Postnatal psychosis

Also called postpartum psychosis. Learn about postnatal psychosis, signs to look for, treatment options and recovery
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Found in: Mental Health Conditions
Date: September 2022

About postnatal psychosis

Many people experience mild, short-lived mood or anxiety symptoms after having a baby, sometimes referred to as the “baby blues”. About 2 of every 10 people will experience perinatal anxiety or depression  after giving birth, with a combination of low mood, sleep changes, appetite changes, fatigue, hopelessness, a loss of self-confidence and anxiety, lasting longer than two weeks. Both these experiences are very common in families with new babies. 

Postnatal psychosis, on the other hand, is a lot rarer and more severe than perinatal anxiety and depression, and typically starts in the first few days or weeks after giving birth.

Only about 1 in 1000 people will experience postnatal psychosis. While having a history of bipolar disorder or schizophrenia increases the risk for postnatal psychosis, about half of people with postnatal psychosis have not experienced psychosis or other mental health difficulties before at all.

Postnatal psychosis involves symptoms of psychosis (being out of touch with reality) associated with changes in mood – either a depressed or an extremely high mood. It usually begins in the first two weeks after the child is born. There is a significant increase in risk of harm to the baby if the parent has postnatal psychosis, which is why early recognition and treatment as well as support are very important.

Outlook for postnatal psychosis

The course of postnatal psychosis can be quite variable, with some people making a rapid recovery and returning to their everyday activities and relationships within a few weeks. Others improve over a number of weeks but continue having residual symptoms or difficulties getting back to normal activities for some months. For a small minority, an episode of postnatal psychosis can lead to an ongoing psychotic condition such as bipolar affective disorder (manic depression) or schizophrenia. 

Myths about postnatal psychosis

Myth: People who have had an episode of postnatal psychosis are dangerous to others.  

Fact: NOT TRUE. The main myth about psychotic illnesses is the image of the dangerous psychotic continually portrayed by the media. People who have had an episode of postnatal psychosis are not necessarily dangerous to their baby or others. However, the presence of certain psychotic symptoms and unusual behaviour can increase the risk of neglect and or harm to the baby. Postnatal psychosis is therefore considered an emergency, as the parent’s symptoms can worsen very quickly, especially if they don’t receive prompt assessment and treatment, together with adequate support to monitor risk through the time of their illness.  

Outside these brief periods of increased risk, people with this condition are no more likely to pose any risk than anyone else.

What causes postnatal psychosis?

As with many mental health conditions, the exact cause of postnatal psychosis remains unknown, although it is known that it is not the fault of you or your partner.

Childbirth is considered a significantly challenging time for everyone. There are many adjustments to be made, and you will find yourself in stressful situations, including the birth itself. While anyone who gives birth is vulnerable, there are certain factors that increase the chances of developing postnatal psychosis. The strongest risk factor is a past history of a bipolar disorder and/or other psychotic disorders.

If you have had a mental illness in the past, and are worried about postnatal psychosis, talk to your midwife or doctor. With early recognition and treatment, and the right support, you will be able to reduce the risk and make a good recovery if you do experience postnatal psychosis.


Signs to look for (symptoms)

Mood disturbance AND being out of touch with reality (psychosis) are the key signs of postnatal psychosis.

Mood disturbance

  • persistently high or elated mood
  • extreme irritability, impatience, or anger
  • increase in sense of self-importance
  • feeling low, flat, tearful or emotional, or crying easily
  • feeling anxious or agitated
  • becoming very withdrawn and not wanting to talk or interact with others
  • being slowed down, tired, without energy or motivation to do anything
  • struggling or unable to care for yourself or your baby
  • decreased need for sleep or not wanting to sleep – some people feel a desperate need to sleep but just can’t switch off
  • increased amount and volume of talk, such that it is difficult for others to interrupt
  • racing thoughts and rapid changes of topic when speaking
  • difficulty concentrating and easily distracted
  • picking up the baby frequently and not seeming aware of the baby’s needs
  • rapid changes of intense feeling states, from laughter to tears to anger and back again
  • increased activity, e.g. embarking on spring cleaning the house, making many plans for the future, etc.
  • increase in pleasurable activities with no regard for the consequences, such as spending sprees, unwise business investments or increased sexual activity.

Some people with postnatal psychosis may also experience a mixture of mood and anxiety symptoms, occurring all at the same time or in a fluctuating pattern. For example, they might appear to have an elevated (high) mood with irritability, increased speech and racing thought patterns, while underlying this they feel depressed and anxious.


Psychosis is a term used to describe a range of symptoms. They usually include thoughts or beliefs that are not within reality or that people around you think are strange and out of character. These are usually summarised as follows:

  • Delusions: These are thoughts or beliefs that are not based in reality: they feel very real to the person experiencing them but are not real to those around them. They can be unusual, strange and out of character. An example would be the belief that someone is plotting to harm you or your baby (where there is no obvious danger). 
  • Thought disturbances: This is when you feel your thoughts being interfered with. You may feel that thoughts are put into or taken out of your head, or spoken aloud so everyone can hear them. People with these experiences sometimes develop delusions to explain the experience, e.g. that thoughts are put into their head by a computer.
  • Hallucinations: This is when you hear, see, feel or smell something that is not there. Hearing voices, which others cannot hear or when there is no one else in the room, is very typical of psychosis. Sometimes these voices will talk about or to you. They will sometimes command you to do things. For some, these voices can be inside their head; occasionally, they may seem to come from within their body.
  • Changed perceptions: This means that you experience things differently from usual. Sensations may take on a different quality from normal, e.g. colours and sounds may seem unusually intense.

 Other signs of psychosis include:

  • Changed, mixed-up feelings: Your emotions may seem uncontrollable, intense and changeable, so you may laugh one minute then cry without knowing why.
  • Changed behaviour: If you have any of the symptoms above, you could behave quite differently to what is normal for you. You may become agitated, on edge and unable to sleep at night. Some behavioural changes are symptoms of the illness itself. Other people may notice that you have become careless in your dress and self-care, or have periods of seeming to do little and periods of being extremely active. You may behave in a very unusual or confused manner.
  • Loss of insight: This describes a lack of awareness that you are unwell and that the strange experiences are the result of being unwell. Some people with postnatal psychosis do not recognise their symptoms and need the assistance of friends or family to get treatment. 

Getting support

If you are concerned, or suspect you (or a loved one) has postnatal psychosis, it’s important to talk to your midwife, doctor or Well Child Tamariki Ora nurse (through Plunket or another provider) immediately. In an emergency, dial 111. 

Please remember unattended and untreated postnatal psychosis places both you and your baby at an increased risk of harm and/or neglect. 

None of these feelings are your fault. Please don’t hesitate to reach out and get the necessary help for your or your loved one’s treatment and recovery.

Close monitoring of risk by a skilled health professional is critical during this period. When risk is present, high levels of support, or separation of parent and baby until the risk has passed, may sometimes be necessary.

Treatment options

Treating postnatal psychosis can involve a number of options, each of which will be tailored to your individual situation.  

Your doctor will recommend a mix of treatment options that best suit you. This will usually include medication as well as talking therapy. 

If you are considering stopping treatment, please always talk to your doctor or health professional about your concerns. It’s important to work together to find some compromise that will ensure continuing wellness but address your concerns about the treatment.  

If you are on medication, it is very important that the decision to stop taking it is made with the input of your doctor and anyone else involved in your treatment.


Postnatal psychosis often requires treatment with antipsychotic drugs, mood stabilisers and/or antidepressants. These are usually prescribed by a specialist psychiatrist. The actual medication you are prescribed will depend on how severe your condition is and how you are feeding your baby. 

Research regarding which medications are safe in pregnancy or while breastfeeding and which are useful for treating postnatal psychosis is ongoing. When looking at medication during pregnancy or while breastfeeding, the risks relating to becoming mentally unwell for both you and your baby need to be weighed against the risks of treatment with medication. It is therefore most important that you check with your doctor about the latest information on which medications are considered safe and effective. 

The medication you are prescribed may make you quite sleepy. Although this will help you sleep at night, which can really be very helpful, it is important that you and those supporting you know this, so you can ensure there is someone else around to help you with your baby.

If you are prescribed medication, you should receive clear instructions about how you should take it and what precautions are necessary.

Find out:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for and what their side effects (short- and long-term) are
  • whether the medication could interact with any other medication you might be prescribed or taking

It’s important the doctor knows all the medications (including any herbal medicines) you are taking, as some taken together can be dangerous. You should not mix different types of antidepressants unless instructed by your doctor.  

Alcohol and other drugs may make your symptoms more intense and are not good for the baby.

Other strategies to support recovery

Psychoeducation (providing education)

A health professional works with you, and your family/whānau, to provide information about the condition, its treatment, and how to support recovery. Central to this approach is that family/whānau, along with the person experiencing the condition, are critical members of the treatment team. Together, you identify ways of dealing with symptoms, difficult-to-understand behaviour and stress.   

The early signs that indicate a possible relapse are identified and a plan of early response is developed. There is also attention to the kinds of support that everyone needs, and how to get this support.

Even after you have recovered, you might still feel sad or distressed about your recent experience and about missing out on some of the early time with your baby. This is normal, and talking to a therapist, friends, family, or your doctor can help.

It may take some time to restore your confidence as a parent and to establish your relationship with your baby.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.  Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.  When considering taking any supplement, herbal or medicinal preparation, you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking. 

Physical health

It is also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. Being in good physical health will also help your mental health. 

Thanks to Mark Huthwaite, consultant psychiatrist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.