Action on Postpartum Psychosis
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Second child, no meds?

Hi all,

I am in the US and see a psychiatric mental health nurse practitioner. I had postpartum psychosis with my son in August 2016. I've been daydreaming about a second baby. My PMHNP said it is an option for me to watch and wait with my second pregnancy and just have an antipsychotic on hand if I start feeling manic. She suggested this because after seeing me on a weekly basis for over a year, she doubts that I have bipolar disorder. Besides the APP guide, where can I learn more about reducing your risk of a recurrence of postpartum psychosis?

Thanks,

Jamie

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you need to investigate the hormones that get out of balance when you give birth so you can replace them this time and avoid psychosis

it's worth looking into omega 3 in your diet too by way of fish, fish oil and flaxseed oil as omega 3 has a very beneficial effect on bpd and the health of your baby although you should lay off eating lots of fish at the end of your pregnancy as it will toughen membranes when you need them to be soft and pliable at the time of birth

also never ever take evening primrose oil when pregnant except if the baby is post term - epo was used to bring on post term babies but could cause a miscarriage if taken before the baby is due

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Thanks for your reply. Where can I read more about hormone replacement postpartum?

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Hi - online I guess - but hormone replacement to avoid pp isn't something that seems to be happening much which is very disappointing considering it seems to be depletion of hormones that cause pp ? good luck

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I asked about progesterone therapy in uk but was told it’s not used as led to depression but I’d heard so many success stories from the 80s and 90s. I really wish more research was done

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Hi waterfallmama

Welcome to the forum :)

There is a lot of great information in the APP guide. I saw Dr Ian Jones through APP’s second opinion service when thinking about trying for a second child (I appreciate you’re in the US so that’s not an option for you) and I opted to go on a low dose of antipsychotic after the birth for 6 months, the dose could then be quickly increased if I started displaying symptoms. The main reason I decided not to go down a watch and wait route was because my PP didn’t hit for 3 weeks - as I was told it would likely follow a similar pattern if I had a recurrence I decided I’d get way too anxious in those 3 weeks. I’m sure others on here have taken that approach though and will share their experience, it’s a personal decision and you have to decide what’s right for you. Luckily I stayed well second time around - I made sure I got plenty of rest, my mum and husband did the night feeds for the first few weeks, I opted to formula feed as I got completely fixated on breastfeeding in the lead up to my PP and just wanted to take it out of the equation.

Regarding hormone replacement therapy, there’s been a recent thread on here asking about it. I can paste the advice we had from APP’s experts if you’d like me to - more research is needed and key clinical guidelines in the UK and around the world (e.g. NICE, SIGN) do not recommend oestrogen or progesterone in the treatment or prevention of PP.

I’d recommend discussing your options with your nurse and I’m sure others on here will share their experiences with you.

It’s a very difficult decision but with good support and planning I think you can reduce the risk of recurrence and be prepared that if PP happened again you could get treatment quickly and it hopefully not be as bad second time around.

Wishing you all the very best.

Jenny x

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Thank you Jenny. I'm reading the APP guide again.

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Hi Jamie

I am currently 9 days overdue with my second after suffering with PPP in november 2015 when my daughter was 3 months old.here is some advice I was given with regards to medication as I was told this is one of the most successful ways to reduce the risk of PPP.

healthunlocked.com/app-netw...

I was strongly adviced by my local psychiatric team to go on a low dose of quietapine in the run up to delivery (I ve been on 50 mg from week 37-39 of pregnancy, now on 100mg). My psych assured me that there is no risk to the baby during the third trimester or breastfeeding while on meds. Hence why I took the precautionary dose of meds.

Wishing you best of luck :)

Dorota

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Thanks for your advice, Dorota. :) Congratulations on your second baby. From your post it looks like you're being induced today. Excited for you!

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I had pp in 2006 with my son 3 weeks after he was born, was hospitalised heavily medicated and under the mental health team with full support for a year. I had my daughter 3 years later, I chose not to medicate this time, instead I looked into hypnobirthing and anything relaxation related, I also had a greater awareness of what triggered my anxiety, the first signs of my PP in the last trimester of my first pregnancy were panic attacks. Sleep is crucial so I made a decision from the start to bottle feed as not only did I not sleep in the last trimester, my son fed literally on the hour every hour. Exercise, power walking with the pram, getting out in nature, music, meditation and eating regularly (every 3/4 hours max) are also very important. I had a scary experience in the hospital first time, couldn’t relax at all, so also opted for a home birth and laboured in a water bath, I had the same lovely understanding midwife, no drugs except gas n air at the end and my second birthing was amazing, completely different to my first. The only wobble I had was when hubby was taking ages getting fish and chips and I hadn’t eaten for 4 hours, I started to panic a bit and thought the tv was talking to me! He arrived I stuffed fish n chips and calmed down. I had complete support from mental health team who were fab and a home visit for first year.

I’m pretty sure the anxiety I felt with my second was the same as any new Mum, I still get anxiety now and again, however I make looking after me a top priority and meditate twice a day, exercise (yoga walking) regulary, spend time in nature a fair bit and eat healthy.

I wish you every success in the choices you make that feel right to you, we are all individual so trust your instincts and don’t be afraid to ask for help medical or otherwise xxx

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A good US based site with information on postpartum psychosis is womensmentalhealth.org. Best of luck on your journey!

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It's essential to have meds after whether you have bipolar or not. I do have bi polar history and am taking lithium last few weeks of pregnancy as I believe if there is a problem post natally starting meds at that point wud be too late. Rest and epidural help a lot too

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Thanks boat1

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