Postnatal depression and perinatal mental health
How specialist teams assess and treat mental illness during pregnancy and in the first year after birth, including postnatal depression, anxiety and the psychiatric emergency of postpartum psychosis.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Perinatal mental illness, including postnatal depression and anxiety, is common, treatable and not your fault; specialist perinatal teams can help.
- Postpartum psychosis is a psychiatric EMERGENCY: it comes on rapidly in the days after birth, and needs urgent same-day help - call 999 or go to A&E if there is any risk to you or your baby.
- Treatment is individualised, including talking therapies and, where needed, medicines that can be chosen carefully to be as safe as possible in pregnancy and breastfeeding.
- If you have thoughts of suicide, of harming yourself, or of harming your baby, get help immediately. In an emergency, call 999 or go to A&E anywhere in the UK. For urgent mental-health support, call 111 and choose the mental-health option in England, Scotland or Wales; in Northern Ireland call Lifeline free on 0808 808 8000 or your GP out-of-hours service. You can also call Samaritans free on 116 123 or text SHOUT to 85258. These thoughts are taken seriously and help is available.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Early help shortens how long you feel unwell and supports your bond with your baby
Private outpatient care alone is not appropriate for a suspected emergency such as postpartum psychosis, which needs urgent assessment and usually...
You are heard, the problem and its urgency are worked out, safety is checked, and you leave with a plan and clear advice on what to do if things get worse.
A named contact and an urgent route to help, day and night, including clear emergency advice.
You are heard, the problem and its urgency are worked out, safety is checked, and you leave with a plan and clear...
Talking therapy and support begin, and any medicine is started and monitored. For most people the worst symptoms...
If this is the diagnosis, urgent treatment is needed, usually in hospital. The most severe symptoms often settle...
Mood, sleep, anxiety and bonding gradually improve. Full recovery, especially after postpartum psychosis, can take...
What is perinatal mental health care?
Perinatal mental health covers the whole period from becoming pregnant until around a year after your baby is born. Many people experience mental-health difficulties at this time. They are common, treatable, and not your fault.
Postnatal depression is more than the short-lived 'baby blues' in the first week or two. It is persistent low mood, tearfulness, anxiety, exhaustion, difficulty bonding or enjoying things, and sometimes frightening thoughts, lasting longer and affecting daily life. Depression and anxiety can also happen during pregnancy (antenatal depression and anxiety).
Postpartum psychosis is different and much rarer. It is a psychiatric emergency. It usually comes on suddenly in the days after birth, with symptoms such as feeling very high or very low, confusion, racing thoughts, not sleeping, and losing touch with reality. It needs urgent assessment the same day, and in an emergency you should call 999 or go to A&E.
Care in this period is tailored to you and your baby. It is delivered by GPs, midwives, health visitors and, for more serious or complex illness, specialist perinatal mental health teams and perinatal psychiatrists. This guide is general information, not personal medical advice.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Baby blues
Tearfulness, mood swings and feeling overwhelmed in the first week or so after birth. Very common, usually settles on its own within a couple of weeks and is not an illness.
Antenatal depression and anxiety
Low mood, worry or panic during pregnancy. Often missed because changes are blamed on pregnancy itself, but it is treatable and worth raising.
Postnatal (postpartum) depression
Persistent low mood, anxiety, exhaustion, difficulty bonding or enjoying things, lasting beyond the first couple of weeks and affecting daily life. Very treatable.
Perinatal anxiety and OCD
Intense worry, panic, or distressing intrusive thoughts, sometimes about harm coming to the baby. Frightening, but treatable, and having the thoughts does not mean you will...
Preparing for your treatment
- If you can, note how you have been feeling, for how long, and how it affects daily life and looking after yourself and your baby.
- Write down any thoughts that frighten you, including any thoughts of harming yourself or your baby, so you can share them safely.
- List all your medicines, including any mental-health medicines, and whether you are pregnant or breastfeeding.
- Note your mental-health history and any family history, especially bipolar disorder or postpartum psychosis, which raise the risk.
- Think about your support at home and who can help with the baby.
- Bring your partner, a relative or a friend if that helps, and your maternity notes if you have them.
- Be reassured that perinatal teams are used to these conversations and will not judge you or assume you cannot care for your baby.
What happens
At an assessment, a clinician gives you time to describe how you feel and what has been happening, and asks about your mood, sleep, anxiety, any frightening thoughts, your history and your support at home. They will ask, sensitively, about thoughts of harming yourself or your baby, so the right help can be offered. This is routine and is about keeping you both safe.
They will work out what is going on, for example baby blues, depression, anxiety or, rarely, something more serious, and how urgent it is. Most perinatal mental illness is managed in the community by your GP, health visitor or a specialist perinatal team.
Together you agree a plan. For depression and anxiety this often starts with talking therapy and support, with medicines offered where needed. If you already take a mental-health medicine, a specialist can help you weigh the options in pregnancy and breastfeeding rather than simply stopping. If postpartum psychosis is suspected, you will be assessed urgently and usually need treatment in hospital, ideally a Mother and Baby Unit so you can stay with your baby.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Private outpatient care alone is not appropriate for a suspected emergency such as postpartum psychosis, which needs urgent assessment and usually hospital care.
- Stopping mental-health medicines abruptly in pregnancy without specialist advice can be harmful, as untreated illness also carries risk.
- Reassurance alone is not enough if there are thoughts of harming yourself or your baby, which need urgent support.
- It is not the right route if symptoms suggest a physical cause, such as a thyroid problem or severe infection, that needs investigating.
Delay or rearrange if…
- There are thoughts of suicide, of harming yourself or of harming your baby - seek urgent help first.
- There are signs of postpartum psychosis - this needs same-day emergency assessment, not a routine appointment.
- A physical illness such as severe infection, bleeding or a thyroid problem may be contributing and needs checking.
- Decisions about medicines in pregnancy or breastfeeding are pending specialist input, so they can be made safely.
Alternatives to discuss
- NHS perinatal mental health teams, your GP and your health visitor, who lead most perinatal care.
- Talking therapies through your local NHS or HSC psychological-therapies service, often a first step for depression and anxiety. In England this service is often called NHS Talking Therapies and may accept self-referral; in Scotland, Wales and Northern Ireland the name and referral route differ, so ask your GP, midwife or health visitor how to access it where you live.
- Peer support, including charities such as Action on Postpartum Psychosis and the Maternal Mental Health Alliance member organisations.
- Practical and social support, and support for partners, which can ease pressure and aid recovery.
- Watchful support for baby blues, which usually settle without specific treatment.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Early help shortens how long you feel unwell and supports your bond with your baby
- A clear assessment tells apart baby blues, depression, anxiety and rarer emergencies, so you get the right care
- Specialist perinatal teams can tailor treatment, including medicine choices, to pregnancy and breastfeeding
- Talking therapies can ease low mood, anxiety and distressing thoughts without medicine for many people
- Mother and Baby Units allow mothers with severe illness to be treated without being separated from their baby
- Treating a parent's mental health also supports the baby's wellbeing and the wider family
Risks & complications
- Talking about painful feelings, or about frightening thoughts, can be upsetting at first
- Worry about being judged or about social services, when in fact the aim is to support you and your baby
- Recovery can take time, and finding the right therapy or medicine may take more than one attempt
- Side effects from any medicine started, which a specialist will weigh against the risks of untreated illness
- Difficult decisions about medicines in pregnancy or breastfeeding, where there is rarely a perfect option
- Symptoms being missed or blamed on normal pregnancy or new-parent tiredness
- Postpartum psychosis, a psychiatric emergency that can develop rapidly and needs urgent treatment
- Thoughts of suicide, of harming yourself, or of harming your baby, which need immediate help
Two things matter most. First, untreated perinatal illness carries real risks for you and your baby, so getting help is safer than struggling on. Second, postpartum psychosis is an emergency: if someone becomes confused, stops sleeping, seems very high or very low, or loses touch with reality in the days after birth, seek urgent help the same day, and call 999 or go to A&E if there is any risk. Decisions about medicines in pregnancy and breastfeeding should be made with a specialist, who can usually find a reasonable option rather than leaving illness untreated.
Published figures to discuss
How common perinatal mental illness is, and how people respond to treatment, vary widely depending on the condition, its severity, personal and family history, and support. Some figures are reasonably well established, such as postpartum psychosis affecting about 1 in 1,000 mothers and a high chance of recurrence after a future birth. Many other outcomes, including individual response to a particular therapy or medicine, cannot be given as precise percentages, so we describe them in words.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Postpartum psychosis after birth | About 1 in 1,000 mothers (around 0.1%) | Higher in those with bipolar disorder, a previous episode of postpartum psychosis, or a strong family history. It is an emergency needing urgent treatment. | NHS - Postpartum psychosisnhs.ukPublished figure |
| Recurrence of postpartum psychosis in a future pregnancy | Reported around 1 in 2 (roughly 50%) in some studies, higher with bipolar disorder | Why pre-pregnancy planning with a perinatal specialist is so valuable, to allow monitoring and early treatment. | NHS - Postpartum psychosisnhs.ukPublished figure |
| Suicide or infant-safety risk | Must be assessed urgently when present | Intrusive thoughts, intent, command hallucinations, severe insomnia, agitation or delusional beliefs need specialist perinatal/crisis input. | NHS - Postpartum psychosisnhs.ukSource-linked context |
| Medication and breastfeeding balance | Individualised | Stopping effective medication can be risky; infant exposure, maternal relapse risk and alternatives should be discussed together. | NHS - Postpartum psychosisnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery as such. Recovery from perinatal mental illness happens over weeks to months, alongside caring for your baby. Many people make a full recovery, including most people with postpartum psychosis, with the right treatment and support.
- Good days and bad days rather than a steady line of improvement
- Tiredness that takes time to lift, partly because of broken sleep with a baby
- Needing a few therapy sessions before they feel useful
- Bonding with your baby growing gradually as you recover, even if it felt hard at first
- Feeling anxious about recovery, or about a future pregnancy, which can be discussed and planned for
Aftercare
- Keep taking any medicine as prescribed and do not stop suddenly; talk to your team first, especially if breastfeeding.
- Use the talking therapy or support offered and give it time to work.
- Accept practical help with the baby, and protect rest and sleep where you can.
- Stay connected with your partner, family, health visitor and any peer support.
- Tell your team promptly if you feel worse, or have thoughts of harming yourself or your baby.
- Keep follow-up appointments so your recovery and any medicine are reviewed.
- Make sure you and those around you know the emergency signs of postpartum psychosis and what to do.
- A written plan covering therapy, any medicine and support
- Contacts for your perinatal team, GP and health visitor
- Clear advice on medicines in pregnancy or breastfeeding
- People who can help with the baby and with rest
- A named contact and a review date
- Emergency signs of postpartum psychosis written down for you and your family
- Crisis contacts saved: 999 or A&E anywhere in the UK; for urgent mental-health support, 111 mental-health option in England, Scotland or Wales, or Lifeline 0808 808 8000 in Northern Ireland; Samaritans 116 123; text SHOUT to 85258
⚠ Get urgent help if…
- Thoughts of suicide, of harming yourself, or of harming your baby - get help immediately. Call 999 or go to A&E anywhere in the UK; for urgent mental-health support call 111 and choose the mental-health option in England, Scotland or Wales, or in Northern Ireland call Lifeline free on 0808 808 8000. You can also call Samaritans free on 116 123 or text SHOUT to 85258
- Signs of postpartum psychosis in the days after birth: confusion, racing thoughts, not sleeping, feeling very high or very low, or losing touch with reality - this is an emergency, seek urgent help the same day
- Feeling unable to care for yourself or your baby, or that your baby would be better off without you
- Severe, persistent low mood, hopelessness or being unable to function
- Severe anxiety or panic, or distressing thoughts that will not go away
- Not eating, drinking or sleeping for a sustained period
- Any sense that you might act on frightening thoughts
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
With the right help, most people recover from perinatal depression and anxiety, and most people with postpartum psychosis make a full recovery. Treatment can ease symptoms, support your bond with your baby and help you feel like yourself again.
Recovery is not always quick or linear, and some people need more than one type of treatment before things improve. Getting help early generally leads to faster recovery. The aim is your wellbeing and that of your baby, not a tick-box outcome.
Recovery from a single episode is common, but some perinatal illnesses can recur, particularly in future pregnancies. After postpartum psychosis, for example, there is a significant chance, in some studies around half, of it happening again after another birth. This is why a clear plan for any future pregnancy, made with a perinatal specialist, is so valuable. It allows monitoring and early treatment rather than waiting for a crisis.
Related tests, treatments or support
Perinatal mental health care works alongside your maternity care, your GP, your health visitor and, where needed, specialist perinatal psychiatry. Support for partners and for bonding with the baby is part of the picture, and physical health, sleep and social circumstances are all taken into account because they affect mood.
Follow-up & long-term care
Your team will review how you are doing, especially after starting therapy or a medicine, and adjust the plan as you recover. If you have had a serious illness, follow-up includes planning ahead for any future pregnancy. You should always know who to contact if you feel worse, and you can get urgent help at any time if you have thoughts of harming yourself or your baby.
- Keep any medicine and therapy under regular review with your team rather than stopping suddenly.
- Protect sleep, rest and support as much as you can while caring for your baby.
- Notice early warning signs and act quickly if they return.
- If planning another pregnancy, see a perinatal specialist beforehand to make a plan.
- Keep emergency information to hand, especially the signs of postpartum psychosis.
Repeat, follow-on and what comes next
- Treatment often needs adjusting; it may take more than one therapy or medicine to find what helps.
- Some perinatal illnesses recur, especially after a future birth, so a plan for next time is important.
- Medicine choices in pregnancy and breastfeeding may need to be revisited as circumstances change.
- Reassessment is needed if symptoms change or worsen, or if a different diagnosis becomes likely.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and an urgent route to help, day and night, including clear emergency advice.
- Written warning signs of postpartum psychosis shared with you and your family.
- A clear plan covering therapy, any medicine, monitoring and review dates.
- Sensitive, repeated checking of mood and safety, and support for bonding with your baby.
- Pre-pregnancy planning for anyone who has had a serious perinatal illness.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How much psychiatrist, psychologist or specialist nurse time is involved
- The number and type of therapy sessions
- Whether specialist advice on medicines in pregnancy or breastfeeding is needed
- Whether care is community-based or, rarely, needs inpatient or Mother and Baby Unit care
- The cost of any medicines and of monitoring them
- How follow-up and any pre-pregnancy planning are arranged
- The psychiatrist and therapist fees involved
- How many therapy sessions are included and how further ones are arranged
- Whether assessment, a treatment plan and medicine advice are included
- What happens, and how urgent NHS care is accessed, if the illness becomes severe or an emergency
- Which medicines, if any, are included and how they are monitored
- Whether pre-pregnancy planning and reports are included
- Who to contact, day or night, if things get worse
On the NHS? Perinatal mental health care, including specialist perinatal teams and Mother and Baby Units, is available on the NHS; private care may be used for speed or choice, but emergencies and serious illness should go through urgent NHS care.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that untreated illness also carries risks, when discussing medicines in pregnancy or breastfeeding.
- Failing to ask, sensitively, about thoughts of harming yourself or your baby, so risk is missed.
- Not giving clear, written emergency advice about the signs of postpartum psychosis.
- Implying that seeking help is likely to lead to a baby being removed, which deters people from getting care.
- Stopping or switching medicines without a clear discussion of benefits, risks and alternatives.
Marketing red flags
- Claims to 'cure' postnatal depression quickly with a single supplement, drip or programme.
- Offering routine private outpatient care for what is actually an emergency.
- Advising that all medicines must be stopped in pregnancy, without specialist assessment.
- Downplaying the seriousness of postpartum psychosis or the need for urgent care.
- Pressure to commit to expensive packages without clear arrangements for emergencies.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Is this likely to be baby blues, depression, anxiety or something more serious, and how urgent is it?
- What are my treatment options, including talking therapies, and what would you suggest for me?
- If I need a medicine, which is safest for me in pregnancy or while breastfeeding, and what are the risks of not treating this?
- What are the warning signs of postpartum psychosis, and exactly what should I or my family do if they appear?
- Can I be referred to a specialist perinatal mental health team, and is a Mother and Baby Unit available if needed?
- Who do I contact, day or night, if I feel worse or have thoughts of harming myself or my baby?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
How is postnatal depression different from the baby blues?
Is postpartum psychosis really an emergency?
Can I take mental-health medicines in pregnancy or while breastfeeding?
Will telling someone mean my baby is taken away?
I keep having frightening thoughts about my baby being harmed. Does that mean I am dangerous?
Can I get this help on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS - Postpartum psychosis NHS - Postnatal depression Royal College of Psychiatrists - Postpartum psychosis Mind - Postnatal depression and perinatal mental health NICE CG192 - Antenatal and postnatal mental health: clinical management and service guidance Action on Postpartum Psychosis (APP) - Information and support Maternal Mental Health Alliance - Understanding perinatal mental health conditions nidirect - urgent and emergency care (Northern Ireland) nidirect - GP out-of-hours service (Northern Ireland) NHS England - 111 mental-health crisis support NHS inform Scotland - get urgent mental-health help NHS 111 Wales - mental health and wellbeing nidirect - mental-health emergency and Lifeline (Northern Ireland) NHS - Talking Therapies for anxiety and depression (England) NHS inform Scotland - psychological therapies and interventions NHS 111 Wales - counselling nidirect - mental-health care professionals (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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