Action on Postpartum Psychosis
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Relapse

Hi all,

I’m just reaching out for some reassurance/ comfort?

I had PPP in September 2016 2 weeks after the birth of my daughter. I was sectioned and fortunately recovery was relatively straightforward and I was discharged after 2 weeks.

Unfortunately I entered a deep depression and was readmitted to a mother and baby unit in February 2017 for 7 weeks.

Following discharge I was taking sertraline 125mg and quatiapine 500mg.

Over time this was gradually reduced and having been well for nearly 12 months I stopped my sertaline and was still taking 150mg of quatiapine.

Everything was going well but I had a relapse and the depression symptoms returned in March 2018. I’m now off work and battling a deep depression again! I’m back taking 125mg of sertaline and still taking 150mg of quitapine im just hoping I feel better soon. I’m not able to look after my daughter at the moment but my family are being supportive.

Just looking for reassurance and tips to help me get over this next challenge.

Thank you all.

X

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Hi LA88....i felt I wanted to reply to your message. So sorry to hear what a rubbish time you've had. I just wanted to say I had PP in 2014 and have been on low dosage sertraline ever since. I have wanted to come off completely a few times but my life is just to challenging and I've stuck with them. And I went on to have another child. The fear of a relapse was too big so i was advised to continue with them. I have a fear as they are my security blanket and to be honest I don't think I could get through the days without them ( 1 have a 2yr old and a 4 yr old!) May I suggest continuing with the sertraline and as and when you feel strong enough gradually drop the dose to the lowest and continue. My fear is you may have stopped too quickly. Sending lots of love to you and hoping you feel better really soon X

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Hi there,

I agree with Emma Potter - I think you came off the pills too soon.

Don’t worry, you’ll get through this. It might take a while but you’ll get back to emotional balance, though you might still need pills.

I had PP in Dec-April last year. I’m pregnant with my second and do worry about a relapse.

All we can do is try our best to be positive- something that helps me is to search for things I’m grateful for and make a list every evening before I go to bed.

Maybe you could give it a go?

Thinking of you, big hug xx

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Thank you both for your lovely messages.

In hindsight, I think I did come off them too soon but I had been very well and thought it was the right time. On reflection I think I may need these medications in the long term.

Just need to get through this and then work on staying well again. X

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Hi LA88,

I’m sorry about what you are going through. I was hospitalized a few weeks after my PP hospital stay for depression. Both times were hard. It took awhile to get out of depression but remember you will not always feel like this you will get better! Are you seeing a counselor or therapist you like?

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I have no input from a counsellor or a therapist since both admissions at a mother and baby unit.

Once I get well again it is my intention to request sessions with a counsellor or psychologist for cbt so I can put some better coping mechanisms in place to try and prevent another relapse.

Like you say I will get better just need to get through this dark period then focus on staying well.

It’s just hard when I can’t be the mum, wife and person I want to be and I can’t work at the moment. But one step at a time and I’ll get there again. X

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ask for CAT therapy if you can. It's a slightly different approach to CBT but absolutely awesome. x

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Hello LA88

I hope you have been reassured and comforted by the shared experiences here. I'm sorry to hear about your relapse and depression returning this month.

After my second PP I suffered what seemed like an endless depression and had medication and treatment. I know it can be disappointing to take medication daily but as long as it keeps you stable I think it's for the best. I do understand though as I reduced my medication to show family I was coping but unfortunately my health took a turn for the worse and I was almost back to square one.

I know you can feel quite isolated with depression. I think it might be an idea to access support for yourself via your GP who will be able to signpost you to counselling or another therapy, rather than wait for the dark period to lift. The more professional support you have around you the better you will be as well as support from family.

Try to focus on what's best for you and make sure you are completely well before taking on the challenges of work and home. You have been through so much and now need time to heal and be good to yourself. I'm not sure if you have heard of PANDAS (Pre and postnatal depression advice and support) which has been mentioned on the forum at pandasfoundation.org.uk/.

Take good care of yourself and build as much support around you. It might not feel like it at the moment but the black dog will eventually leave you again and you will feel better day by day. We are all here for you until then .......

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Hi LA88,

Well done for reaching out. So sorry to hear about your experience.

I had PP in Dec 2016. I did experience low mood after my discharge from MBU, but was never medicated outside of my antipsychotic. It was close though, so I do understand how you must be feeling.

Take each hour at a time, if that’s too long (and sometimes it is, isn’t it) just take each five minutes, or each moment. Try and find one thing that’s positive each day and hold that close. Again, not at all easy, but in time you can get there. You will conquer this, you already are conquering this.

Glad your family are supportive with the little one, I would have been lost without mine.

Don’t be too hard on yourself, you just need time to heal. X

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Hello LA88,

welcome to the forum, well done for reaching out.

I have not suffered from depression after PPP, but struggle still nowadays with hyperactivity. Luckily my extreme Insomnia has drastically improved.

Assessing and evaluating including making choices about treatment and therapy depends very much on your experience and the availability of professionals around you. It is a very individual path of recovery.

I was weaned off medication within one year under close supervision of my Psychiatrist and my partner. I was sectioned and lucky to be able to leave after 39 days. The first 6 months I still was very poorly and my partner had to look after me fulltime. I improved gradually, but had to work a lot on myself in order to reduce some of my fear and anxiety issues.

Each day I am grateful and I very much live with the momentum and try to avoid stressful situations as much as I can.

some suggestions:

- regular contact with your GP and advise on therapeutic options

- a second opinion with regards to diagnosis and choice of medication or therapy

- availability of a mental health team within your region (art therapy, care coordinator, support worker, Psychiatrist, Health Visitor)

- engage with other mums and kid's activities...when still recovering from PPP I managed to go to a baby massage once a week and then added a play group session

- exercising, swimming, walking, cycling etc. increases happy hormones". I also enjoy Yoga and Meditation

...so pleased you connected with APP...I waited too long and isolation is not very good...it is important to know that you are not on your own and we are here to support each other with our shared experiences.

x

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Sorry to hear you are feeling pretty crappy still and suffering from depression after having ppp. It’s ok to feel this way and many do, it’s ok to still be on your medication, it may help to accept these two things as part of how you are are right now, whilst taking steps to recover alongside this. The secondary suffering we add on top ie guilt, failure etc can sometimes make things seem worse as we fight to recover rather than acccept things as they are right now.

I had psychosis in 2006, and found the following things vital in my recovery and still do now when I feel down or anxious, they are my coping strategies for a calm and peaceful life when things are tough!

Sleep, makes a huge difference I use a sleep app called ‘I sleep easy’ most nights to drift off and sometimes in the night if I wake

Eating regularly and mostly healthy unprocessed foods, every 3/4 hours

Daily meditation, I’m now training to be a mindfulness teacher and started meditation daily about 5 years ago, I used it in my recovery also but didn’t realise I just knew focusing on my breath cleared some of th nightmares away. This takes practice the calm app is a good starting point

Exercise, walking in nature is excellent or yoga and Pilates are my favs

Music & dancing a greasy way to lift the mood!

Something creative, I do poetry on occasion drawing or writing could help

Learn to love and accept yourself more just as you are! Look in the mirror daily and say ‘I love myself, I love myself, I really do love myself!’ I have actually done this lol

Trusted people to chat to, a group or forum perhaps I find my hubby has been fab get it all out don’t keep it in. Cry if you have to, scream in a safe place climb up the emotional guidance scale to a better feeling even anger is ok! It beats depression.

You can do this, little by little step by step, aim to do 1-2 things a day to send you in the right direction ❤️❤️❤️

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Hi LA88,

I too had PP 2 weeks after my first born daughter in 2008, I also recovered quickly after a hospital stay and a few months on olanzapine. A few months later I felt that i was slipping into a deep depression. Not wanting to go back on anti-psychotics (olanzapine) I did some research and discovered bio identical progesterone. Got my levels tested and they were extremely low, started on 20 mg bio identical progesterone cream and quickly began to feel better.

In 2010 and (jan) 2018 I took 100mg of bio identical progesterone in micronized capsule form daily for one month following the birth of my 2 sons and haven't had any symptoms of pp, pnd or the baby blues.

This therapy was pioneered by Dr Katharina Dalton, I read a few of her books and my Dr was always happy to prescribe the progesterone.

Hope this helps and you feel better soon x

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Hi Emas and welcome to the forum,

The treatment you have shared from your subsequent pregnancies after PP is something that others have talked about on different threads too. I don't have any experience of it myself, as my PP was treated by anti-psychotics, mood stabiliser and also a course of ECT. When I had another baby, I took a low dose of anti-psychotic on delivery, as part of my care plan which was around doing pretty much anything I could (and as much different than the first time, when I'd been ill) to try and avoid a recurrence. Luckily, like you, I did stay well - although a 3rd baby is not something I am planning!

I just wanted to share some information from the Clinical Experts at APP, in connection with the treatment you mention (& for any others reading here):

APP’s experts say:

"Although hormonal changes may well play a role in PP we need more research to understand this better. At present, there is not enough evidence that treatment with oestrogen is beneficial in PP or for maintenance of mood stability after PP.

Katharina Dalton advocated the use of progesterone therapy for prevention of postpartum mood episodes a number of decades ago, and reported a number of positive case studies. However, there is still a lack of good evidence for it helping and there may in fact be a higher risk of depression in the group treated with progesterone. There haven’t been any studies examining progesterone and PP specifically.

The 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. More research in this area would be very helpful."

I hope this provides some further info for those reading. PP whilst a horrible and cruel illness, is still hugely under-researched and treatment can vary by each person's experience.

A number of ladies also report positive feedback from a Second Opinion Consultation with Prof Ian Jones, who is a leading expert on PP; the link is here, and is free to access via GP or mental health team referral: app-network.org/what-is-pp/... I know that for me it was invaluable, as so many areas of the country are still lacking specialist perinatal mental health teams to advise on treatment.

Thanks once again for sharing your experiences, take care, xx

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Thank you all so much for your support, reassurance and coping mechanisms.

I am doing a little better, I’m now able to look after my daughter and able to get up on a morning which I was really struggling with.

I am due to be back at work on Thursday but not sure how I feel about that at the moment. I want to be back but I don’t want to set myself back again.

I’m going to go see my gp on Tuesday to ask for psychological therapy and will discuss my return to work then too.

Thank you again for all your support, it really means a lot x

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It's really important that you push to get a psychologist. It completely changed my life...albeit a little later than i would have hoped for. Ask for CAT therapy if you can. It really worked for me, so something for you to look in to. I found it much more useful than CBT. x

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Hello LA88,

what lovely responses above...I hope mums' life experiences, view points and support help you to clear some of the cobwebs.

Pleased you are "doing a little bit better".

I never returned to my busy schedule of teaching Research and Pedagogy, but have used my skills otherwise since improving my health. It is quite interesting to read about mums and their new path of discovery.

I definitively have had to step back from the political arena of Education, but still contribute in little ways, beside my art work and volunteering.

After having had such a traumatic illness it is important to listen to your own voice without fulfilling the expectations of others. All in stepping stones and with a support network has been my only way forward.

My partner was looking after me for 6 months full time and then went back to work in an integrative way, part-time in the first instance. He actually was very open to the occupational health and was prescribed therapy. I am just taking my partner as an example, because I want to highlight that you have choices and implemented legal rights at the work place where mental health and welfare of the worker should take priorities...he has become the leading Union Rep in his company supporting people with mental health issues within the work environment.

Look after yourself and take time to heal...

x

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Hi LA88, sorry to hear that things have been tough recently, although your recent update that you are feeling a little better is good to hear. I hope that the GP appointment on Tuesday is helpful for you and that you have good support around going back to work, whether that be this week or whenever is best for you. As others have said, working after PP can sometimes be an additional challenge and it's important to find the right balance, which is of course individual to us all.

I also wanted to share the link to the Second Opinion Consultation with Prof Ian Jones, which is offered by APP. He is a leading expert on PP; the link is here, and is free to access via GP or mental health team referral: app-network.org/what-is-pp/... I know that for me it was invaluable, as so many areas of the country are still lacking specialist perinatal mental health teams to advise on treatment.

Hope all goes well this week for you, take care, all the best, xx

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Give yourself time. You will overcome this. I too had a relapse after 2 years of feeling fine. My depression was so deep that I had ECT for the second time 6 months ago. Things are looking better now.

Somethings that have been helping me:

1) Reminding myself that everyone deserves love, respect, and safety,

2) Having a loose schedule that includes morning outdoors exercise,

3) Being med compliant,

4) Communicating openly with my psychiatrist and therapist, and

5) Listening and reporting out in the group therapy sessions with Depression, Bi-Polar Support Alliance (DBSA)

Do what feels right for you and again you will overcome this.

Hope this helps.

Love,

Gina

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Give yourself some credit, you are doing amazingly well and have been through so much. You are obviously a fighter and will get through this next challenge. Life is never easy is it? :(

It's great that you have such a supportive family and even better you can spend some time with your daughter now.

Just take your time, look after yourself and you will get through it again. You have done it before and you can do it again.

Thinking of you. xx

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Hi there. So sorry you're still struggling with your depression. I had a similar experience after a year or two of being well. I decided that I needed to seek psychological help to tackle both my PPP issues and my general depression, (my need to be 'perfect' and inability to focus on myself and to accept myself) which I have always known contributed to my PPP. I feel much better these days with much shorter periods of low mood that I can mostly rationalise and cope with. It's not been a quick process. My daughter is nearly 5 and I've had nearly 3 years of therapy but I'm going to finish soon. I'm also ready to contemplate another baby and am getting excited about that. I'd recommend therapy over medication or alongside medication. Hope this helps. All the best. xx xx xx.

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Bless you. It's really admirable that you went back to work. Which mother and baby unit were you in? I was diagnosed with PPP in March 2016, just under 3 weeks after my daughter was born.

I too returned to my job albeit part-time (3 days a week). I started to struggle about 4 months ago and just felt like the job wasn't for me (marketing) and needed to do something where I felt more valued. I found it hard that I didn't enjoy my job anymore and although I sometimes really appreciated that time away from my daughter to be 'me' and have a cup of coffee when I fancied, pop to the loo when I needed to etc I felt like my time away from my daughter was valuable and wanted to do something that felt worth leaving her for. I've since signed up and have started training as a mental health peer support worker. I'm loving the training and it feels so rewarding that i'll be able to give back and hopefully help other people going through a hard time...and improve mental health services in my area. I wonder if this is something you could look in to in your area?

It's fab that you have a supportive family around you. Have you tried other anti-depressants? I'm now on 150mg Venlafaxine and 200mg quetiapine (modified release). The quick release version of quetiapine effected me so badly and basically made me feel drunk (the horrible part of being drunk, slurred speech, confusion, extreme fatigue). Maybe look in to whether that might be a better option for you?

Have you looked in to mental health resources in your area? We have the recovery college here which run a variety of courses which i've found quite useful. Mind also do courses which is something i'm going to be looking in to.

It's a really tough age that we're going through with our kids at the moment and I am promised it does get easier!

Doing things that help you regain your sense of self again has been really good for me. With PPP it's so easy to lose yourself and forget what you even liked before you were unwell. Give yourself time and take it easy on yourself.

Let me know if I can do anything to help. Will be thinking of you.

Lots of love,

Natalie xxx

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Hello LA88

I'm glad you were feeling a little better when you last posted and managing to look after your daughter. That takes a lot of strength and courage when you're fighting the challenge of depression.

Did you ask your GP about psychology input? I wondered what he advised about returning to work? It might be too soon to return ...... as with the support already here, try to give yourself time to come to terms with all you have been through and be kind to yourself. I think it's best not to rush back to work if you can manage financially for a little while longer.

Take good care of yourself. We are all here to support you. xx

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Thinking of you, too LA88,

We are here and listen!

Look after yourself. I find little stepping stones less overwhelming! Not too much long term planning and loads of breaks and "me time" in between. (preparing bits and bops for my son's activities, painting, meditation, walking, yoga etc.) If not much time, short bursts help, too.

xxx

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Hello LA88

Just wondering how you are and if you returned to work after advice from your GP? I think it's early days since your depression in March to return to work so I hope you are ok. Perhaps it would be better to build your confidence with routine at home before venturing back into the workplace despite financial considerations.

I hope you have been able to access psychological therapy which you mentioned in your last post. Take good care of yourself and rest as much as you can. xx

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Hi Lilybeth,

Thank you for your lovely message and for thinking of me.

After some pleading I managed to get an urgent referral to a psychiatrist in my area as continuing to rely on Nottingham services wasn’t sustainable. I was wary as I’d had a bad experience previously with my local services but my new psychiatrist proved herself to be extremely competent and I had confidence in her.

My new psychiatrist managed to get the balance of my medication right again and I’ve been told I’ll be on this medication for at least a year.

I returned back to work a month ago on a phased return and last week I went back to my full time hours and all is going well.

I’m now taking extra care to look after myself which includes eating healthy and regular and also exercising frequently.

Things are going well at the moment and I’m just hoping I can stay well for as long as possible. A possible diagnosis of bipolar 1 was suggested to me at my first meeting by the psychiatrist and this has never been mentioned to me before. I suppose it is what it is and I’ve not questioned this any further at this stage. I just know that I have to take my medication for the foreseeable and do my best to stay well. I haven’t got another appointment with my psychiatrist unless I feel the need for one but I do have a CPN if I want to check in with her.

At the moment I’m not going to start any psychological therapy I just want to enjoy being well at the moment and I may explore this at a later date.

Thank you for all your support it really did help. Lx

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Hi LA88

Thank you so much for taking the time to reply. So pleased things are going well for you and you are back at work ..... such a great achievement. It's good to know the professional support is there if you need it.

I'm glad you are taking extra care of yourself. Try to make sure to have as many breaks as you can at work too. Take care ...... you're a star :) xx

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Dear LA88,

so lovely to hear from you. You are such a brave lady and have done exceptionally well with the re-integration of work.

It is so important to listen to your own body and needs and obviously find some me-time, such as exercising in your case. I enjoy my meditation and yoga very much and I can slow down my hyperactive phase...sometimes I need gentle exercising or in case of mind racing I go cycling through our beautiful Somerset Hills.

I hope you have a support network in place, especially when it has been suggested that there is the chance of bi-polar 1.

Wishing you well and good luck with your work. I hope your work place is supportive with regards to mental health issues.

x

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