PP even after preventative meds?

Actually my question is... Has a good prevention plan failed for anyone?

I don't have any personal experience but it might be worth you having a second opinion consultation with Ian Jones in Cardiff (something APP offers - info can be found on the website here

app-network.org/what-is-pp/...

I can't remember if you are in the UK?

I know that he does consultations over Skype if you're not able to travel to see him. You need to be referred by your GP/psychiatrist. You will probably see that a lot of people on here who have had other children after PP met with him and he was really helpful for them in putting together a prevention plan and talking about risks etc. All say the support he offered was invaluable.

Hope that's helpful, am sure you will get other responses

Take care, and good luck with any of the decisions you make, they are hard ones to be sure...

Thanks sunnyandwild for your advice. I am in Australia so that referral did not suit me but it did prompts me to look for a doctor in my area who specialises in this field.

I have just found a place that specialises in this area. Here is the site for anyone who lives near by nestclinic.com.au/services/...

Hi there,

I would also be interested to hear if anyone has experienced a second PP after taking all precautions including medication at the optimum time for them. I'm afraid there are no statistics on this as research in this area has been woefully neglected, but I can say that in the 7 years I've been working with women in this field (during which time I've met or talked to scores of women in this situation), I can honestly say I have never met anyone who made all the preparations (seeing a perinatal psychiatrist, making a detailed plan and preparing support afterwards to avoid sleep deprivation) and still got ill. This is an argument I use all the time for health services to invest in preconception advice. The single instance of someone getting ill a second time that I have come across was because she - initially - refused to take meds on both occasions.

Take a look at some of the true stories like Helen’s Story: Self Managing for Two on the app-network.org/what-is-pp/...

page for someone who felt she was at very high risk and yet it all turned out well after preparing well.

There are some good perinatal services in Australia and some excellent research going on there: good luck and don't give up hope!

Thank you very much for your helpful post Florence 21. Very much appreciated

I had a severe episode after last child 5yrs ago. I am currently six months pregnant and on no meds. Lithium was stopped suddenly. This is generally not advised only I believe better than a very slow reduction due to all the side effects.

I intend to start medication after the birth. With a good care and proper care it is perfectly possible to have a child with this illness. The main things are organising help with the baby after the birth, medication, also pain relief during labour which I believe is a major trigger. I may have an epidural. I Did not take medication after the birth last time. This was the main reason for relapse. I am much more confident this time. Time to relax ie exercise massage oils srx are helpful during pregnancy. Proper rest is v imp. Do not focus on breastfeeding like I did last time. It is much more imp to take the right medication and rest especially for the 1st month. If you do notice any signs get help straight away.

Thanks for your advice boat1. All the best for your arrival

Hi, I don't want to bring negative news but I did get unwell in second postpartum period even after preventative medication and robust support plan. However the second time it was "only" severe postnatal depression, arising at 9 weeks postpartum, rather than the acute manic psychosis followed by very a long depression that I'd had with my first baby. I won't pretend it was easy but forewarned is fore-armed so it was much easier to quickly access effective treatment second time around, less traumatic for my husband and family, and recovery happened much more quickly. I agree with the point above that my mistake may have been to choose to breastfeed despite advice to the contrary, which impacted on which preventative medication I could take and probably put me under unnecessary additional stress, so I'd advise anyone to think very carefully about that in a prevention plan. The bottom line is I'm still glad I completed my family, but also relieved that I only ever wanted 2 children so don't need to make that difficult decision again. Good luck whatever you decide, and definitely try to get expert professional advice.

Hi TraceyR72 and thanks for your post. It is good to hear you will never have to go through it again. Can I ask did you take an anti depressant after the birth of your second child? Or did you just take an anti psychotic?

Hi PPx2,

I too am in Australia. I had PP in 2011 and then a slight recurrence in 2013 after the birth of my daughter.

Have you had a chance to get a second opinion? Often people are too quick to judge based on mental health when they themselves have no personal experience. Funnily enough my GP had no idea and was just like 'oh that won't happen again you'll be fine'. I was like, yeah I still need a referral to a perinatal psychiatrist thanks.

Second time around I had a detailed plan in place but decided (somewhat against Dr advice) not to take medication until I had symptoms. I was a lot more aware of my state of mind so picked up pretty quickly that my mind had started to race by day 6. I then went on to take serequel (anti-psychotic) which was the same medication I had taken previously.

This worked really well at halting my symptoms. Saying that I would consider that my 1st episode in 2011 was relatively minor as I recovered quickly after starting medication and did not end up with PND so I was comfortable with my decision to delay medication.

It also gave me the chance to heal some of my misconceptions about the illness being more related to unfortunate situational factors that occurred the 1st time around. As in I came to realise just how little control I had over it.

Good Luck with your decision.

Hi BronSyd,

thanks for your reply. It is very helpful to know what happed to you second time around. I am glad it worked out for you. I am still on anti psychotic and anti depressants so have put off getting the second opinion for another baby until I come off these. We figured there is not much point even considering trying for another baby until I come off these meds because they are unsafe in pregnancy. I have found a perinatal psychiatrist I want to see as soon as I am medication free.

I had PP in 2009, I decided not to carry on with meds and relapsed 10 months later. I desperately wanted a second child but waited four years before I went ahead. My GP is fantastic but I think I was possibly her only case of PP my local psychiatrist only had experience of two other cases so I drove a distance (by UK standards) to talk to the MBU psychiatrist who'd seen me through it.

The MBU psychiatrist questioned why I might want to put not just myself but my family through a potentially traumatic time, pointing out that my then three year old would be aware of what was happening if anything did go wrong. I wondered if I was being selfish.

In 2012 I got pregnant again. I came off meds to conceive and was med free for the pregnancy. The MBU psychiatrist had told me it was a safer period, NOT a safe period. I had my second by C-section and really didn't mind how she was born. I breast fed her once (I'm crying at that). Then I took a very high dose of medication and gave up caring for her through the night for two weeks.

I'm so glad I had her. She's amazing and she completes our family.

Good luck with your choices and all the best. I hope you find good advice and that you have a positiv. outcome.

Hi Sarah2015,

thanks for your reply. I am so glad to hear it worked out well for you second time around. I can understand your disappointment with not breastfeeding but considering the meds helped you stay well for everyone it is worth it. Glad to hear from you, it really helps me.

I know that not breast feeding was the best thing. It meant that anyone could look after my child and I could get much needed rest for the main 'danger period' It also meant I could take a whack of medication -which I did for the first six months. There's a graph showing incidence of PP in the first month and most incidences happen in the first fortnight. I believe sleep (and possibly sleeping pills) is (are) really really important.

How's your decision making working out? Have you managed to find a psychiatrist with more experience of PP?

Good luck.

We did find a more experienced psychiatrist and after consultation decided the risk was too great for relapse so we are not having any other children.