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. 

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• becoming very withdrawn and not wanting to talk or interact with others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

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. 

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.