From the Research
For peripartum psychosis, the best evidenced-based antipsychotics are second-generation (atypical) antipsychotics, particularly olanzapine (5-20 mg daily), quetiapine (300-800 mg daily), and risperidone (2-6 mg daily), as supported by the most recent study 1. These medications are preferred due to their efficacy and relatively favorable side effect profiles compared to first-generation antipsychotics. Some key points to consider when treating peripartum psychosis include:
- Treatment should begin promptly when peripartum psychosis is diagnosed, with dosing typically starting at the lower end of the range and titrating up as needed based on symptom response 2.
- The duration of treatment generally involves acute management for several weeks, followed by continuation therapy for 6-12 months to prevent relapse.
- When prescribing these medications to breastfeeding mothers, consider that olanzapine and quetiapine have lower milk transfer rates than risperidone 3.
- These antipsychotics work by blocking dopamine D2 receptors and affecting serotonin pathways, helping to reduce hallucinations, delusions, and disorganized thinking.
- Treatment should be part of a comprehensive approach that includes close monitoring, consideration of mood stabilizers if there's a bipolar component, and coordination between psychiatric and obstetric care 4.
- Hospitalization is often necessary initially to ensure safety of both mother and infant. It's also important to note that lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP, and can be used in combination with antipsychotics in the acute treatment of PPP 2, 1.