Diagnosed with Bi Polar 24 Years After PP - Could start of menopause be hormonal trigger?

[bernie123]

Hi All

I am really hoping to connect with others who have suffered PP in the 80's and would be now approaching or have gone through the menopause to share experiences. My brief 26 year history is;

1988 Plural Psychosis – treated in hospital for 8 weeks with hariparadol. I had no previous mental health problems.

1997 Child 2 – No problems

1999 Child 3 – Unstable mood and stress relating to marriage. No treatment.

2002 Manic Episode - treated at home with hariparadol followed by treatment for depression. Bi Polar mentioned but not diagnosed. This was during a time that I was suffering from a badly broken leg and going through a divorce.

2013 August – Manic episode sectioned and diagnosed with Bi Polar – treated with olazapine, stayed in hospital for 3 weeks. Drugs reduced gradually until April 2014.

2014 November – Very Stressed Episode (not completely manic this time) sectioned again. Section Appealed and Revoked by Mental Health Tribunal. Treated with olazapine and a cocktail of other drugs. Recommendation is now 26 years later is to take a mood stabiliser probably for life. I have started taking Depekote but have developed anxiety so also taking Quitipien. At present sitting out a very low mood.

I know I am very lucky as I have a great family and very supportive friends, I have a professional career, concerned now for the future and would love to hear posts from others of their journeys. Would also like links to any long term research studies on this topic.

Many thanks

[AndyHenderson Volunteer]

I'm very sorry to hear about your problems since recovery from PP.

I'm replying on behalf of my wife with her help and permission.

Her first episode of PP was in 1978 following our first daughter's birth. It was a traumatic birth. She had toxaemia and - after a cesarean - our daughter was diagnosed with a heart condition that meant she was whisked off to Great Ormond Street for treatment (our daughter is now fully recovered and has a daughter of her own). A 'perfect storm' and her PP was very severe.

Our second daughter was born in 1985. My wife had PP a second time but this was much less severe and was treated in a mother and baby unit.

Following a second complete recovery, she had no symptoms or treatment until 2001 when at 48 she had another episode with all the same symptoms as the PP ones. Since then she has been hospitalised four times. She's also had long periods of acute anxiety.

We're not out of the woods yet. We've been through loads of different drugs. She started Lithium six months ago and that seems to be addressing the anxiety (she still has it, but less severe and for shorter periods). We have to be vigilant for spells of occasional inhibition, but things seem to be stabilising.

I'm not surprised to hear the suggestion of taking mood stabilisers for life. My wife has been taking prophylactic doses of Quetiapine and then Olanzapine since 2001. Taking Lithium is also a long-term treatment.

You are certainly not alone.

Andy

[Mungomia]

Hi there

I also had severe puerperal psychosis in 1988 after the birth of my son.

I had had two previous depressive episodes, one in 1981 and the second in 1985. Both times amitriptyline was prescribed. It seems that I was actually bi polar but it wasn't diagnosed at the time.

Because of my depressive episodes I was terrified about getting postnatal depression when we started a family, however when I got pregnant I was feeling quite well. Within a matter of weeks I became depressed and was prescribed another tricyclic antidepressant.

Unfortunately my son was born prematurely at 32 weeks and I convinced myself that he had arrived early because I had taken drugs in pregnancy. This wasn't the case but it was something that I believed for a very long time.

I was treated at home whilst my son was in the intensive care unit with drugs (I remember that haloperidol was one of them) but I wasn't really improving & my consultant recommended ECT. This worked well for me however after 3 treatments I had gone high and I had to have a tranquilizer injection. It was probably a good 12 months before I was well again.

I had a second child in 1993 (against advice!) and thankfully I didn't have PP but I was very stressed with various family situations and did have prothiaden for a while.

In 2002 I became very ill again and after trying numerous drugs (including lithium) nothing was working and I had ECT again which this time didn't work. Eventually my psychiatrist prescribed the old tricyclic antidepressant that I had taken in the 1980's and it worked again for me.

The long term recommendation at that point was for me to take anti-depressants and mood stabilisers for the rest of my life. I took quetiapine and then lamotrigine for quite some years but I now only take the tricyclic antidepressant.

Since 2002 I have had some periods of acute stress and some periods when I've thought I was getting depressed again but they have mostly been 'event' or work stress related. I have pretty much gone through the menopause now but for a while my mood dipped during that period and I tried HRT but it didn't seem to make any difference.

I would say that I am pretty well at this moment in time but I have learnt to live my life in a way that I don't allow myself to get 'high' or put myself in situations of prolonged stress, I know my triggers. If I do start to feel low I have taught myself not to panic about being ill again and normally it eventually passes.

I hope that your low mood will soon lift.

All the best

[Florence21 Action on Postpartum Psyc]

I'm sorry you're having a tough time, Bernie 123. I had my daughter in 1988 and had to go into hospital for 5 weeks but I already had a diagnosis of bipolar disorder (manic depression then). I had been diagnosed 5 years earlier after a manic episode which landed me in hospital where I was prescribed lithium and - part from coming off for my two pregnancies - I have taken it ever since (though in later years I reduced the dose which I feel was beneficial). Though not as 'popular' now with doctors (for a variety of reasons, but you do have to have a bloom test every 6 months which puts some people off), lithium is something that seems to either work very well for you or you can't tolerate it. It's a natural salt and I'm lucky to have suffered no side effects except mild cognitive 'dulling' which, as I say was improved when I very gradually reduced the dose. Fears about long-term kidney damage have little evidence to back them up; I've been on it for 30 years now and my annual organ function tests show no problems at all so I'm not worried about that.

Re the menopause, yes there is research suggesting women with bipolar are more likely to suffer mood lability at this time, which is probably due to the hormonal changes, though the mechanisms have not been discovered. I'm lucky that I haven't suffered in this way, but I think that is probably because of the protective effect of lithium. See below for an account of a recent study in the US. If you google Bipolar AND menopause you should get the abstracts of some more research. Best of luck!

Bipolar Disorder and the Menopausal Transition

by Mgh Center For Women's Mental Health on July 21, 2014 in Menopausal Symptoms

Women with histories of major depression are vulnerable during the transition to menopause and are at increased risk for relapse; however, we have less information on how this transition affects women with bipolar disorder.

At the American Psychiatric Association’s 2014 Annual Meeting, researchers presented data from an observational study of 56 women between the ages of 40 and 60 years with bipolar disorder (BD).

Women in the late menopausal transition (MT) period and early postmenopause had significantly higher depression and mood elevation scores than women in the early stages of the menopausal transition.

The findings are a bit surprising. Although clinically we do often see destabilization during the menopausal transition, I would have expected to see the highest levels of destabilization during the early part of the transition, when levels of estrogen fluctuate more dramatically. The findings of the present study may suggest that estrogen — even when its levels are fluctuating — has a mood stabilizing effect or may enhance the effects of traditional mood stabilizers.

Future studies will help us to better understand the impact of the menopausal transition on the course of bipolar disorder. The study highlights the importance of monitoring women as they transition into the menopause. This constitutes a period of increased vulnerability, where even women who were previously stable on a medication regimen may be vulnerable to relapse.

Ruta Nonacs, MD PhD

Read more on Medscape:

[bernie123]

Thank you all for your very honest responses. It was only when I was ill in 2013 that I was told that having had PP increased risks of further episodes. I now keep a mood diary and a speed checker daily to monitor my conditions.

My NHS area has very few consultants so I have seen six (mainly locums) since Aug 2013, so very conflicting advice.

It would be great to share any tips on managing both the high and lows onsets.

Many thanks