Anti-psychotics during pregnancy

[Healthy_mummy]

Hi everyone,

I'm now 6 months pregnant with my second child. I experience PP with my first so am desperate to try and prevent it this time. My consultant has recommended that I take a low dose of trifluoperizine in the latter stages of my pregnancy (a couple of weeks/a month before due date) so that I have it in my system before labour. Has anyone else taken anti-psychotics in pregnancy? There's very little research out there into side effects for the baby. Also, has anyone else experienced the onset of psychosis from gas and air? This (along with lack of sleep) appeared to trigger it last time and I wondered if anyone had experienced the same.

[Hannah_at_APP Administrator]

Hi Healthy_Mummy,

When I had a second child after PP with my first, I too was keen to do everything I could to try and prevent another episode of illness. I took antipsychotics (low dose of Olanzapine, which is what I had previously been on) but only after delivery so not during pregnancy in my experience.

Your care team will be able to best advise and I know having a care plan and trying to avoid any triggers was also important for me. For example, I chose an elective c-section after having an awful emergency one the first time (I would have loved to try for a natural birth but was just too scared it might go wrong again). I did have gas and air in my first birth and found that it made me really scared and sick, not sure that this was connected to PP but it didn't agree with me.

Different areas in the country or overseas vary in what support they can offer though, and now, a few years on, there is a trauma after birth service locally which could have perhaps talked me through my fears and I might have had a different birth experience. The APP Guide for further pregnancies might be helpful as well if you have not seen it (or to share with others, my midwife found it useful too): app-network.org/what-is-pp/...

For me, it all turned out well and I did not get ill again. Feeling somehow empowered by my choices, whilst accepting that I could only do so much, did help. It was a scary and anxious period at times though. I hope you are getting good professioal support, and from family and friends, and wish you all the best. Take care, xx

[suzannah0]

Which country are you in? I didn't have in my last pregnancy but not sure if I will need it in this one. I found the gas to be great in calming my anxiety last time, reminding me to breathe deeply etc, so it didn't affect me, but each case is different. If your in Australia monashvictoriamonash uni pharmacist/medicines helpline victoria are the best I've found in the country for online advice...I've looked across three states.

[violetx]

Hi healthy mummy

I had pp with my first child and when i unexpectedly fell again with my second who is now 10 months i was advised by my phyc to continue with quietipin as the baby had already been exposed and did not want to give me anything eles. I was told that it was advised not to fall pregnant whilst taking this type of anti phycotic as there were risks of the spine.

The amount of quitiepin was lowered to about 400mg. Which i still take today. I was very distressed about the feotus but was re assured that everything was fine at my 12 week scan. Then of course the anxiety kicked in of becoming unwell again.

I had alot of support from my family, partner and care team. I also had therapy sessions with the teams phycologist. In these sessions we put together some points to reassure me. For example: once baby is born mum and partner will be there to ensure i get the sleep i need. My medication will be increased after baby is born. Although becoming unwel again will be unlikely accept that it can happen again but team are on board and it wont be as bad as before.

Please look at my old posts as i have details in more depth of my care plan and my plans of staying on the labour ward once i had the baby. I stayed four nights. This could be something to talk to your midwifes about.

I also got my care co ordinator to put a copy of all relevant contact numbers and care plan and i stuck this in the front my maternity notes.

If you have anymore questions please contact me. Keep positive. Have plenty of rest now and when baby is born.

Wish you all the best

Keep in touch x

[Cicerenella]

I'm currently taking olanzapine and am in my first trimester - there isn't really any other option for me, as I've had a diagnosis of bipolar disorder since my mid-late teens and I have never been able to come off meds safely since. I've also known lots of people who were medication free in their first and second trimester but recommenced in the third to try to stave off having an episode.

I'm in Australia, but I think the NICE guidelines from the UK were very helpful in guiding my medication choice, because they are so robust and based on evidence - nice.org.uk/guidance/cg192/... . I also had some pretty long conversations with a colleague who is a pharmacist and primarily works with pregnant women and young children - and he got me access to lots of research about olanzapine and other antipsychotics. I feel very confident that although there's limited evidence that they are safe, there is also no compelling evidence that they cause malformations. They do increase the risk of gestational diabetes, macrosomia in the baby, and sedation when baby is first born (or ongoing if breastfeeding), and there are one or two studies that say children exposed may have "behavioural issues" - but those risks are ok to me because none of those risks is death.

Trifluoperazine is a very old antipsychotic, and may have been recommended because there is more research about older classes of antipsychotics during pregnancy. I have been on two antipsychotics from the phenothiazine class (same class as trifluoperazine), and had pretty awful experiences with both of them in terms of excessive side effects. I also began to experience tics that the psychiatrist worried were caused by really early/mild TD, so had to stop. I'd ask your doctor about why they want that drug in particular, and why they've recommended you start during pregnancy - probably they've got a good explanation for both, and you might decide that it's what you want to do, or you might want to ask about alternatives or compromises.

[Healthy_mummy in reply to Cicerenella]

Hi,

Thanks for your reply. It was really helpful. I've been on stelazine (trifluoperazine) previously and it works for me although there are side effects on higher doses for me. I tried several other drugs including olanzipine bit the side effects for me were much worse and the drugs weren't as effective as the stelazine. I'm seeing a perinatal psychiatrist on 6th Feb so will know more then but it's reassuring to know there are other people out there going through similar experiences. Good luck with the rest of your pregnancy!