Hi, I'm currently 23 weeks pregnant with my second child and would like some advice re my care plan. I had a severe episode of PP in Feb09 after my son was born. I was sectioned and spent 3 weeks in a general pych hospital (there are no MBUs near me). I have read on this website information about Dr Katharina Dalton and taking progesterone and sleeping tablets, when I mentioned this to my psychiarist she said her work had been discredited and wouldn't recommend it. It took me 3 years to come off my medication. My psychiarist wants to put me back on 10mg of Olanzapaline as soon as our baby is born. This is the dosage I was one when I was in hospital and it made me feel like a walking zombie. I don't mind taking the medication if I become ill, but as there is a 50% chance of not becoming ill again I feel this is a bit severe.
Advice needed re second pregnancy - Action on Postpar...
Advice needed re second pregnancy
My wife had a recurrence with our second child. Unfortunately there is evidence to show a recurrence is likely: see "Risk of Postpartum and Non-postpartum Recurrence of Illness" on this page of the APP site: app-network.org/research/cl... . It's not an easy call, but I think it's worth taking some precautions - hopefully unnecessarily.
It's possible that you're being recommended to take a preventive dose, lower than the one you had in hospital. My wife's been on a preventive dose of Olanzapine long term without ill effects.
Andy
Hi maryraff
We're all here to help. I too was sectioned to a general psychiatric hospital when I was 23 following PP but that was because there were no MBU's in those days. I have to admit that I haven't read the article about Dr Dalton but I know there are professionals here who will be able to comment and advise you about medication also.
Although I had a second episode of PP, I have read on here of some mums who did not have a recurrence. I hope all goes well for you and apologise that I cannot be of more help.
Take good care.
Hi I don't know anything about 2nd pregnancies, as I only have my son. But i know there are some great threads on here with people giving advice about what they did re 2nd pregnancy. As someone has also said there is also the medical team (Ian Jones?) as part of APP who specialise in this, and could maybe advise you? It might reassure you to have a specialist input?
Hope others can give you more personal and concrete advise than me.
Good luck,I really hope you get the support you need,
Ellie
Hi Maryraff,
I'm so pleased you've posted, there are lots of us here who understand the predicament you are in and have been through similar.
I had PP in 2005 with my daughter and went on to have my son in 2008 with no sign of PP. It's so important to recognise, however, we are all different and each case of PP needs to be considered individually.
A little about my experience. I too was treated in a general psychiatric hospital when I had PP and found my drug treatment only had limited effect, I was also given ECT which I found very traumatic. After a few months I managed to see a perinatal psychiatrist at a different hospital. My drug treatment was changed and I made a rapid recovery and was off medication within the year.
I stayed in touch with the same perinatal psychiatrist during my second pregnancy and he monitored me closely in the first few weeks after my second birth. Thankfully I was absolutely fine. Getting good sleep was a high priority for me in those first few days and I was lucky that I had lots of family and friends who were very supportive. My husband took time off work and he would take my son at night after I had fed him so I could sleep.
As sunnyandwild has suggested, a second opinion from a perinatal psychiatrist may give your more options, Dr Ian Jones, the Chair of APP, would be a good starting point.
I hope this helps and please post with any other thoughts/concerns you may have. We are all here to support you.
Warmest,
JonesieB
Hi Maryraff,
Congratulations on your pregnancy! I realise this can be a very worrying time after having PP before, but you're doing a great thing getting info, advice & a good care plan in place. There are quite a few threads on here about second pregnancies & care plans so try doing a search on the category 'Pregnancy' to list all those. Here's one from a while back: healthunlocked.com/app-netw...
Also here's the link for the second opinion service that Sunnyandwild mentions, many have found it extremely helpful & it could be worth getting in touch for more info: app-network.org/what-is-pp/...
The general consensus about hormonal treatments such as progesterone or oestrogen is that there isn't sufficient evidence to recommend them. While there's anecdotal evidence about progesterone and oestrogen therapy from mums in the 70's and 80's this treatment is unlikely to be an option on the NHS in 2013 - systematic reviews of research have failed to find any effect. I think it's important that pregnant mums are given the best advice relevant to current UK practice.
Keep discussing your options & medication with your psychiatrist & professionals until you reach a plan that you're all comfortable with. I often post this link to further medication info because I think it's easy for non medical people to understand, you could have a read through the 'Women's Health' section for more info: choiceandmedication.org/ncm...
Plenty of women here have had second & third births PP free & I'm sure they'll be able to offer more specific tips & advice. Being aware of the risks of PP again, being prepared & having a good care plan in place is key & will make a huge difference - it's great you're discussing it now to get this in place.
Take care & let us know how you're getting on - there's a wealth of information on here & we're all here for you.
Hi Maryraff
I have just had my second child (9 wks ago) after suffering PP in 2011. I chose not to take meds as a precaution for the same reasons you've identified. But 6 days after my daughter was born I recognised my symptoms of the beginning of mania.
So I started on 150mg of Quetiapine, half of what I took last time. I don't regret my decision not to take meds straight away as I felt I had control over the decision to take them. It also helped to resolve any concerns that I had that I was somehow responsible or could have prevented it if I'd made different decisions last time.
Due to catching the symptoms very early the dose was too high and I was very drowsy. We've now reduced it three times down to 25mg. I'm seeing my psychiatrist on Tuesday so hopefully will stop taking it altogether in 2 weeks.
It wasn't easy accepting that it had happened again but it was under control very quickly and it had very little effect on me apart from the few days it took to get my meds down to acceptable levels.
I have posted on here about my experiences in 2011 and with this pregnancy and baby. I even asked a similar question to you. There was lots of support and other experiences shared if you'd like to check it out see below.
Good luck with everything. The people on here are a great source of information and support so don't hesitate to ask and share your concerns at anytime.
healthunlocked.com/app-netw...
Hi Maryraff
Congratulations on your pregnancy! Really glad you have found the forum and are thinking about your care plan.
Your psychiatrist is right that research done after Katarina Dalton's work in the 80s sadly showed no beneficial effects of hormone therapies to prevent PP.
However the important thing is that this is your care plan and you need to feel comfortable with it. Could you talk through your concerns about starting on 10mg olanzapine through with your psychiatrist?
In my own experience I chose to watch & wait for early warning signs of PP but had meds prescribed and ready to take on the postnatal ward. I did have the beginnings of mania and started olanzapine at 7.5mg on day 7. I guess the main thing for me in hindsight was that it made the first week quite stressful with me, my family and the midwives all quite twitchy about changes in my mood. But on the flip side it was lovely to breastfeed for a week.
Decisions about whether to take preventative meds are always tough but I hope you can have a good conversation with your psychiatrist. Starting at a slightly lower dose could be an option with perhaps having 10mg tablets available if symptoms escalate and a clear plan with your care team and family about what the early warning signs are etc.
Thinking of you - I do remember how tricky these decisions were back in 2011 for me but we got through to the other side and I'm very grateful for my two girls!
All the best
Naomi
Hello Maryraff,
I do sympathize with your predicament - I too had PP after my first daughter was born, was sectioned, sent to a general psychiatric ward, threatened with ECT, and then thankfully, due to my husband's and my employer's intervention, transferred to a MBU. I made a full recovery but it was a horrible and bruising experience, made worse by the fact that neither I, my husband or my family had any idea that this illness existed. This was in 1982. I went on to have two further children, in 1984 and 1987 and for both I used Katherina Dalton's progesterone treatment, which consisted of an injection of progesterone immediately after delivery, and progesterone pessaries for three weeks afterwards. I was perfectly well, breastfed both babies and completed my desired family.
My daughter is shortly expecting her first baby, and according to the present state of knowledge the risk of PP for her as my daughter, is not 1 in 1000, but 3 in 100. While the consultant psychiatrist she saw did not offer her progesterone therapy, the obstetric consultant was quite willing to prescribe the treatment when she requested it, though she had to pay for the progesterone ampoules for injection. The NHS can provide the pessaries. While it may not work, the treatment does not have any obvious disadvantage, and does not prevent breastfeeding.
I think it is important to recognize that the treatment has never been the subject of a proper randomized controlled trial, so to that extent it is not known whether it works, and it has dropped from favour. I and the other mothers like me might not have got ill anyway. Dr Dalton did however publish a paper in 1989 which reported on 242 patients who, having no history of previous mental illness, had suffered an episode of PP or severe postnatal depression. They inquired through their doctors about the progesterone treatment and were sent instructions on dosage etc. Questionnaire follow up by Dr Dalton 6 months later showed that of these women 181 used the therapy and of these 7% had a second incident of the illness. 21 did not use the therapy for a variety of reasons, and 67% of them became ill again.
Absence of rigorous research is a problem, but it is not the same as disproof. While this observation is not statistically significant, I have noticed a number of people who have contributed to this forum have used progesterone as a preventative, and none of them have said that they became ill.
Good luck. And I'm sure that the other advice given by younger mothers about drugs which may quickly control things if you feel you are becoming ill is most valuable. My daughter's view though was that she'd rather not go there and that the precautionary approach would at least do no harm.
Thanks for that Caroline. Congratulations on your daughter's pregnancy!
This makes interesting reading re. progesterone therapy, 'Katharina Dalton and progesterone dangers': bmj.com/rapid-response/2011...
Hi Maryraff,
How are you feeling now? Have you had any more thoughts or discussions with your psychiatrist, midwife or care team about your options yet? It's great that there's no rush & you've got plenty of time to mull them over & prepare.
Hi, thank you all so much for taking time to reply to my question. Sorry I haven't replied earleir but I was back at work for a few days and then we had a family day out on the train yesterday. I have a meeting with my widwife in early Jan and another appointment with my psychiarist in mid Jan. At 30 weeks there will be a meeting with everyone involved in my case including my psychiarist, CPN, social worker, midwifes, health visitor and GP.
I think I will start on 5mg of olanzapine and if I notice that things are starting to go askew I will increase it straight away.
I will keep you informed of how my meeting goes.
Wishing everyone a Merry Christmas and peaceful 2014, looking forward to whatever it will bring.
Thanks again
Maria
Hello Maryraff,
Good to hear from you. Never worry about how long it has takes you to reply, we all know how busy life is, especially at this time of year. How lovely to have a family day out on the train.
It sounds as though you have a good supportive team to plan your ongoing care in January and are well organised yourself.
Take very good care and please keep in touch if you can. We're here to lean on if needed.
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