Link between post partum psychosis and the peri menopause

[Carmen25]

I had my first child in May 1999 when my son was born 7 weeks early. Two weeks later I had a rapid descent into post partum psychosis and was in hospital for 2 months. This was a general psychiatric ward that had two mother and baby beds. I made a gradual recovery and was then well again for the following 17 years, including through the birth of my twin daughters in 2002.

Fast forward to August 2016 when I was 48. Very suddenly I started to feel extremely unwell. This felt very similar to when I had my son.

Initially I was managed at home by the Crisis Team but quickly this became unmanageable and I was admitted to a psychiatric ward with psychotic depression. I was there for the next 6 months while various drug regimes were tried, all to no effect. I recovered when I had ECT. The speed of my recovery on receiving ECT was astonishing.

At that time I did not know about the potential link between post partum psychosis and subsequent psychosis during the peri menopause.

I believe this is a vital issue that needs further research and understanding. At no point did my psychiatrist tell me about this potential link and I wonder how much knowledge there is among psychiatrists and GPs about this. While I do not know if having this knowledge would have made a difference to my illness and the progression of it, at the least my family and I would have taken comfort from the knowledge that this was a similar illness to my first episode and that I would recover.

At best I could have been monitored by mental health services and I would have had the opportunity to put together an advanced directive, as I had done during my pregnancy with my daughters.

While I appreciate that monitoring people has an impact on NHS resources, if it can reduce admissions and shorten the length of illness then the benefit to the NHS is potentially significant. I can only imagine that my 6 month hospitalisation must have cost many thousands of pounds.

Today I am well and happy. I continued on antipsychotic meds for a while after discharge but no longer need these.

I am happy to chat with anyone who has similar experience

[lillyofthevalley37]

There is a hormonal change after giving birth progesterone drops dramatically this can have consequences because it means estrogen is dominant or is unmoderated by progesterone,

progesterone is calming whereas estrogen is excititory giving rise to autoimmune disorders or even ppp

When progesterone drops after giving birth some women develop an autoimmune disorder called hashimotos which effects the thyroid often this will be temporary when the ovaries make more progesterone

Perimenopause and menopause means hormones wane and if treated with estrogen hrt can give rise to late onset autoimmune disorders or mania if the person with bipolar disorder has hormone related bpd

My sister had ppp and hormonal bpd

I have had autoimmune issues from menopause treatments

[Jocelyn_at_APP Partner APP in reply to lillyofthevalley37]

Hi Carmen25,

Thank you for reaching out to us and sharing your experiences. I am so glad that you are doing well now.

I think that everyone’s personal experience is so different and tends to involve so many different factors unique to each person, rather than just one thing (such as hormonal changes). We think that hormonal / biological changes is certainly one of these factors.

The information on our website says what we know so far about what causes PP under frequently asked questions: app-network.org/what-is-pp/

There are likely to be many factors that lead to an episode of Postpartum Psychosis. We know that genetic factors are important. You are more likely to have Postpartum Psychosis if a close relative has had it. Changes in hormone levels and disrupted sleep patterns may also be involved. Postpartum Psychosis might be more common in women with thyroid problems or pre-eclampsia, but further research is desperately needed though to understand the complex interaction of biological, psychological and social factors that are involved. For this reason, we are very keen for people to help us with research into PP - click here to find out more - app-network.org/research/

APP’s experts say although hormonal changes may well play a role in PP we need more research to understand this better. 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. At present, there is not enough evidence that treatment with oestrogen is beneficial in PP or for maintenance of mood stability after PP. The key clinical guidelines in the UK and around the world (e.g. NICE, SIGN) do not recommend oestrogen in the treatment or prevention of PP.

Definitely more research in this area would be very helpful!

[Hidden]

After 2 episodes of pp, I was dreading the menopause. But I was given the minera coil and oestrogen and I feel better than I have for years - since the children were born. I do agree that more research needs to be done, particularly into the effects of hormone imbalance in triggering and treating extreme mood. It’s hard to believe that such extreme episodes can be simply down to hormones, but in my own experience, yes, they really can. That’s why we need more research. 🙂

[Anna_10]

Hi Carmen25, I had ppp in 2013 after the birth of my daughter. Then in 2019, I had something similar to my 1st episode, but it was more of a depression this time round. I luckily didn't suffer any psychosis. I was also so lucky to avoid hospital this time round. Just had to go back on anti depressants, which I'm still on & HRT patches! I had 4 lots of ECT the first time round. Its amazing and literally saved my life!! I'm always here if you ever want a chat. Take care. Anna 10. Xx 😁

[Carmen25 in reply to Anna_10]

Thanks Anna. I’m on HRT now too and find it very helpful. ECT was absolutely amazing. I didn’t expect it to work but by the time I was offered it I had been so unwell for 5 months, 4 of which were in hospital and nothing had helped. I signed the consent form because I felt I had nothing to lose.However within the first couple of sessions I started to respond really well. Friends who visited me said the transformation was astonishing-as if a light had been switched on (a GP friend says it’s like pressing CTRL ALT DELETE in other words a reboot). I was discharged at the end of February 2017 and by 20!March I was well enough to start a phased return to work.

People who campaign against ECT need to hear stories like ours. For the right people it’s literally a life saver

[Anna_10 in reply to Carmen25]

Hi, soz for late reply! E C T literally saved my life. I agree. Hope your well and have a great Christmas. Hope all the new rules don't affect you too much. Love Anna x

[Vikrika]

What ect stands for?We had our daughter in february this year,after couple of weeks when we called out an ambulence ,one of the stuff said to me,your wife need help,than she stayed at the hospital's menthal health unit and I had my daughter with me and friends who also looked after both of us.

Couple of weeks(felt like half of my life)later she had the opportunity to go to the mother and baby unit,

Fast forward:

She is at home about 3 month ago and just a good month ago we found a good mixture of medication.

She need to return back to work in january,

My question is :

How long does it take to not take any medication.

Thanks if you read that through!

[Carmen25 in reply to Vikrika]

Hi VikrikaECT is electro convulsive therapy. It is really a treatment of last resort when nothing else has worked.

Medication is very individual so it is difficult to say how long someone would need to remain on it.

In my case, after I had my son, I stopped my antipsychotic medicine after 12 months. It is important to do this with the help of the doctor.

Congratulations on the birth of your daughter by the way 🙂

[Vikrika in reply to Carmen25]

Thank you very much for your answer,I was just a shoked husband who didn't even know what was going on until the tipping point,when they took our baby from mother and gave her to meI think you either grow or run away,I felt like I have no other chance just be there for her.

And everything happened in the complete first lockdown.

I couldn't visit,could not give a hand,I want her out ,but also want her to get better.

She was in "room quarantine" for 2weeks!!!

I would went crazy if that was me.

Like prison.

I had no information for 3days when every minute counts .

But hey,I think we are on the better part now.

She still have aripripazol and some medication for its side effect,plus antidepressant.

Nora is growing now inbetween Us ,happy days,

Only good part of the virus is I spend looots of time with both

Thanks for listening

[Maria_at_APP Moderator in reply to Vikrika]

Hi Vikrika,

Belated congratulations on the birth of your baby. I am very sorry that your wife had pp after, it is a terrible illness and such a shock for you both. I had pp a couple of years ago, and like your wife I spent some time in a psychiatric hospital before being transferred to the mother and baby unit.

I am glad that your wife and her doctors have now found a good mix of medication that works well for her. I was on antipsychotic medication for 13 months and on anti-depressants for a bit longer. But like Carmen25 says, medication is a bit different for everyone and it is best to come off it following a plan agreed with your wife's doctor.

In terms of returning to work, I am just wondering if it were possible to agree a phased return, like doing part-time for some months? This is such that the stress of work does not feel too much to begin with and your wife can transition more easily to it. Also, maybe talk openly with her manager, if you think he/she would respond well to that, and explain a bit of what has happened this year?

Recovery from a serious illness like pp does take some time but mums do recover and they go on to lead full lives.

I wish you and your wife all the best, and write here whenever you want to, we are all here to listen

[Vikrika in reply to Maria_at_APP]

Thanks for the long letter,we count everything from that night when called out the ambulence for the baby(vaccination caused problems)And that was the first sunday of may 2020.

It is a long journey,never taught would be this long.

She still have aripripazol and antidepressant plus there is a sideffect of stiff muscle,she feel like her head shakes sometimes all due to the antipsychotic "medication".So 3.medication to cure that.

She never had drog in her life ,no cigarette,and for her very hard to accept,all of sudden she taking so much and every day.

But now we looking at the brighter side of the things,we work at an airport, not gonna be a lot to do even on the full time pattern.

When this happened one of the administrator told me,talk to our manager,he went through same or similar with his wife.

So I talked to him,he put me for long time for furlough so I was there for my wife when she was at the mother and baby unit.

There was no visiting for long long time,so can you imagine you drive there you want to be with them but still the nurses take the food what she want and whatever she asked for and I can turn back and go home?

I was happy to see through the window my daughter.

Felt like I am alone.

Good to be here to talk about.

Thanks

[Maria_at_APP Moderator in reply to Vikrika]

Hi Vikrika,

I am so glad that it is helping to talk about it. It's so much easier to share things with others that have been through a similar time.

I can't imagine how hard it must have been for you and your wife not being able to see each other for a long time while in the mbu. And for you to only see your precious daughter through the window. When I was in the unit 2 years ago, visits from my husband and my brother meant so much to me. I am sure she felt your presence in all the things you brought for her.

Its such a relief that your manager has been understanding, and that thanks to covid the workload at the airport is much less now, all this things are a great help.

Take care you three, enjoy this time you have together with no interruptions

[Hidden in reply to Vikrika]

Very traumatic times. Your wife has had a serious illness and she probably wants to just put it behind her and get back to normal - as I did, and I’m sure we all do. But it is a serious illness and it does take a while to recover. With the medication, it’s worth her saying something if she feels ‘slowed-down’ or is sleeping all the time. They may adjust the dose. It’s a big adjustment to accept that you’ve had this problem, but really it is just a chemical imbalance, like diabetes, not a character flaw.

Take care, and I hope things are improving now your little family is at home.

[Ellie_at_APP Partner in reply to Vikrika]

Dear Vikrika,

I'm so sorry to hear that your wife has had PP and also had some side effects from the medication, that sounds so difficult. And the time when she was in the MBU sounds hard, with the covid restrictions. I'm glad it's been helpful to talk on here and get support. Your wife really will come through this and get better. I too had PP, and then also had depression afterwards. It was so difficult, but I have come through it and am fully myself again.

And yes, these times are so worrying. I'm glad that you have been able to be on furlough though, so you have been able to be with your wife. It is very worrying times though I know.

I just wanted to let you know that we do have husbands / partners who volunteer for us, and who we can link you with to write to or chat to if you'd like to. You can email us [e-mail]

We also have a private Facebook group for partners / husbands of women who have had PP. It is private so your friends on Facebook won't be able to see you belong to the group, or the content of the group.

The link to the Facebook group is here: facebook.com/groups/APPpart...

There's also a guide we have written for partners, which you might find helpful to read: app-network.org/partners/

I hope it helps to write to us on here too, know you can write anything, you're not alone.

Ellie

[rocky77]

Hi Carmen

I am so pleased to hear you are doing so well after your recent experience.

Though I suffered with post natal depression and not pp, it never even occurred to me that I might struggle during menopause/perimenopause especially as my mum breezed through this period. I am 47 years old and at about 42 noticed by mood drop significantly and become more anxious as well as a whole host of other physical symptoms .

There seems to be little information about this link!

Thank you for raising this issue !