Just because I had PP does it have to... - Action on Postpar...

Action on Postpartum Psychosis
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Just because I had PP does it have to mean im bipolar. Before my son was born I had no mental health issues and was very stable.

bravesurvivor411
bravesurvivor411

I was percribed lamictal by my psych. He says since I had one manic episode then followed by a depressive episode then im bipolar. I really dont want to be over medicated. Im currently on 20mg prozac and its supposed to be 50 mg lamictal but I want to go down to 25 mg and wean off.

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Naomi_at_app
Naomi_at_appVolunteer

Hi atrautman

Diagnosis is a really tricky one - we seem to find that women have lots of different experiences depending on their psychiatrist and which area they live in. Ideally, it should be a shared agreement between you and your psychiatrist so it's OK not to feel like you agree with him in this instance. For many women, like yourself, PP is their first episode of mental illness and there is no history of mental health problems before childbirth. However, after PP there is around a 50% chance of having another episode of mania, depression or psychosis in your lifetime. It may be that this is the reason your psychiatrist is being quite cautious with your medication.

I was wondering how long ago it is since you had your PP episode? I had a similar experience to you 9 years ago - a manic psychosis followed by depression which needed treatment with antidepressants. One of the reasons psychiatrists tend to add a mood stabilizer when treating depression after PP is that there is a risk of further 'high' or hypomanic episodes - so in a way the mood stablizer is used to help balance treating the symptoms of depression without risking tipping you over into another period of high mood.

Similarly to you, after PP both my husband and myself felt that my dose of Olanzapine (an antipsychotic which can also be used as a mood stabilizer) was too high and I was very sedated. I stayed on a higher dose for around the first year of recovery, and then reduced the dose gradually over the next six months, while staying on my antidepressant. It's really important to be able to have an open and frank discussion with your psychiatrist about your concerns about the 50mg lamictal and any side effects you feel you are having. You may not reach an agreement straight away - but it may be that you can plan to reduce in a few months time, with careful monitoring of your sleep and mood.

I guess from my own more recent experience I can only advise caution against rushing to reduce or discontinue medication. I had two very severe episodes of depression after the birth of our youngest who is now three, and I think with hindsight I wish I had stayed on my antidepressant medication for longer. I now take an antidepressant and low-dose mood stabiliser as my long term maintenance and it's been brilliant to be well for over a year. However it's a very personal choice, and also a process where you can only learn what works for you and what keeps your mental health stable by some trial and error. I guess I'd just say if you are now feeling well after a fairly recent episode of PP that it's OK just to enjoy the stability, spend time with your baby and don't rush to make any big medication changes as it's such a shame for you and your family if things do deteriorate.

I know it can be very difficult when you don't agree with your psychiatrist. I hope you are able to have a good open discussion with him soon about your concerns, and where you'd like to go in the future with your medication.

Warm wishes

Naomi

Hi there I can't say for certain in your case, but I can tell you about my own experience. I had PP after my first son, which had preceded an extraordinarily stressful pregnancy. I went on olanzapine ( which is an anti-psychotic and at a lower dose it is a mood stabiliser) straight after the psychosis and then they added an antidepressant when I went from manic too extremely low within a few weeks. I remained on the olanzapine for about a year, slowly reducing the dose down until I came off it. I have remained on the antidepressant, as I am prone to severe PMS and it helps significantly with that.

When I had my 2nd child, they put me on olanzapine for about 4 months as a precaution, but I was well. And I have never had a psychotic episode again.

Looking back, I was very prone to mood swings (but for me it was related to my cycle- 1st 2 weeks I'd be very buoyant and then hugely irritable and low prior to menstruation). And I was told off a lot by my mum for 'talking too much'. But these days I'm not like that, I think it's because I had a lot of stress in my 30s and now my life is much calmer (through choice) and that keeps me more stable. Plus staying on an antidepressant has helped me.

I spoke to my perinatal psychiatrist about 'being bipolar'. It seems there is a spectrum with mental illness, she said I would never have been diagnosed as bipolar, but my previous symptoms suggested cyclothymia which is like a mild form of bipolar which for most people never gets diagnosed and may or may not lead to full blow bipolar. She certainly hasn't given me a bipolar diagnosis now.

So having PP does not suggest you are actually bipolar, but as Naomi said you are more at risk of developing it or having a future psychotic episode. So be kind to yourself. Don't rush to come off meds, they do have side-effects but it's good to be on them for some time to give you the best chance. But I also wouldn't personally assume you are bipolar either (more that you are at risk of it, although it can be managed very well). As you said you have no prior history, and it's too early to say. I'm sure in time he will let you wean off them very slowly. My perinatal psychiatrist had me come off it slowly over a 6 month period until I stopped. Good luck.

A good question! I suffered an episode of PP thirty-three year ago. Six days after my first daughter was born, I was sectioned and treated with chlorpromazine ( the then-used anti-psychotic drug). After seven weeks in a mother and baby unit I was discharged on no drugs. I did feel low following this, and and was given a few months of anti-depressants by my GP, but frankly, there seems nothing odd about feeling insecure and miserable in the recovery period after a trauma of this magnitude.

I had no history of mental illness before the episode of PP, and have not required either psychiatric help or mood altering medication in the subsequent three decades.

So I would contend that although something went seriously wrong for me ( probably triggered by the hormone upheaval of childbirth) that does not make me bipolar.

Good luck with weaning off the drugs: it is perfectly possible that you will not need them ever again.

Hannah_at_APP
Hannah_at_APPAdministrator

Hi atrautman,

I had PP in 2009 after no previous mental health issues and the link to Bipolar wasn't something I knew about until fairly recently. I have to say it probably wouldn't have been helpful to me to be told whilst I was in the early stages of recovery - when was your PP episode if you don't mind me asking?

In my experience (and everyone is different), I was severely manic, psychotic, hallucinating and lost all touch with reality, so was very "high". Whilst I don't think anyone ever said to me "you are depressed", I was certainly pretty low in the year or so after I was in hospital. Part of this may have been due to medication, and the huge loss of confidence and traumatic experience I'd been through - not to mention being tired and whatever with a small baby to look after. I also took Lithium as a mood stabiliser to try and even me out, which helped for me.

I've since had a 2nd child with no recurrence of PP, although I was told it was a fairly high chance of recurrence and we prepared for this, partly through taking some low dosage anti-psychotic medication on delivery and for the first few months.

Is your psychiatrist a general or perinatal one? It may be worth asking for a referral to a perinatal service if you can, although they are in desperate short supply. APP also have a Second Opinion Service which might be helpful: app-network.org/what-is-pp/...

As Naomi said, it ideally should be an experience that you are involved in and a shared agreement but things can be different in different areas. Hopefully you get some more answers and I hope the medication issue is resolved for you too. I personally found it helpful to have reduced dosages before stopping, but at the time I was impatient for it all to stop. With hindsight, I can see it was the "better safe than sorry" approach, and it was right for me. I stopped medication 2-3 years after my PP episode and now don't take any medication at all.

Take care, x

Hi spannerb,

Thanks for your insight. I had my episode in the middle of april this year so it was fairly recent. The psychiatrist I see is a perinatal one. He has treated ladies with pp before. I also had a second opinion from another perinatal psych and she agreed with my psych about the bipolar diagnosis. But they both said since I have no previous mental health issues there is no way to be certain. Im going to take the lamictal for atleast another year and then consider the pros and cons with my psych.

Hannah_at_APP
Hannah_at_APPAdministrator

Hi again,

Sounds a good approach to me. I know the fact of taking medication can feel pretty negative, but the positive (which is the overwhelming bit, or at least was for me) is that it keeps you well and that's the main thing.

It's great you have seen a perinatal psychiatrist. There really should be more of them available, there's nothing in my area and if I needed to access one I would have to travel 40 miles or more. It could be worse I know, but at least some more awareness amongst general MH professionals would be good. More than one has said to me in the past that they'd never heard of it - not great!!

Hope it continues to go well for you then, it sounds like you have a good plan and support in place. Take care, x

Ellie_at_APP
Ellie_at_APPAdministrator

Hi Atrautman

Your post is an interesting one, and I think others have said similar things that I will say too. My experience of PP sounds very similar to yours - I had no previous mental health history, and had sudden and acute onset 3 days after giving birth. I also suffered from depression afterwards. I am 3 years on now, off all meds - I stopped taking anti psychotic after 12 months, and anti depressant after 18 months.

I had a diagnosis of PP and no one ever suggested I may have bipolar. This is why I do find your diagnosis strange. I know that mental health diagnosis' are fluctuating, change with time, and perhaps different people have different views about them (e.g. previously mental health professionals wouldn't have had a name for PP, or as much understanding of the illness as we have now). However I think they can be helpful in how you view your own mental health, and also how you are treated by psychiatrists, medication etc.

For me, I wouldn't feel bipolar was a correct diagnosis as I guess I see that as something someone would have long term, outside the very specific isolated situation of how I reacted to childbirth (i.e. PP). I know we can never know what lies in the future, but I feel quite confident that I won't suffer psychosis, or depression, in the future and therefore I don't think a diagnosis of bipolar would be accurate. Perhaps I am being too optimistic.

I think it would be worth getting a second opinion through APP - which someone suggested above. They are really specialised in diagnosing and treating PP.

In terms of meds I was weaned off slowly and I recommend this, and being led by the professionals. I know the feeling though of wanting to be off them, and feeling well enough.

Take care

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