Severe mental illness

Bipolar disorder

Healthcare professionals should follow the guideline that NICE has produced on bipolar disorder (see other NICE guidance for more information) but should adapt it as explained below, because some of the choices about treatment may be different in pregnancy and the first year after giving birth.

If you have bipolar disorder, you may be offered psychological therapy, including a type of therapy to lower the chance of it coming back. This might be particularly helpful if you change or stop medication.

If you develop mania or psychosis and you're not taking medication already, you should be offered a type of medication called an antipsychotic.

If you develop mania and you're already taking medication, your doctor should check the dose and increase this or suggest changing to another type; if this doesn't work and your mania is severe your doctor may suggest other treatment such as lithium or, as a last resort, electroconvulsive therapy (also known as ECT).

If you're taking medication for bipolar disorder and you plan to breastfeed, your doctor should make sure that you can take the medication while breastfeeding. You should be offered 1 of the antipsychotics recommended in NICE's guideline on bipolar disorder (see other NICE guidance for more information) if you are not taking 1 of these already.

If you're taking lithium and decide to stop this when you become pregnant, your doctor should offer you an antipsychotic recommended in NICE's guideline on bipolar disorder.

Psychosis and schizophrenia

Healthcare professionals should follow the guideline that NICE has produced on psychosis and schizophrenia (see other NICE guidance for more information) but should adapt it as explained below, because some of the choices about treatment may be different in pregnancy and the first year after giving birth.

You may be offered psychological therapy if you are pregnant and:

  • there is a risk that your condition might get worse because you have changed medication or you are feeling stressed, or

  • you've stopped taking medication.

During pregnancy and the year after birth you should be able to start psychological therapy more quickly than at other times.

If you are pregnant and need urgent sedation

If you have a severe mental illness and your behaviour is very disturbed, you may be given medication to help calm you down quickly. You should not be left alone after this has happened.

Electroconvulsive therapy

Electroconvulsive therapy (also known as ECT) is used only rarely to treat severe mental illness, such as severe depression and severe mania. ECT is always given in hospital and involves passing a small electric current through the brain. Doctors should fully explain the risks and benefits of this treatment.

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