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Action on Postpartum Psychosis
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Lithium in late pregnancy

Hi everyone 👋

My doctor has suggested taking lithium and haloperidol from 7 months pregnancy, to reduce the risk of PP. I was up for it, but now I’m 20 weeks I’m starting to feel differently. I’d prefer to take haloperidol and start lithium after the birth.

I understand that Lithium means I can’t feed baby my milk at all, and I’ll probably have to be induced at 39 weeks so they can plan when to stop lithium before birth.

I’ll discuss with him further on Friday, about his thoughts about just taking haloperidol, and starting lithium a few days after the birth. This means I can go into labour naturally, and baby can at least have some colostrum before we switch to formula as I start lithium.

What do you think?

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Hi Jesse, I can’t really comment on your situation, but here is what I did. I was stable through 2nd pregnancy so was able to stay drug free. I decided with my drs to not bf due to massive hormone involvement. Took lithium directly following delivery and gave baby donor milk 2 times per day till nearly 6 months. We also had support overnight for 8 weeks post delivery so I could sleep. I was prepped to go back on lithium if any changes during pregnancy, but didn’t need to. All the best. It’s such a difficult time to navigate through. 🌻

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Hi Jessi_D, I don’t have this exact experience to share but did take lithium after I had pp when I had my first son in 2009. It was added to my treatment when the anti-psychotics weren’t quite getting me well enough, a couple of months in, and I took it for 3 years in a reducing dose. I found it to be a good medication in terms of getting me well and stabilising me.

I’ve had a second child and didn’t take any meds in pregnancy, tho I took a low dose of antipsychotic on delivery and luckily there was no further pp episode.

I wasn’t able to breastfeed after my first, and was separated from him for a few weeks and chose not to breastfeed my second son, as part of my care plan to try and promote sleep, as stress free as possible etc (breastfeeding was a big stress the first time round sadly). I was able to give a few feeds for colostrum after I gave birth and before taking meds on the first night.

This felt like the right balance for us and we were lucky to escape any further illness although I was naturally anxious about becoming unwell. I know pregnancy after pp is a really tough time in many ways and I hope you are getting good support.

All the best with your appt tomorrow, thinking of you, xx

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Hi Jessi, I had two episodes of PPP fourteen years apart. Obviously it was a shock first time but the second time around I had hoped to not be ill again. I hadn't had any medication for approximately 12 years since first episode and was advised that as a precaution that I take lithium 3 days following birth. Unfortunately I had a hallucination on day one and asked for the lithium early....however this was too late! My illness happened first time on day 3 and began similarly the second. I wish I had medication during the later part of my pregnancy as I could of avoided hospital, Ect and sectioning. Follow the doctors advice they know now through years of experience what they are doing xxx

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Hi Scissorsister, I discussed it with my doctor and seems like not taking lithium before birth is just taking unnecessary risk. Just as you said, taking lithium after birth is too late. I’ll follow the doctor’s advice, take the medication during pregnancy and hope it will keep me well!

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How did things go. I'm 39 wks started lithium a few weeks ago. Now at correct dose.

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I have a meeting tomorrow to discuss taking lithium (with a pharmacist), I’ve not started it yet.

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Having started lithium at end of preg is not as bad as I thought it wud be. There are weekly blood tests and I think I was panicking too much bout levels going toxic. They keep a good check. I asked a pharmacist but they can just advise on the medication. They do not understand the high risk post natally and what is at stake. I wud hate to have a repeat of PPP as I did in 2009. That's why I decided last few weeks to take the lithium. The baby is already developed

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I am wondering exact same thing. To start lithium or possibly low dose quetiapine at the end of preg or just use them straight after. I am well off meds and last time medication after was enough. Please share if anyone has any thoughts

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I’m off meds too, but was advised that taking meds after is too late! I’ve been told to take haloperidol and lithium from seven months pregnancy.

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Yes it's very tricky. After could be too late. I was thinking if I do this to up the quetiapine. But there are side effects. Do you lithium or quetiapine is better at end of pregnancy? Anyone ?

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Hi boat1, medication is such a balance and also something that can be different for each person depending on their preferences and previous responses to particular meds.

I don’t have any experience of quetiapine I can share I’m afraid and whilst I took lithium this was after my pp, and not in pregnancy (I was fortunate to have a meds-free pregnancy with my second child).

Lithium does require careful monitoring, to ensure that thyroid, liver, and kidneys are not affected negatively and also to maintain a “therapeutic level” of the drug in your body. Regular blood tests every 3 months, or as advised by your clinicians, is how this worked with me. As Jessi_D has also mentioned, timing around levels for the end of pregnancy can be something to bear in mind and professionals will be able to advise on this.

Do you have good professional support to get some input with these decisions? I hope the personal experiences here have helped and that all is going well in your pregnancy. Take care, xx

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Thanks for ur reply. I have been on lithium for many years due to bipolar history. Now 32 wks preg off meds and fine. But consultant has suggested either lithium or quetiapine at end to lower post natal risk or just to do post delivery. Last time I just had meds post delivery and with early epidural was fine. But it's tricky as this time may be different

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Hello Jessi_D

Are you on maternity leave yet? I hope you have a fun, relaxing Easter break :)

Take care.

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Happy Easter! I’m not planning to go on maternity leave until July, but have a few weeks off between now and then.

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Happy Easter Jessi_D :) I hope you are ok and have not been too stressed at work.

Thanks for your good wishes and taking the time to reply.

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I told my new boss about the risk of getting PPP again, as I’m five weeks from going on maternity leave and worried I might contact him when I’m not well. So now he’s aware, and has my husband’s contact details so they can get in touch if needed. My husband also has his contact details and will let him know if I get PPP again. Worrying about losing my one’s capacity and behaving strangely is horrible. Maybe it might’ve been better not to say anything and leave it to HR and Occupational Health, but I think that showing some vulnerability and trust in him was a good thing (especially as I come across very strong and confident).

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Hi Jessi_D

Hopefully with all the good care you have in place PP will not return. Perhaps your new boss will be more supportive since you have given him an insight about the risk of getting PP again? Take it easy at work in these last few weeks before your maternity leave.

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