What medicines are recommended for postpartum psychosis?

Mood stabilisers

If you are taking a mood stabiliser (also known as an anticonvulsant or anti-epileptic medication), it is important that you discuss the benefits and risks of these medications with your doctor as soon as possible. There may be other treatment options that would be safer for your baby during pregnancy and breastfeeding. Your doctor can contact a specialist psychiatrist for advice on the best medication for you.

You can access up-to-date information about the safety of these medications during pregnancy or breastfeeding from:

NHS inform guide to help you choose between the medicines to help the symptoms of depression in pregnancy and breastfeeding.
the BUMPS (Best Use of Medicine in Pregnancy Site) provides reliable, evidence-based information about use of medicines in pregnancy, in the form of freely available patient information leaflets. You can register for the site to create your own BUMPS resource with medicines information specific to your needs.

If you take mood stabilisers when you are planning a pregnancy or while you are pregnant, it is recommended that you also take a high dose of folic acid (5 mg/day) to support the development of your baby. This is a higher dose than recommended for all pregnant women (400 micrograms per day) and should be prescribed by your GP. It is particularly important in the first 12 weeks of pregnancy.

Folic acid is a vitamin that is recommended for all pregnant women for the first 12 weeks of pregnancy. It reduces the risk of problems in the development of your baby’s spinal cord and brain.

Sodium valproate

If you are taking sodium valproate and become pregnant, talk to your healthcare professional as soon as possible. Taking sodium valproate when you are pregnant can seriously harm your unborn baby. The benefits and risks of continuing valproate should be clearly explained to you by a psychiatrist.

If you are taking sodium valproate and become pregnant, your healthcare professional will help you to slowly stop taking it and change to another therapy.

You should not be prescribed sodium valproate as a new therapy when you are pregnant or if you are able to become pregnant.

If you have had your baby but could become pregnant again, you should not be prescribed sodium valproate unless:

there are no better options for you, and
you have a plan in place to avoid pregnancy by using long-acting contraception.

Lithium

Taking lithium during pregnancy has benefits and risks for you and your baby. Stopping taking lithium may increase the risk of having a relapse of your mental health condition during pregnancy or after birth. It is recommended you discuss your treatment with a specialist and agree a plan for monitoring the health of you and your baby during pregnancy and after birth.

If you are taking lithium during pregnancy, you will need closer monitoring of your lithium levels and kidney function. As your pregnancy progresses into the third trimester (28+ weeks), your blood tests will be taken more often and should be monitored closely before and after childbirth. You should be given information about side effects and signs of toxicity.

It is important to tell your maternity team you are on this treatment as lithium can interact with other medications.

Your dose of lithium may need to change as your pregnancy progresses and after you give birth.

If you are taking lithium and considering breastfeeding, you should discuss this with a specialist doctor. Lithium can reach the breastmilk so careful consideration is needed about whether or not this is safe for you and your baby.

Lamotrigine

If you are taking lamotrigine during pregnancy, closer monitoring is needed during pregnancy and for you and your baby after birth. Your dose of medication may need to be adjusted during pregnancy and after you give birth.

Antipsychotics

Antispychotics are medicines that reduce psychotic experiences such as hallucinations or delusion. They may also be used for other reasons.

Antipsychotics are safer to use than mood stabilisers during pregnancy or breastfeeding.

If you take antipsychotics, your healthcare professional will check your symptoms throughout your pregnancy to make sure the dose is right for you.

The decision on which antipsychotic is right for you is based on your response to taking antipsychotics in the past, the risk of relapse if you changed medicines, and whether or not you wish to breastfeed your baby.

If you take an antipsychotic when you are planning a pregnancy, are pregnant or breastfeeding, then an oral medication (such as a tablet or liquid) is usually preferred to an injection. However, if you are responding well to antipsychotics by injection, this might still be the best choice for you.

If you are taking antipsychotics while you are pregnant, healthcare professionals will monitor your and your baby’s health. The type of monitoring and how long monitoring will last will depend on the type of medication, the dose and the health of your baby. This is usually agreed as part of your birth plan with the healthcare professionals involved in your care.

One side effect of some antipsychotics is that they can make it more likely that you could have gestational diabetes (a temporary form of diabetes that develops during pregnancy). Your healthcare professional will monitor your health to check for gestational diabetes.

If you are taking clozapine during pregnancy, discuss this with your mental health professionals, who will help you understand the benefits and risks of taking this medication. You and your baby will need closer monitoring during pregnancy and after birth.