

There are many parts of the country with no Mother and Baby Unit. Even where there are MBUs, there may not be a bed available. You may be admitted to a general psychiatric ward. If that happens, your partner or family will need to care for your baby. If you have nobody else who can look after your baby, social workers can find a temporary carer. This will only be until an MBU bed is available, or until you are well enough to care for your baby yourself. You may choose to be admitted to a general ward if the nearest specialist MBU is far from your home.

·                  Medication and breastfeeding

Most women with postpartum psychosis need treatment with medication. This is usually an antipsychotic, a mood stabilizer or both.

It is possible to breastfeed whilst taking some medications. Your psychiatrist can discuss the risks and benefits of medications in breastfeeding with you. You may be unable to breastfeed. There are several reasons for this. You may be too unwell, or you may be admitted to hospital without your baby. You may need a medication which is not safe in breastfeeding. Some women feel guilty about being unable to breastfeed, but you should not feel this way. If you have postpartum psychosis, it is not your fault. It is important for your baby that you have the treatment you need so that you get better.

·                  Help in caring for my baby

During the severe part of the illness you will probably need help caring for your baby. You are likely to need practical help. You may also need help to bond with your baby. Mother and Baby Unit (MBU) staff are trained to support you with all aspects of caring for your baby. If you do not go to an MBU, there are people who can help and support you once you go home. These include health visitors and mental health professionals. There may be a local perinatal or parent-infant mental health service. In some areas, Children’s Centre staff and/or voluntary organizations can also help.

It is normal to lack confidence with mothering after postpartum psychosis. Remember that most new mothers, who have not had an illness, also feel like this. You may find it hard to attend mother and baby groups when recovering from postpartum psychosis. Health visitors and community psychiatric nurses can give you one-to-one advice until you feel up to attending groups with other mothers.

Some mothers have difficulty bonding with their babies after an episode of postpartum psychosis. This can be very distressing. Usually these problems don’t last long. Most women who have had postpartum psychosis go on to have very good relationships with their babies. Talk to your health visitor or other professionals involved in your care. They can tell you what help is available in your area. Health professionals can support you in learning how to interact with and respond to your baby. You may find baby massage and other groups for new parents helpful.

·                  Care and support for you during recovery

Allow your partner, family or friends to help and support you while you get better (see section on partners below).

Usually you will need to have care from a mental health service until you fully recover. This team can advise you about treatment. They can support you and your family. You may have care from a perinatal or parent-infant mental health service.

These specialist teams do not exist in all areas. In that case your local community mental health team, health visitor and GP will continue to support you whilst you recover.

It is important to ask for advice about contraception. It is a good idea to avoid getting pregnant again too soon after an episode of postpartum psychosis.

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Postpartum Depression and Anxiety Symptoms.

• Feeling sad or depressed
• Irritable or angry at those around
• Difficulty bonding with the child
• Feeling anxious or panicky
• Problems with eating or sleeping
• Having upsetting thoughts that cannot be brought out of mind
• Feeling out of control or going crazy
• Feeling that one should not have become a mother
• Worried that one might hurt their baby or themselves. 

Any of these, and many more are the indications of perinatal mood or anxiety disorder, such as postpartum depression. While many women experience some mild mood changes during or after the birth of a child, 15 to 20% of Women experience more significant symptoms of depression or anxiety. Kindly note that with informed care worsening of these symptoms can be prevented and fully recover.

Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth. There are advanced treatment options available which helps to recover.  Although the term “Postpartum depression” is most commonly used, there are actually several forms of illness women may experience including

Antepartum or Postpartum Depression: PPD, a woman with PPD might experience feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, trouble concentrating, thoughts of hopelessness and sometimes even thoughts of harming the baby or herself.

Antepartum or Postpartum Anxiety: PPA, a woman with PPA may experience extreme worries and fears, often over the health and safety of the baby. Some women have panic attacks and might feel shortness of breath, chest pain, dizziness, a feeling of losing control and numbness and tingling.

Postpartum Obsessive-Compulsive Disorder: Women with PPOCD can have repetitive upsetting and unwanted thoughts or mental images and sometimes they need to do certain things over and over to reduce the anxiety caused by those thoughts. These women find these thoughts very scary and unusual and are very unlikely to ever act on them.

Postpartum Post Traumatic Stress Disorder: PPTSD is often caused by a traumatic or frightening childbirth, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event.

Postpartum Psychosis: PPP sufferers see and hear voices or images that others can’t called hallucinations. They may believe things that aren’t true and distrust those around them. They may also have periods of confusion and memory loss, and seem manic. This severe condition is dangerous so it is important to seek help immediately.

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Postpartum Depression

Postpartum depression is a feeling of extreme sadness and related psychologic disturbances during the first few weeks or months after delivery.

• Women who have had depression are more likely to develop postpartum depression.

• Women feel extremely sad, cry, become irritable and moody, and may lose interest in daily activities and the baby.

• A combination of counseling and antidepressants can help.

The baby blues—feeling sad or miserable within 3 days of delivery—is common after delivery. Women should not be overly concerned about these feelings because they usually disappear within 2 weeks. Postpartum depression is a more serious mood change. It lasts weeks or months and interferes with daily activities. About 10 to 15% of women are affected. Very rarely, an even more severe disorder called postpartum psychosis develops.

The causes of sadness or depression after delivery are unclear, but the following may contribute:

• Depression or another psychologic disorder that was present before or developed during pregnancy

• Close relatives who have depression (family history)

• The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones)

• Stresses of having and caring for a baby (such as difficulties during labor and delivery, lack of sleep, fatigue, loss of freedom, and feelings of isolation and incompetence)

• Lack of social support

• Marital discord

• Other significant life stressors such as financial difficulties or recent move
If women have had depression before they became pregnant, they should tell their doctor or midwife. Such depression often evolves into postpartum depression. Depression during pregnancy is common and is an important risk factor for postpartum depression.

Symptoms

Symptoms may include frequent crying, mood swings, and irritability as well as feelings of extreme sadness. Less common symptoms include extreme fatigue, difficulty concentrating, sleep problems, loss of interest in sex and other activities, anxiety, appetite changes, and feelings of inadequacy or hopelessness. Women have difficulty functioning. They may have no interest in their baby.

In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.

Fathers may also become depressed, and marital stress may increase.
Without treatment, postpartum depression can last months or years, and women may not bond with their infant. As a result, the child may have emotional, social, and cognitive problems later. About one in three or four women who have had postpartum depression have it again.

Diagnosis

Early diagnosis and treatment is important for women and their baby. Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks after delivery or if they have thoughts about harming themselves or the baby. If family members and friends notice symptoms, they should talk with the woman and encourage her to talk to a doctor.

Doctors may ask women to fill out a questionnaire designed to identify depression. They may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.

Preventing Depression After Delivery

Women can take steps to combat feelings of sadness after having a baby:

• Getting as much rest as possible—for example, by napping when the baby naps

• Not trying to do everything—for example, by not trying to keep a spotless house and make home-cooked meals all the time

• Asking for help from family members and friends

• Talking to someone (husband or partner, family members, or friends) about their feelings.

• Showering and dressing each day

• Getting out of the house frequently—for example, to run an errand, meet with friends, or take a walk

• Spending time alone with their husband or partner

• Talking with other mothers about common experiences and feelings

• Joining a support group for women with depression

Treatment

If women feel sad, support from family members and friends is usually all that is needed. But if depression is diagnosed, professional help is also needed. Typically, a combination of counseling and antidepressants (see Mood Disorders: Drugs Used to Treat Depression) is recommended. Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the baby to remain with them. They may need antipsychotic drugs (see Schizophrenia and Delusional Disorder: Antipsychotic Drugs) as well as antidepressants.

Women who are breastfeeding should consult with their doctor before taking any of these drugs to determine whether they can continue to breastfeed (see Taking Drugs While Breastfeeding). Many options are available in order to allow continuation of breastfeeding.

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