Action on Postpartum Psychosis
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Quetiapine dosage question

Hello all. I'm sorry for writing another post so soon. I just have nowhere else to turn. I live in country with no MBU's and a somewhat old-fashioned psychiatric system. I was on a general ward with very serious mental health patients for 5 days (it was awful) and then sent home, and had to go visit a clinic as an outpatient just 2 days after coming home. I will continue to have to go out of the house for appointments. In the meantime, I'm afraid whether or not my treatment is appropriate because I don't fully trust the system here and don't have an expert to talk to. I've been put on 125 mg of quetiapine to take in the evenings before bed. It's been 11 days now. It helps me fall asleep although I usually wake in the night and can't always get to sleep. I also have something short-term for anxiety (oxazepam; the doctor I last spoke to said she might add Zoloft for long-term anxiety management) and sleeping pills (Sanval) in case I need them. I feel I am getting better every day but I'm worried that the dose of quetiapine is really low. Can I ask what dosages other were given, if you were given this drug?

I definitely feel less "psychotic" but still feel like I'm not "in the world". Is that normal after 11 days? Do I need a higher dosage?

Thank you all.

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Hi thanks for your post.

Your question is a tricky one as everyone responds so individually to medication and need different treatment. I had pp 6 years ago and I can't remember now which dosage I was on.

I know that it did take me about 2 to 3 weeks to fully respond to the anti psychotic medication so it may be that it hasn't taken complete full affect yet. I was very acutely psychotic as well.

Perhaps you could keep a mood diary and list any symptoms you have, unusual thoughts and how you're feeling. It could be helpful in letting the psychiatrist know how you are so they can adjust meds if you need it.

The important thing is to discuss everything with your mental health team, particularly psychiatrist, and get their advice. Does the psychiatrist specialise in perinatal mental health?

I hope you're able to get the support you need. You will recover and be fully yourself and well again.

Ellie

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Hi, thank you Ellie. I realize it's difficult to answer this question. I guess I was just wondering what other people's doses were, if they remember. I think I'm just having a hard day. Being at home is nicer than the horrible psych ward but at the same time it makes me more aware of how "not normal" I am and makes me push myself too much to be the normal that I can't yet be. I think I just need to take it easy, not expect so much from myself, and be patient. It hasn't even been 2 weeks yet and I keep reading that the meds take 2-3 weeks to kick in.

Thank you.

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Hi Kaktus

I'm sorry you're having a hard day. You're doing so amazing, to be coping at home. I was in a mother and baby unit, I'm so sorry you don't have that where you are. I can imagine that home is better as you say, than the general psych ward, but also difficult in different ways. Do you have family / friends supporting you and some regular professional mental health support?

I do know I was given the anti psychotic, and it was increased at one point, and then I slowly reduced it when I was ready to come off it. It is really early days for you yet as you say, and that the meds can take 2-3 weeks to take full affect, this was definitely my experience. You are right that you need to just be patient, rest, let people look after you, and take one day at a time. I had such high expectations of myself too, and felt awful that I was ill and not able to look after my baby at times, or not do everything I wanted. But it really isn't our fault that we became ill.

Others may be able to tell you about dosages they took etc, they may have a better memory than I have!

Take care, and do keep writing on here for any support, and any questions.

Ellie

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Hello kaktus

No need to apologise .... you can pop in here as many times as you like :) I know you're not in the UK but can relate to general psychiatric care as there were no MBUs at the time of my PP. So at the time I was sectioned to a mixed general psychiatric ward with quite a few men and women who were also having a hard time. I was also admitted as an outpatient in times of crisis. Thankfully I fully recovered and am so grateful to the NHS here and also this forum to share experiences.

I took a cocktail of medications but from my notes Quetiapine wasn't one of them, probably because my PP episodes were years ago. There's a website which might be helpful and has been suggested on the forum before, choiceandmedication.org/ncm... with various questions and answers about this medication.

I'm sorry you're having a hard day. PP is such a a traumatic illness and there are ups and downs to recovery but with good medical care and support from professionals you will eventually fully recover. I'm sorry it probably seems a long way off today but you will get there, as many of us have. Try not to push yourself to be well .... take things gently and give yourself time to heal.

Take very good care of yourself ..... sending you a virtual hug across the miles :)

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Thank you all. This is such a wonderfully supportive forum. I don't know what I'd do without it. I have a lot of help at home from family because I basically can't do anything yet but sit in bed with a colouring book and work on a puzzle. Being at home feels safer but of course there are lots of reminders/triggers and it's still hard for me to be around my baby. Every day I don't know what to expect, what my state will be but I do see a general trend towards better. Of course I realize it's still very early. Again, thank you all. You really give me hope when I need it most.

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Hello Kaktus

I hope you have had a better day today. Being at home and having family support is very good as you slowly come to terms with all that's happened and how you feel. As you said earlier you just need to take it easy and not expect too much of yourself at this early stage in your recovery. Your motherly instinct will kick in but you need to make the most of the support around you for now as you give yourself time to recover. We are all here for you too. Take care.

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Hello Krakus,

I had PP is December 2014 and was prescribed quitiapine. I was fortunate to access a MBU after a short time in an adult mental health unit. I am so sorry you are unable to access a MBU in your country.

The first month is a bit hazy for me to remember as I was so poorly. I do remember being on around 300-400 mg of quitiapine when I was in the MBU. I think my medications were increased during my stay there as I was monitored closely by staff. I also took zopaclone sleeping tablets to help me rest when I was really suffering from mania & psychosis.

I stayed on quitiapine for about 2 years & have now successfully come off them after a very slow reduction programme.

You are so strong to be coping at home without support & I wish you all the best with your recovery. Be open & honest with the mental health service you do have in your country & hopefully you will get the right balance of medication & support you need.

Best wishes

Emily

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The problem with quetiapine is that it can make you very drowsy and not with it. When I was on a larger dose I used to drop cups of tea, walk into things and act like a zombie. If you are getting better then I would say stay with the current dose. It sounds like you are getting better which is great :)

I'm not a doctor, have no medical training so this is my opinion only xx

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Hi Krakus,

Yes, I agree with Arabella that a large dose of quitiapine can knock you sideways & make it harder to function. I had to have so much support with looking after my baby when I was on this dose as it was difficult to function properly.

Thankfully, like you I had lots of family support when I got home while I was recovering.

Take things one moment at a time & work with your family & support services. Medication dosages are so tricky to get right & personal. My case was different as I was monitored closely in the MBU & advised accordingly.

Best wishes.

Em x

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Hello Kaktus

Just wondering how you are and hope you are slowly recovering with family support.

Take care.

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Hello. Thank you for checking up on me. I’m better but now dealing with low mood and tiredness, probably from the meds. I feel the emptiness might be from the quetiapine. I also feel vaguely depersonalized and trouble grasping what happened to my brain. Basically I’m still not myself but I’m working on it. I’ve started therapy which wasn’t working out so well and am trying a new therapist today. I hope that will help more. The psychiatrist says he wants me off all meds by spring and has already reduced the quetiapine and clonazepam.

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Hello Kaktus

Thanks for taking the time to reply. I'm sorry you're dealing with low mood and tiredness. As my PP was some years ago I didn't take quetiapine but I do remember the sedating effects of medication making me tired but keeping me stable.

It's good that you're persevering and working towards feeling better. I hope the new therapist was more helpful today. It must feel reassuring when your psychiatrist is looking at Spring for you to be meds free but remember not to push yourself ..... all in your own time.

Take care, we are all here to support you.

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Hello Kaktus,

thank you for sharing your experience on this forum.

You already received some useful links and reassurance of others based on their own experience.

I have had PPP in the Summer of 2010 and spent August and September in a mixed Psychiatric Gender Hospital. My experience were awful and professionals did not know what to do with me. I was in seclusion for most of the time when in hospital. Unfortunately there was no MBU in my region.

Nevertheless I eventually got much better once I was in the care of my partner. The after care off the Partnership was a more positive one, because a support network was established consistent of a Psychiatrist, Care Co-ordinator, GP, Health Visitor (probably a few more) and my partner and his parents.

Do you have a "care plan"? I hope your therapist can help and listen to your needs. Eventually my care-coordinator referred me to some very useful therapeutic sessions, which enabled me to gain self-management skills again. It was quite a learning curve and huge re-adjustments...my life used to be on the fast-track, and nowadays all in stepping stones and with mindfulness :-) (support groups, art therapy, support worker etc,)

You mentioned also your medication. For one year I have had to take a mixture of very traditional medication, but have been so very fortunate to come off those with the help of a wonderful Psychiatrist and my partner. On the other hand I am now very much aware that I would not have survived PPP without the medication. I am always grateful for those once who helped me to see the light again.

x

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Thank you Jasa.

i don't have a "care plan".. it's a bit different here where I live. I have a psychiatrist who sees me about every 6 weeks and I found a therapist I go to weekly but they are not connected to each other.

I'm having a hard day today because of not sleeping very well. It always throws me off and I feel very depersonalized. The calming pills help with that but it makes me miserable.

Sometimes I'm afraid I'm not getting better. I don't have serious psychosis symptoms but everything still feels kind of unreal and I don't feel grounded in my body. I've been on medication for almost 2.5 months. Is it normal to still feel so ungrounded/disconnected? Sometimes I feel like consciousness itself is a kind of dream so that what I'm feeling isn't "unreal" but all I want is to go back to feeling IN my body, IN my life. I feel like I've lost the safety and sanctity of my inner world. Also, the world I shared with my partner seems to be gone. It’s like I’m living in this new reality. Is it the meds or just part of healing? I’m so afraid I will never have my old world back.

I also have absolutely no sex drive (sorry if it’s too much information) and it makes me wonder what will happen to that part of my relationship with my partner.

I don’t know, even though I am a million times better than when I was really bad, I don’t feel joyful about it. I still feel like I have lost everything.. it’s so odd…

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Thank you for your reply, Kaktus.

I am so sorry that today has been difficult.

I only remember the transition from hospital to home life, because I can relate to pictures. I just remember little snap shots and over the last few years my partner helped to fill the gaps. I guess life became much easier when home,-my own sanctuary.

Medication helped me to improve, but the side effects were a great struggle. Yes, meds have had a big affect on how I managed (and/or did not cope) with a new adjusted daily routine. My partner taught me gradually how to look after myself again and to take my medicine. In addition I had to learn to be a mum. Role adjustment after PPP is not easy and takes time.

Yes, you are recovering, ...being poorly means to walk a slower pace and approach things in stepping stones and to regain or acquire new skills, depending on which way you want to go. Obviously at the beginning it is tremendously difficult...not only for oneself, but everybody involved, especially the ones who love you.

...I have regained life, but a different one than before...I am happy,-you will re-discover

and much more...we all have on this forum.

Look after yourself.

x

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Hi Kaktus

You are doing so amazing, in the short space of time that passed. And what you describe I could have written when I was in early recovery. I too felt very disconnected from everyone, and everything, including myself (that feeling of not being in your body or your life..).

You also mention your husband... I felt the same with my partner... my illness had a big affect on him and our relationship but somehow we stuck through it, and slowly we recovered, and we found ourselves and our relationship again... I think having a baby is such a huge change in a relationship anyway but then you add PP on top of that...

What is so positive is that in some way you are connecting with it as you can voice how you are feeling, and you long for things to be different...and it sounds like you're doing so much to help your recovery, to fight the illness, which is amazing.

Thinking of you, you will get there and get better

Ellie

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