Should I take Quetiapine as a precaution?

[BronSyd]

I’m interested in hearing about other’s experiences of subsequent children. Did you take medications as a precaution or not? Did you have another episode and was it easier to deal with the second time around?

In 2011 I was diagnosed with PP and hospitalised (in a general psych ward as there are no public M&B units in Sydney) when my son was 6 weeks old. He was also hospitalised for a week due to being severely underweight (I wasn't feeding him often enough and therefore ended with low milk supply). I recovered very quickly from my episode. I was released from hospital after only 10 days and was not taking any medications only 3 months after diagnosis (although this was without my psychiatrist’s knowledge).

I am reluctant to take the advice of my psychiatrist (she was not my doctor last time) as I don't like taking medication at the best of times. The low dose of Quetiapine she is suggesting could still impact my baby as I intend to breastfeed. She is suggesting it mostly to ensure that I am able to sleep, however in order to establish good breastfeeding I will need to feed overnight anyway. My husband is very supportive although he is more cautious than me.

[AndyHenderson Volunteer]

Our experience was that my wife suffered very badly with our first child, but much less severely with our second. Admission to a Mother and Baby unit second time around helped a lot, though (she was in a horrible Victorian place the first time, separated from our child for six months). The medications my wife took meant she was advised no to breastfeed (this was over 30 years ago, however). Both children have grown up healthy with no ill effects.

There is evidence from research (app-network.org/research/#R2) that you are at risk with a second pregnancy. For what it's worth, I would advocate precautionary measures as being in the best interest of you and your family. The trauma of PP can have a much greater and lasting effect than the alternatives.

At the end of the day, however, there are no clear-cut answers. Just a balance of risk. I would say, though, that I think a lot of unfair pressure is put on women to breastfeed. There are many who can't for various reasons and, while it's a shame to miss out, it's by no means a disaster.

[smiles1975]

Hi, I'm 7 weeks pregnant and I'm taking quetipine for bipolar. I've been on this for 4 years so I've had to stay on it. I've managed to reduce my dose from 800mg to 400mg and I intend to come down further once my sickness gets better. I don't know how low I can go to and I'll more than likely still be taking quetipine up til the birth and during breastfeeding. I have researched into it and from what I have read the baby is affected more by taking quetipine during pregnancy than it is by breastfeeding with only a tiny amount going in the milk. I intend to breastfeed while taking quetipine because I'm already on it now and will continue to be on it throughout my pregnancy anyway. My baby may have withdrawal symptoms after it's born so in a weird way it might be better for him/her to receive a small amount in the breast milk.

[Lilybeth Volunteer]

Hi BronSyd,

My first PP was nearly 38 years ago and my second 32 years ago. Unfortunately at that time there were no MBU's and as with the wife in your first reply, I was sectioned to a Victorian asylum without my baby. I was then transferred to another Mental Health facility and my baby was able to come with me. With my first baby I was in general psychiatric care for six months.

Some years later after much soul searching my then husband and I decided that we would like another child. I sought advice from my G.P., who said if I was prepared to take the risk he would help me (he was on holiday when baby was born !). Unfortunately PP hit me again and I was sectioned to a different general psychiatric hospital as we had moved from the area in which my first child was born.

The only medication I remember taking at the time was Imipramine so I can't comment on Quetiapine. I had ECT on both occasions so I'm sorry my memory of this time is vague. Also for all the right reasons in those days my mother insisted that these periods in my life would remain known to immediate family only and not spoken of to this day.

Although all here on this network have had PP, each journey has been different. I have read some accounts here of mothers who had only one PP experience and no ill effects with subsequent births. So I hope my account is not worrying for you and very much wish you well for the future.

[Naomi_at_app Volunteer]

Hi BronSyd

Thanks so much for posting your experience also on your other thread. I realise I may be a little late in replying as your baby was due this week!

I opted to watch and wait for any early warning sypmtoms with our second baby, born in 2011 - I was really keen to have at least a few days of breastfeeding and I think I felt with a 50:50 chance of being well it was worth the relative risk of not taking medication immediately after birth. For me, I did begin to have symptoms of mania very similar to those you describe in your other thread, and so at day 7 I made the decision to begin taking Olanzapine. I guess reflecting on it now, the only thing I'd say is that it possibly made those 7 days extra stressful in knowing that myself, my family and especially the midwives on the ward were monitoring my mood like crazy (!!) Baby #2 was an emergency c-section and then spent some time in neonatal Intensive Care so there were extra stressors. However taking quick action with Olanzapine meant that the mania subsided quickly and didn't develop into a full psychosis. I think for everyone it's such a difficult and personal decision...

Sadly for me after four months being really well I had a very severe episode of postnatal depression and I've sometimes questioned whether not taking medication straight away contributed to something of a crash after the beginnings of mania. However, I did have depression also the first time around - I noticed from your other thread that you didn't suffer depression at all after your first. Taking all things in balance, I still feel that it's really important that mums have the choice whether to watch and wait, or go for preventative medication immediately. I think for me I was glad to know that I was taking Olanzapine because I definitely needed it, and the first 7 days of breastfeeding were very precious. I hope that things go really well for you - and that you feel that you've had the choice you wanted with medication. When baby gives you a chance it would be lovely to hear how things go. I'd definitely say also remember it's not a failure if you do spot warning signs in the early days and need to take medication - it's 'nipping it in the bud' as Andrea said.

Very, very best wishes for the new baby and fingers & toes crossed that it all goes well!

Naomi xx