Long Term Risk of Relapse

It has been 2 years since my PP and 1 year since being back to 100% well after the depression I had following the PP. I am still on the anti psychotic and anti depressant. I went to see my psychiatrist today to talk about coming of the medications. I am feeling very disappointed after he told me there is always going to be a risk of a relapse after having PP,even if I do not have any more pregnancies. I found this information that backed up what he said...http://www.ncbi.nlm.nih.gov/pubmed/22563736

Has anyone here had a relapse after coming off medication?

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  • Hi PPx2

    I can really understand you feeling disappointed to hear from your psychiatrist that there is a possibility of future episodes of mental ill-health after PP. I imagine it feels like a real blow after getting through PP and depression afterwards, and feeling 100% recovered. I wondered whether your psychiatrist was recommending that you stay on a maintenance dose of medication for a longer period or just discussing with you your risks of future illness? How are you feeling about it all now?

    There are lots of mums on the forum who have stayed completely well after having PP and coming off medication, and other mums like me who have unfortunately experienced relapses not related to childbirth. I have never personally had a relapse of psychotic symptoms, for me it has been relapses of mild mania and depression - and I did have recurrent depression before the children were born so I imagine I am just one of those people who are more predisposed to depression! Although it is incredibly disappointing to go through periods of mental ill-health after PP, I have found that it's helped me to learn each time how to look after my mental health better, and I have learned strategies to head off early warning signs at the pass. I have personally chosen to take longer term maintenance medication, after a relapse around 18 months ago where I had come off antidepressants very suddenly (I had been worried about going 'high').

    One of the most helpful things I've found to do to look after my mental health after PP is to keep a mood diary so I can track any big changes in mood and ask for the help and support I need from friends, family and my health professionals.

    I hope that it's encouraging to hear that, although there is a risk of future relapses, what you learn from PP does help you to manage. And also that there are also many mums on here who have stayed completely well after PP. The most important thing is to congratulate yourself on the strength you've had to get to this stage of recovery, and to talk openly with your psychiatrist about what your choices are to minimise the risk of future relapse - both in terms of looking after yourself and minimising stress, but also in terms of medication if that's something you want to look in to.

    All the very best

    Naomi

  • Hello there. I will have a look at the link but if it helps I had my PP in 1988. I had two more daughters without PP and other than stress full times when i could feel a little bit low I have had no relapse and I came off my medication in 1989. Hope this helps. Kind regards Helen

  • Hi PPx2,

    I understand feeling disappointed being told about possible future risks, I remember being told the same & feeling nervous about coming off meds & what would happen in the future. I hope you find it reassuring though that for some of us (around 50%?) it'll be our first & only episode. I had my PP out of the blue in 2006 without any previous history of mental illness & it was my first episode. I've been well ever since my recovery without any relapse. I do however take a lot of ongoing care of my mental health, (as everyone should), & monitor it pretty closely. I'm very aware of my moods & if I'm feeling too tired or stressed or my mind is too 'busy', I make sure to take plenty of time out. This is something I've learnt to do better as I've got older & I realise how important it is, not just for me but for everyone - especially after PP. As Naomi says, 'we've learned strategies to head off early warning signs at the pass'.

    Try not to feel apprehensive about the future but to focus on how far you've come & how strong you are getting to this point. I was also on medication for two years & although I was nervous about coming off it, it was a really positive stage & felt like I was finally putting it all behind me. It was actually far easier in the end than I thought it'd be. Good luck with it! Let us know how you get on, were here if you need us.

  • Thanks Naomi, Helen and Andrea for your replies, they were very helpful. Even though I knew the risks I wanted to try reducing the anti psychotic. 10 days later my father in-law passed away and it was a very stressful time. At the funeral my husband, mother in-law and Priest all could tell something was not right with me. My husband said I looked grey and had a look in my eyes like when I had the psychosis. I was struggling with negative thoughts and did not feel right at all. Could not put my finger on it but just knew I needed to go back onto the previous dose of meds strait away. It has been only 3 days since and I am feeling better, but not 100% yet. It was very bad timing to reduce my meds but I had no idea I would have to deal with something so dramatic so soon. I will be very reluctant to change any medication again.

  • Hi PPx2, I'm so sorry to hear that, it must have been/still is a really difficult time for you & it's totally understandable to continue the meds - it sounds like a very sensible move to me. I hope things have eased & you're feeling more stable now.

    I understand being reluctant changing or stop the medication & being scared of any relapse but I wouldn't rule it out at all. I was worried too, but there's no rush & you can just do it when you feel ready. For me I knew when I was ready, it just felt right - I had few stresses at that time & it was Summer so I felt much more cheery anyway. I never took medication before PP (barely even paracetamol) & haven't needed anything since.

    Have a look at these results from a survey of our members a while back - I think it's actually really reassuring & positive about reoccurance if PP was your 1st episode.

    app-network.org/wp-content/...

    It's quite hard to read as a cropped image but the chart on the left shows mental illness before 1st child - the blue is those with None. The chart on the right shows mental illness after PP. So although around half (ish) go on to have another episode, it shows that a large proportion of those already had a history of mental illness. I think it's actually reassuring when you've had PP completely out of the blue, so try not to feel disappointed by your psychiatrists words about the future.

    (The full survey is on pages 8 & 9 here: app-network.org/wp-content/...

    I hope that's helped in some way, you've done brilliant getting this far, keep going! x

  • Thanks Andrea for your reply. I am feeling 100% again and will not be trying to reduce my medication again, at least for a couple of years anyway. My doctor thinks I may have bipolar or schizoaffective disorder. After how I felt trying to reduce my medication the other week I really think there is something not right with me. There is a lot of mental illness in my family. All my siblings in fact. My eldest sister has schizoaffective disorder. My other sister has bipolar and my late brother had schizophrenia. The sister with bipolar had 3 children and did not get PP. But I had it 2 out of 4 times.

  • Hi PPx2, I'm so glad you're feeling 100% now. With all your family experience you'll know how manageable it all is. Maybe in the future it'd be different reducing your meds, you could learn from this time & make sure the timing is better? I wouldn't rule it out in the future anyway, but for now it's good you've got it sorted, well done!

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