Treatments to help prevent psychosis in women who have just given birth

There is a small percentage of women for whom giving birth leads to psychosis. Postnatal psychosis affects one to two in every 1000 new mothers and is almost always a mood disorder accompanied by loss of contact with reality, hearing voices and seeing things (hallucinations), having strange beliefs (delusions), severe thought disturbance, and abnormal behaviour. It can be a life-threatening condition with an abrupt onset within a month of childbirth.

Postnatal psychosis is more common in first time mothers and the risk is greater for mothers who are single or in older age. Risk is also greater in those with past mental health problems, family history of mental illness, depression before pregnancy and hormone problems. The most common symptoms of postnatal psychosis are feeling excited, elated or high, not needing to sleep or the inability to sleep, feeling active and talking more or feeling very chatty. Other women with postnatal psychosis may have severe depression with delusions, hearing voices, little or no speech, mental numbness and stupor. Such symptoms are themselves distressing but can also lead to harmful behaviours which include suicide, child neglect and abuse, or even in some extreme cases killing their child. Without treatment postnatal psychosis can last many months, but if women do receive modern therapy the symptoms usually resolve within a few weeks, reducing the risk of harm to both mother and baby.
As well as treatment, prevention could save the lives of both the mother and her baby, improve the mother-baby relationship, and lead to better family relationships. Preventive interventions for postnatal psychosis aim at identifying women with risk factors, the early recognition of imminent psychosis through screening, and preventive drug therapy. 

This review investigated the best available evidence for interventions aimed at preventing postnatal psychosis. Unfortunately, no studies were found that could be included. Nevertheless, this review raises many unanswered questions and strongly suggests that future research on postnatal psychosis is much needed. Despite a growing interest in women’s mental health, knowledge and research on postnatal psychosis is still very limited. Future well-designed, well-conducted and well-reported studies are necessary to help improve prevention of symptoms and treatment for women with postnatal psychosis.

This plain language summary has been written by a consumer Benjamin Gray; Service User and Service User Expert. Rethink Mental Illness.

Authors' conclusions: 

This is not an empty review - it is a review full of unanswered questions. Despite growing interest in women’s mental health, the literature in the area of postnatal psychosis is still very limited. It seems that clinicians have no choice but to continue with their current practices guided solely by varied clinical judgement. Women at risk of postnatal psychosis and their relatives are justified to be disappointed in the medical/research fraternity. A post hoc PubMed topic (not methodology-specific) search identified mainly case series. Policy makers have no trial-based evidence upon which to base their guidelines. Certainly, preventive interventions for postnatal psychosis are difficult to justify with confidence without well-designed, well-conducted, and well-reported randomised studies. Available publications suggest that such studies are possible and funders of research may wish to make this work a priority.

Read the full abstract...

Postnatal psychosis is a worldwide life-threatening condition that affects one to two in every 1000 new mothers. It has an abrupt onset within a month of childbirth. Affected new mothers rapidly develop frank psychosis, cognitive impairment, and disorganised behaviours. Factors that increase the risk of postnatal psychosis include primiparous mothers who are single, women who are older, or with a past psychiatric history and family history of affective psychosis, prenatal depression and autoimmune thyroid dysfunction. The risk of a future postnatal recurrence is 25% to 57%. Preventive interventions for postnatal psychosis aim at identifying women with risk factors, early recognition of imminent psychosis through screening, and preventive drug therapy. Mood stabilisers, antipsychotic drugs and hormone therapy may be beneficial in the prevention of postnatal psychotic episodes in women at risk.


To investigate the best available evidence for interventions aimed at preventing postnatal psychosis.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2012 using the search strategy of the Cochrane Schizophrenia Group.

Selection criteria: 

All randomised controlled trials relevant to the prevention of postnatal psychosis.

Data collection and analysis: 

Two review authors inspected all citations to ensure reliable selection. If we had included relevant trials, we planned to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors would have independently extracted data. For homogenous dichotomous data, we planned to calculate the risk ratio (RR), 95% confidence interval (CI), and the number needed to treat to benefit/harm (NNTB/NNTH) on an intention-to-treat basis.

Main results: 

There are no included studies in this review. The electronic search produced three relevant references, among which we identified two old planned trials that seem never to have started, and one which we excluded a study because it was a report of a case series.