Second episode olanzapine resistance - Action on Postpar...

Action on Postpartum Psychosis

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Second episode olanzapine resistance

Malta213 profile image

Hi all,

I’m writing as the husband who’s wife is currently experiencing her second PPP episode following the birth of our second son. She is currently in an acute psychiatric unit after being moved from and mother and baby unit after deteriorating.

After the birth of our first son she took olanzapine and started to recover from her acute phase after a couple of weeks. This time she has had olanzapine titrated up to 20mg per day but showing no signs of recovery. She has been on it for 3 weeks now.

I am so scared as the medication isn’t working and the benzodiazepines are not really calming her much. She is I a near constant state of mania and distress .

Can I ask if anyone else has experienced olanzapine resistance in a second or subsequent episode? The doctors have talked about ECT but as her next of kin am so scared of allowing this and it damaging my wife.

Thank you

22 Replies
AndyHenderson profile image
AndyHendersonVolunteer

So sorry to hear what you're going through. I can't comment specifically about olanzapine - although it's one of a variety of drugs my wife was given. As you're discovering, medication is a "voyage of discovery" with few, if any, absolutes.

I can, however, reassure you about ECT having had the same initial resistance when it was suggested for my wife. However it proved an effective treatment for her with no ill effects. I know it sounds barbaric but modern ECT is nothing like how it is portrayed in films.

There's specific advice on the APP web site at app-network.org/partners-2/ in the section headed "I want to know more about treatments for Postpartum Psychosis". It also includes a link to a page that provides a lot more detail.

Andy

Thank you Andy, I’m pleased to hear ECT worked for your wife.

EmiMum profile image
EmiMumVolunteer

Hi Malta213,

I took olanzapine and clonazepan max dosis both during my episode of pp in 2018. During the worst of my crisis I was refusing medication and spitting it out, so the doctors switched me to the orodispersable version and that worked better. I don't want to be indelicate asking this, but do you know if perhaps your wife is feeling some paranoia towards the medication and hiding it?

I can't imagine how hard this is for you, having only experienced not from the point of view of a partner. I feel very much for you both.

The environment of an acute general psych ward is not ideal for a mother experiencing pp, but I also went to such a place initially as my psychotic episodes were quite disruptive and I was in too much distress to stay in an mbu. I was fortunate to be under a perinatal psychiatrist while in the psych unit, so my experience although scarring was better for it. I hope your wife is receiving compassionate care while she is treated in acute.

I have no experience to offer regarding ECT as I didn't get such treatment, sorry to say.

Take good care and thinking of you

Lilybeth profile image
LilybethVolunteer

Hello Malta213

Welcome to the forum. I’m so sorry your wife is struggling at the moment. I had PP twice many years ago, six years apart, and was sectioned to mixed general psychiatric care as there were no mother and baby units at that time.

From my notes I didn’t take Olanzapine but given that other medication alone wasn’t working and I was actively suicidal, my husband consented to ECT. My episodes and depression followed similar patterns so this treatment in tandem with medication eventually made all the difference and saved me from further self destructive behaviour.

I can understand what a big decision it is for you to make especially when your wife is so ill and you have a young family to think of. From my own experience I had no ill effects, though perhaps a ‘fuzzy’ head after a session! I needed several sessions before a difference was noted as an inpatient. I also attended a psychiatric unit as an outpatient for this treatment during depressive episodes.

There is a lot for you to weigh up I’m sure but I am so grateful that my husband chose this option when I couldn’t speak for myself. We moved on from these harrowing experiences to a very happy life with our sons.

I hope you have support around you at such a worrying time. Perhaps the perinatal team will be able to advise and support until your newborn in one year?

Take very good care of yourself and please talk openly to family and friends (here on the forum too) so that you are not overwhelmed. Thinking of you.

Hi, I'm so sorry to hear about your wife. It's a horrific trauma to go through but I suspect, even more so for partners and husbands. I had ppp nearly 7 yrs ago. I was on sertraline and olazapine. Can't rember the dose but I do remember not liking it much!! I had 4 lots of ECT and I can honestly say, I think it was that, that saved me! I don't remember the 1st two, as I was in a very bad way. But I do remember the 4th one, briefly. It's nothing like it used to be. You have a general anaesthetic, so don't feel a thing and everyone is so lovely. It doesn't affect you after either as I was worried I was going to loose my memory! That didn't happen. They ask you memerable questions about your life, before and after. But that's all fine. I wish you well and hope your wife makes a speedy recovery real soon. Kind Regards, Anna :0)

Thank you all for your replies and support. The doctors are going to inject my wife with an olanzapine depot due to non compliance. I hope that finally gets my wife all the dosage she needs to improve.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

I hope the olanzapine depot will make a difference in your wife’s recovery.

I’m not sure if it will be helpful as this is your wife’s second episode and you probably know that recovery is up and down but there is a PP Guide “Postpartum Psychosis “A Guide for Partners“ which might be helpful. There are also personal experiences on the page at app-network.org/what-is-pp/....

There is also a facebook group for partners of women who have had PP to connect and support each other at facebook.com/groups/APPpart...

Thinking of you and your family .... take care.

I am so sorry to hear what happened. Lot of time what we can do is support and pray. Wait for the body chemical get balance again. Change pills are most like a guess game. Some pills works some not. Have to test and give it time. I will pray for you

Lilybeth profile image
LilybethVolunteer in reply to Newdaddy

Hello Newdaddy

Thank you for your supportive reply here. I notice from an earlier post that you are in Texas and hope you are safe and well. Take care.

Newdaddy profile image
Newdaddy in reply to Lilybeth

Thanks

Hannah_at_APP profile image
Hannah_at_APPAdministrator

Hi Malta123, I'm sorry to hear things are tough at the moment for your family. I had PP when my eldest was born, almost 11 years ago now, and my treatment included ECT which I can say made a real difference to me too. The Royal College of Psychiatrist info is quite useful: rcpsych.ac.uk/mental-health...

From your latest update I can see that the plan is try a depot of Olanzapine now but hopefully the info is of use if that becomes an option. I also took Olanzapine and it worked well for my symptoms. It can take some time for it to get into the system and work effectively, so whilst I know that this period of trying to get the right dose and the worst of the symptoms under control can be difficult, it will get there.

I know that it's been shared already, but I also wanted to let you know that APP has a Partners group on Facebook, if you wanted to take a look (link above from Lilybeth). We have a number of Dads of women who have "been there" on the group, as well as on this open forum, who could be another source of info and support for you too.

Take care & all the best.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

I hope your wife will slowly improve when the injection has had time to work. It must be very distressing for you so please take care of yourself.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

Thinking of you and hope your wife is slowly recovering from such a traumatic experience. I hope you have support around you at such a difficult time. Take care.

Dear Malta . I’m sorry to hear of the stress and anxiety you are going through and that you wife is not at present responding to Olanzepine this time around . I understand what you are dealing with at this time .

I’d suggest in the first instance ask for a review with the consultant and nursing staff so that you express your concerns . .and ask about what alternatives they advise.

Do you think for sure your wife is taking it as prescribed? It’s not uncommon that with the turmoil of PPP she may not actually be taking it?? Only a thought !

ECT is something most people dread as it sounds sort of “mediaeval “but I have known several very successful cases where it has worked where drugs have not done .

,and knowledge and methods are so brilliant these days I’m sure you wife would be in very competent hands .

I’m sending you best wishes , resilience and patience to keep optimistic as your wife will come through this and you’ll have happier times ahead as indeed I did after PPP.!

Denise

Lilybeth profile image
LilybethVolunteer

Hello Malta213

Thinking of you and hope your wife is slowly recovering at home now. Take care.

Malta213 profile image
Malta213 in reply to Lilybeth

Hi Lilybeth,

Thank you for your message. My wife came home last week after 3 months away from me and the kids. I can honestly say she wouldn’t be home without the course of ECT which brought her out of her psychosis.

She is finding everyday very hard and feeling guilty and anxious at just about everything but I think that is very normal at this stage of the recovery. It is a difficult balance of getting her to rest but also try to build her confidence with the children again. Fingers crossed we will get there. Thank you for your support

Lilybeth profile image
LilybethVolunteer

Hi Malta213

Thank you so much for taking time out to reply. I’m sure your wife is so glad to be home after 3 months away from you and treasured children. It must have been a big decision consenting to ECT.

With my first PP I came home for good after 6 months of of being under general psychiatric care. So it must have been very hard for my husband and family caring for our newborn. Like your wife, I don’t think I would have recovered had it not been for ECT. Similarly, with my second son, ECT was they key to my recovery.

I’m sorry your wife is finding everyday hard, feeling guilty and anxious at just about everything. I can relate to feeling the same. Although I was happy to be home it took me a while to settle into a routine and come to terms with my psychosis. I also felt very guilty but have since realised that it wasn’t my fault and I had no control over what happened. I think as mums we try to pick up where we left off but it did take time for me to build my confidence and find my place again. Do you have support from the perinatal team until your baby is one year, or a community nurse?

You have been through so much together. It’s early days in your wife’s recovery but with your loving support she will get there. I hope you have help around you too if you need a break. We are all here to talk if it helps.

Thinking of you and your family ... take care.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

About a month on since your update post and I hope you are well. Just wondering if your wife is a bit more settled at home? In time she will regain her confidence and place.

Do you think the PP Insider Guide”Recovery after Postpartum Psychosis” might be reassuring for your wife to have a look through at app-network.org/what-is-pp/...? Please remember to take care of yourself too.

Hi Lilybeth, thank you for getting in touch and apologies for the slow reply.

It’s been a long few months since my wife came out of hospital. I’m not sure overall much progress has been made since discharge. She has a good couple of weeks and then her sleep is disrupted and her condition deteriorates. It is mainly anxiety and depressive symptoms at the moment and her memory deteriorates very quickly if she doesn’t sleep well. She clearly loves the kids is good with them but is constantly worried that they are unwell or that something will happen to them.

The doctors have got her to go back up to 20mg olanzapine again and I am surprised this isn’t getting her to sleep properly. I know with time she will get there but it’s tough for her when she doesn’t see progress and an end of the tunnel! We hope 2021 will bring better luck

I hope you’re well.

Lilybeth profile image
LilybethVolunteer

Hi Malta213

Thanks for taking time to reply .... no need to apologise as it sounds as though you have a lot going on at home. I’m sorry you aren’t sure much progress has been made and your wife has a few good weeks and then not so good.

It must be very distressing for you to watch as your wife tries so hard to be well but is constantly worried that your children are unwell or that something will happen to them. These thoughts are so real and frightening to her so it must be very tough.

I’m sorry that even though your wife has gone back up to 20mg olanzapine she isn’t able to sleep properly. If you are in the UK I wonder if the APP Second Opinion Service might be able to advise your wife’s care team? The link is app-network.org/what-is-pp/.... The team of professionals can offer a consultation with the aim of assisting clinicians in diagnosis and management. Requests must be made by the doctor in charge of your wife’s care. There is no charge for this service to you or the referring NHS Trust.

I think I mentioned earlier that I had PP twice so I’m very sorry you are both struggling . I know how hard it was for my husband to cope with me being so unwell and trying to care for our boys at the time. Do you have family or friends to lean on? I really hope with regular reviews your wife will slowly improve as it must be awful for her to think something is going to happen to your children.

As this is your wife’s second PP, I’m sure you know how much time it takes to recover from such a traumatic illness. It’s good that she has you by her side and I really hope that with support you will both have peace of mind eventually.

Please keep in touch if you find it helpful just to write here. Take really good care of yourself ..... I’m well, thank you.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

I hope your wife is managing day by day. I wonder if the doctors have reviewed her medication as although it was increased she wasn’t sleeping? Is it possible your wife could have counselling to help with her fears about your treasured children? I’m sorry your wife is struggling but I’m sure with all your good care she will eventually see progress and an end to the tunnel.

Take care.

Lilybeth profile image
LilybethVolunteer

Hello Malta213

Thinking of you and hope your wife is making slow but steady progress. I hope you have support for yourself too. Stay safe and take care.

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