Recovery Setback

HI all,

I found this website online looking for help and answers. My wife had PP in 2013 after the birth of our daughter. She spent 3 weeks in the hospital before coming home. She was not manic after that time but very depressed for several months. Outside of the hospital she only used lithium, which she tapered down after 6 months and dropped completely after 1 year. Thereafter she has had no signs or symptoms of mania/pp or depression. So we know it gets better.

Fast forward to this past August. After much deliberation we decided to get pregnant again and she gave birth to our son on August 10. Knowing the risk of reoccurrence of PP, she started lithium 2 days after delivering him. Unfortunately, about the same time I began to notice the first signs of agitation and over-energy and gradually over three weeks she developed full blown mania. She ended up spending only 6 days in this hospital this time as I think having the lithium in her system helped speed the recovery, and then was given several other drugs (Seroquel, Ativan) in the hospital to bring her back to earth. Since being released from the hospital she has tapered off everything but the lithium and has been doing well for about 6 weeks.

I took over 2 months off work and just returned last Wednesday. I know the stress of caring for 2 kids (one a 3 year old and one an infant) was source of stress for her. I and other family have been doing most of the overnight feedings and we have been protecting her sleep, which she is mostly getting.

Since going back to work, I've notice that my wife seems to exhibit some symptoms of hypomania. She's got elevated energy that doesn't seem to break at all through the day, though she is sleeping at night. She is very talkative. Talking almost non-stop and conversations with her often divert onto other tangents. Her sense of her self, self-esteem and beliefs about herself have become more inflated though I wouldn't call them delusional at this point.

Anyway, I'm very concerned about what I see as a setback in her recovery. WE didnt experience this last time so my frame of reference is different. Any thoughts or suggestions from the board?

14 Replies

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  • HI

    Welcome to the forum. I hope we'll be able to help.

    I'm sorry to hear that you have concerns your wife may be becoming unwell again. It must be really worrying for you. You know your wife, and it's good I think that you are feeling cautious, and noticing changes. Often as well it is people around who notice when someone become unwell, sometimes the person can't see it themselves.

    Have you talked with your wife about your concerns? Or family members / friends who see her regularly? Have they noticed too? My gut feeling would be if you are concerned, to talk to your wife and suggest she sees the psychiatrist, but that you try and go along too to give your perspective? And if you are very concerned perhaps you could talk to the psychiatrist yourself? I know it may be difficult if she doesn't want you to, I'm not sure what the situation is in regarding all that (whether you've spoken to her, how she may receive you expressing concerns etc). I'm also not sure what professional support is around your wife, and whether they are easily available? I do hope so.

    It may be good to write down some observations yourself too, just so you have some examples you can give about what causes you concern.

    I hope that this helps and that your wife will stay well. She will recover, it may be your being over cautious, or it may be she has reduced meds a bit too soon? the most important thing I would say is to get the professional input as they will know and be able to advise.

    Take care X

  • Thank you for your reply. I'd really like to have her start back on the seroquel But she is very resistant to taking medications, though she is sticking with lithium. Any advice on persuasion techniques I can use to start back up on that?

    I have reached out to her psychiatrists office without her knowledge and put them on notice to what I'm observing. They are going to try and reach out to her to talk and maybe have her come in to be seen.

  • Hi Nosdalp

    How is your wife now? Has she managed to see the psychiatrist? It sounds like you have done all the things I would have thought of, like trying to feedback to your wife your thoughts, and contacting her psychiatrist etc. I hope her mood settles, and your concerns lessen. Do come on here to ask any questions or just to off load.

    Take care

    Ellie

  • Two nights ago after a difficult and tearful conversation my wife reluctantly agreed to resume taking Seroquel, and has now done so 2 nights in a row and slept about 7.5 hours each night.

    I'm still noticing elevated mood/energy, increased goal-setting (non-essential, unusual goals) and agitation around noise (hard with a 3 year old and infant) and focuse. She's also still pretty chatty.

    It seems as though this is more in the range of moderate hypomania than full blown mania.

    Her psychiatrists office called her at my prompting yesterday and she was very irritated that they called but explained to them that she had added back the seroquel. She's going back and forth between acknowledging the enhanced energy, etc., and simply feeling that its a natural development of her feeling better, which can be very frustrating.

    I should add that she is in her mid-thirties; the only times she has ever been manic is after the birth of our children.

    The psychiatrists instinctively diagnosed her BP type 1 since she had had a depressive episode in her mid-20s and she resents and struggles with the label and stigma of that even when she's not having symptoms of mania.

    I felt like we were on the same path as last time, a period of mania for a few weeks, then depression and long recovery with no further manic symptoms but this time is different. I thought we were through the worst part and just to the healing, now it feels like we are going back.

    I'm going back to part-time at work, and have a generous leave policy so I'm thankful for that. Oh, and I'm in the U.S., not UK, so it's generous as compared to US policies. We are not advanced like UK in both workplace policies and health care. All the best info about PPP and postpartum issues is on UK websites.

    Just trying to get through this....

  • Hi it was good to hear your update, well done for having that difficult conversation with your wife, and it is good that she's taken seroquel again.

    That is hard though, to feel like you're taking a step back. But I'm sure, she won't go back to being very ill again, I am sure this is all part of the recovery. She obviously wasn't quite ready to come off the medication. I hope that she continues to settle, and her mood stabilises.

    Take care, and do write whenever you need to.

  • Dear nosdalp,

    hello I am Sabine and I have had PPP in 2010.

    Congratulations to your new arrival and I am so sorry that your wife is struggling again.

    I believe you are doing exceptionally well. My partner was my full time carer for 6 months until he re-integrated back to his job gradually. It is such a difficult time. It was a huge learning curve for all of us.

    I was very poorly and sectioned, but my actual recovery started once I returned to my partner and baby.

    A support network was developed once I returned. Thanks to the commitment and love of my partner, but also some of his family members - we gradually found our way back to a routine & I had to learn in stepping stones and eventually was able to look after my son again.

    I did not suffer from depression, but still live with hyper activity and often take on to many tasks at once, but my little man and big man make sure that they slow me down.

    Your kindness and love towards your wife will help her on the path of recovery.

    Lots of inner strengths and will power. Look after yourself.

    Sabine x

  • Thanks so much for this reply. It helps to hear. I've added some info in my responses above that sort of adds some things about our situation.

    Its so hard for her and for me, and we do have a fairly good network of support. I am just so disappointed we had this setback.

    I know a lot of this is due to hormones normalizing postpartum and thought we had gotten past that point but apparently not.

  • Hello nosdalp

    It must be a worrying time for you, watching your wife struggling with what you see as a setback. I had PP twice, six years apart, a long time ago. I tried so hard to be well but was held down by the different aspects, i.e. delusions, hallucinations etc. After my second PP I also suffered an enduring depression which must have been so hard for my husband and family to witness.

    Your wife seems to be doing well, even by just communicating her reluctance to take the medication suggested. At least she is talking which is something I was unable to do for a while.

    You might have looked on the site and already be aware of the APP Insider Guides, "Recovery after Postpartum Psychosis" and "Postpartum Psychosis : A Guide for Partners" the link being app-network.org./what-is-pp... There is also a book "Husband in a Storm" here which you might find helpful.

    You're a great support to your wife and children. With good medical care, patience and understanding, your wife will be well eventually. In the meantime we are all here to help if we can.

    Take care of yourself too as this is a very stressful time for family and friends.

  • Has anyone experienced a setback like this, where you have postpartum mania, the mania goes away, and then a month later it comes back?

    Really struggling to manage this relapse since we are exhausting our support network.

  • Hello nosdalp

    I'm sorry to hear you are struggling with your wife's relapse. It must be very hard for you to watch her suffering again. As I mentioned in an earlier reply I had PP twice and the second time it was also my husband who noticed similar traits to my first PP.

    I'm not sure that my mania went away and returned, although I did have a relapse with my second PP. After months of medication my delusions did finally fade but unfortunately I suffered an enduring depression for almost a year. I was mainly treated at home and the Psychiatrist, CPN and my GP would visit to assess me on a regular basis. In times of crisis I was admitted to hospital for other treatment interventions.

    It must be very draining for you to try to cope with work and home. Like your wife, I did have family watching me when my husband was at work. In "Husband in a Storm" the author gives a very descriptive account of his wife's ups and downs. It does seem unfair to go through such a traumatic experience twice as a family but it is possible to fully recover.

    I know it's very difficult to experience this setback. I hope your wife's psychiatrist continues to be supportive. Perhaps you can discuss your concerns and he might review the medication?

    Take care. We are all here for you.

  • Hello nosdalp

    How is your wife now? Did you manage to discuss your concerns with the Psychiatrist? It's so difficult for your wife who wants to be well but is held back by this awful illness. As you know she will be well eventually but it is hard for you to cope with work and struggles at home. I hope you are having support for yourself.

    Take care .... we are all here to talk if you feel it helps.

  • Hello Lilybeth,

    Thanks for checking in with me. I have had the opportunity to talk a bit with her therapist and psychiatrist and she agreed to more medications a couple weeks ago. Its been challenging watching the mania happen again, though it didn't get as elevated as it did in August, it was definitely heightened and then has waned. I would say that about a week and a half ago she started seeming more at her base line, though there were intermittent periods of a few hours where she got "busy" and more frenetic in her activity. These happened more often in the morning, as that always seemed to be the time she was most affected.

    Since about last Friday I haven't noticed any more of these spurts of energy and she's definitely been overall more fatigued, which is what she experiences after the come down. This time it just feels more drawn out.

    I'm still part-time at work, but its fine and we've made some adjustments with child care and our dogs to keep the chaos down a bit in the house when I'm at work.

    I'm hoping that we don't have another relapse. All we can do is wait and see at this point and continue with the meds, therapy and just living.

    Thanks for everyone's advice. THis is so hard and there is so little that can be done to help the healing process beyond meds, therapy and time.

    Our son will be 12 weeks old in a couple days; hoping that will be a milestone for us and marks the end of the illness and the beginning of our recovery.

  • Hello nosdalp

    Thank you for taking the time to reply. I'm glad that your wife seems a little calmer after the increase in medication. It's very thoughtful that you have adjusted the house routine to help your wife when you are working. I imagine it can be like walking on eggshells at first. I was completely unaware of the strain on my husband but so grateful to him and family for taking care of me and being patient, so I understand how hard it must be for you.

    I hope your wife continues to improve slowly but surely with all the support you are giving her. Make sure to take care of yourself too.

  • Hello Nosdalp,

    I am pleased that you get some very good guidance and support, especially from Lilybeth.

    As I told you before I have been so extremely poorly and was sectioned and in hospital in August and September in 2010. According to my partner life changed quite drastically once I got released from the Psychiatric mixed gender hospital.

    My support was my partner, I was improving with the Psychosis, but the general recovery begun once in my home, in my own sanctuary. Creating a support network was on a high agenda, and changed according to my needs, which were continuously evaluated by professionals and my partner (care recovery plan). I have had to learn to do the basics of life again such as looking after myself and covering other primary needs such as learning a daily routine in order to get better.

    I was so poorly that I could not look after my baby. This was another learning curve, which my partner tried to teach me simultaneously. He wanted me to become a bit more independent again and despite my drugs I managed in the following year 2011 to participate in a baby massage group (March), followed up by other Sure Start activities.

    I have had such strong traditional and different type of drugs that side effects were huge. My mobility was affected, my concentration level, communication skills, memory system, blurred vision etc. The medication has helped to kill the Psychosis, but I also have become a different person. My partner has been my full time carer for one year.

    I have had to have group therapy, because life goes on and you are still bombarded with new and different experiences. I am much more sensitised towards life and very appreciative of each day. I guess I am much more conscious. My partner says, that I am differently tuned now, because channels have been opened up, because of the anti depressants. Very creative and working a lot with my right side of the brain.

    Take good care of yourself and your family.

    Sabine x

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