Managing schizophrenia in the postnatal period
How is schizophrenia treated?
Talking therapies can be very helpful in treating symptoms of depression and anxiety. They can help you recognise and change the negative thinking and feelings that depression brings. They also give you useful tools to stop anxiety coming back. Talking therapies include:
- Cognitive-behavioural therapy (CBT): the cognitive (or thinking) part of this therapy teaches you to think logically and challenge negative thoughts. The behaviour part helps you change the way you react in situations and can help you to get involved in activities that you have been avoiding or have stopped doing
- Interpersonal therapy (IPT): helps you to find new ways to connect with others, overcome losses, challenges and conflicts that you may have.
Registered practitioners with appropriate training and experience provide talking therapies for individuals or groups. You can find these types of professionals on the e-COPE Directory.
The main medicines used to treat schizophrenia are called antipsychotics. These assist with symptoms such as delusions or hallucinations. Some antipsychotics also help improve problems of mood, thinking and socialising and anxiety or agitation. Other than clozapine, antipsychotics can be safely used when breastfeeding. As some antipsychotics increase weight gain, it is good to talk to your doctor or another health professional about managing your weight. Depending on your symptoms, your doctor may also prescribe other medicines.
- Antidepressants are used to treat symptoms of depression and/or anxiety. Antidepressants that can be safely used when breastfeeding are called selective serotonin reuptake inhibitors (SSRIs).Your doctor may also suggest another type of antidepressant called tricyclic antidepressants, especially if they have worked for you in the past.
- Mood stabilisers help to reduce the likelihood of your symptoms recurring (relapse). The most common mood stabiliser is lithium but this is not safe if you are breastfeeding. Other mood stabilisers that may be used are carbamazepine, lamotrigine and sodium valproate. However, sodium valproate is not safe for use in pregnancy so it should not be used unless you are taking contraception.
It is important not to change or stop taking your medicines without talking to your doctor.
Women with schizophrenia who experience relapse in the postnatal period may require admission to a psychiatric hospital.This allows the woman to be monitored by health professionals in a safe environment. Some hospitals have mother and baby units, where the baby can stay with the mother. This allows the mother to remain close to her baby and encourages ongoing close contact between them.
This approach may not be appropriate for women who are severely unwell and unable to care for the baby and/or when there are concerns for the safety of the baby. Following discharge from hospital, you and your baby will need ongoing support and monitoring by a specialist mental health professional.
Advice for women experiencing schizophrenia in the postnatal period
1. Seek help and treatment
- Seek help from a doctor or other health professional.
- Learn about effective treatments.
- Call a support service or mental health crisis line if other help is not available.
2. Accept help and support
- Develop a support system of friends, family and professionals and accept help.
- Discuss your feeling with your partner, family and friends.
3. Look after your physical health
- Try to eat healthy meals, including fruit, vegetables, whole grains and lots of water.
- Plan some enjoyable physical activity every day.
- Try to establish good sleeping patterns.
- Practice techniques to reduce stress, such as muscle relaxation and deep breathing.
Advice for family and friends providing support
1. Listen and reassure:
- Encourage the woman to discuss her symptoms.
- Explain that schizophrenia can be treated and managed.
2. Provide information:
- Tell women about the ‘Ready to COPE’ guide. This can give them information and support strategies throughout early parenthood.
- Give the woman good quality information about schizophrenia in the postnatal period, such as this factsheet.
- Give details of helplines if she is feeling distressed and needs support.
- Offer information to the woman’s partner/others.
3. Direct to care and support:
- Encourage the woman to talk to her GP or other health professional.
- Encourage the woman to identify and draw on possible supports and services that may be available to her for practical and/or emotional support.
- Remind the woman that she can go to her doctor or local hospital if she is at risk of harming herself or others.