26 weeks pregnant with Twins (first t... - Action on Postpar...

Action on Postpartum Psychosis

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26 weeks pregnant with Twins (first time mum & single), bipolar diagnosis & been off meds for ages, advice on prevention of PP



I have a Bipolar diagnosis since age 19, im 27 years old now. I have had 3 manic episodes (2 included psychosis) and many untreated depressive episodes since my diagnosis. I have only ever been on medication during crisis with the 3 manic episodes and have managed without medication to stay reasonably stable over the years in between episodes.

I am single and currently 26 weeks pregnant with twins (this is my first pregnancy). I am under a perinatal mental health team who have advised me that I am at increased risk of relapse because of my Bipolar Diagnosis and that at increased risk of 60% of suffering with postpartum psychosis following the birth of my babies. The psychiatrist has prescribed me Quatiapine to take in my pregnancy as a preventative measure- I have not been on this medication before and haven't yet made the decision to start it yet. I was wondering what other people's experiences with Quatiapine have been and if you started it in pregnancy (at how many weeks gestation?) Or waited to start after birth as a preventative measure instead? I would like to protect myself from any possible relapse and stay well but I am very reluctant to start medication in my pregnancy although I have been told it is relatively safe for my babies? I am worried and anxious about side effects (especially weight gain and increased risk of gestational diabetes), how it will affect my unborn children, and how long I will have to take it for ( I haven't been on any medications for a long time now ).

I am open to take this medication however I would like to start it as late as possible in my pregnancy if I have to or ideally after birth all together. I am really anxious to take meds whilst pregnant but just as much anxious about the possibility of becoming unwell- really stuck between a rock and a hard place at the moment and not sure how to proceed.

I have been advised I can breastfeed safely whilst taking Quatiapine as it only passes into breastmilk in very small amounts which is a positive I guess.

Any advice or personal experiences will be useful. Thank you in advance x

12 Replies

Hi sienna2505

Really glad you have found the forum here and reached out for some support, at what can be a really anxious time as a pregnant mum with a bipolar disorder diagnosis. I am really glad to hear you have some support from a specialist perinatal mental health team, but can very much understand your worries and concerns around making the best decisions about medication. It sounds really sensible

There are a couple of detailed information guides that might be really useful for you as you work together with your perinatal team to make treatment decisions.

Insider Guide for mums at increased risk of PP - app-network.org/wp-content/...

Bipolar UK Guide to pregnancy and birth - bipolaruk.org/Handlers/Down...

Lots of mums in contact with APP have also valued a consultation with Dr Ian Jones, who specialises in PP and bipolar disorder - this service is offered free on the NHS, through referral by your own psychiatrist or GP. There's more info here app-network.org/what-is-pp/...

There are lots of mums in our peer support community with a bipolar disorder diagnosis, myself included - and lots of lived experience of using antipsychotic medication such as Quetiapine during and after pregnancy. I was treated with Olanzapine (another antipsychotic) during my first episode of PP, and took this shortly after birth in my second pregnancy. Both times, I took the medication for about a year after birth.

Do keep in touch, and we are here for any support you need as you go through the process of finding the right treatment decisions for you.

Warm wishes,


Dear sienna2505

First and foremost,Congratulations on your pregnancy ❤

Secondly, your post really resonated with me as it describes my 2nd pregnancy (I had ppp in 2015 after my 1st daughter was born,pregnant in 2017 and was prescribed quietapine as a preventative measure). I m going to bullet point to make sure I am answering all your questions.

1. I took 25mg quietapine at 37 weeks gestation and stayed on it for 12 months (i think they increased it to 50mg,then 100mg at some point and because I was well reduced it back down and finally took me off it) My psychiatrist said the medication shouldn't affect the baby as they are quite big at that stage and I shouldn't be worried.

2. In terms of breastfeeding-I breastfed successfully for 13 months and if you also want to breastfeed,make sure it is in your notes/birth plan. let all the health care staff know and speak loud and clear about it.please don't put yourself under pressure,but be concious that you want to do it and give it a go if you want to. Make sure you remember to drink plenty of water and eat to breastfeed.we need fuel in our bodies to make fuel for the babies 😊

3. In terms of birth plan/care plan after birth - this is what made the difference in preventing my PPP (i m sure medication played a part too,but it was the wraparound care that made a massive difference I think). I note the you mentioned you are single, but hoping you have a support bubble with the babies?maybe friends or family? The reason I ask is to educate them on your triggers and symptoms so they can keep an eye on you. And make sure you ask for help and welcone it as much as possible.

4. I live in Hertfordshire in the UK and my notes from the perinetal mental health team included the following points:

- i had to stay in the hospital for 72 hours after birth so they could keep an eye on me

- if possible,they asked that i have a private room in the hospital and the ward team was asked to wake me up as little as possible. I remember the hospital stay so well - my ward had a trainee midwife that never dealt with PPP so was so keen to learn about it and help me as much as possible. She read my notes in and out and followed them to a T. She even took my baby with her to reception to keep an eye on her and let me sleep.... she was only wheeling her to me for feeding....honestly,i appreciate that is exceptional service,but it was sooo important to me that they read my notes.

- i also had huge support with breastfeesing in the hospital-again,that was in my notes and I had someone every day with me to help out with it.

5. After care,after I got discharged I had a visit from the community midwife every day for 2 weeks once I was home and I think a phone call from the mental health team every 2nd day or so.the frequency reduced down to maybe weekly afterwards but they kept a really close eye on me for the first 6 months.

6. Side effects of quietapine - i do appreciate these suck- weight gain was mine and sleeping a lot (this depends on the measure of medication that you are on). Please be kind to yourself and discuss with your mental health team if you are worried about any side effects.

Finally,I apologise for my long post,I just really wanted to relay all the information (apologies for the information overload!).if you have any further questions,let me know😊

Good luck sienna2505,i look forward to hearing from you and hoping all goes well!!!

Naomi_at_appAdministrator in reply to DoraDonig

Thanks DoraDonig for sharing your really relevant and practical experience so clearly! Naomi x

I wish I knew this information ahead of time in my first pregnancy.

PikoruaVolunteer in reply to DoraDonig

This has been so helpful dearest DoraDonig. Thank you for being so open and sharing in order to be supportive to women, who are reluctant to take meds throughout their pregnancy. I did not know about my BP and obviously PPP kicked in, two weeks later after giving birth. I am not a fan of meds, but very much aware that the very traditional mix of drugs saved my life. Once again thank you for your contribution!!!


Hi siena2505

Welcome to the forum, and congratulations on your pregnancy. It most be an exciting but also anxious time for you, and I am very glad you have reached out here for support from other mums who have also planned and gone through a pregnancy at risk of postpartum psychosis.

I have little to add to the already fantastic replies from Naomi and DoraDonig, but to also refer you to this excelent site for choice of medication during pregnancy:


Take very good care, I am sending all my best wishes for you to remain well and have a good positive experience bringing your babies into this world.

I would be inclined to take the medication now, before babies get here and see how it affects you. Quetiapine wasn't good for me, I found it far too sedating and there is no way I could have taken it and cared for children (I'm a single mum of 2). I am particularly sensitive to antipsychotics, so my experience might not be yours, and I know many people who swear by quetiapine.

If you haven't already, have a look at this website and you can search for your medications for the up to date info on medicines in pregnancy. I found it really helpful. medicinesinpregnancy.org/Me...

PikoruaVolunteer in reply to AstroSue

Thank you AstroSue,

somehow your statement resonates with me and the way how I feel deep down about the responses I get in general. I explain further below;

I find it of great significance that individual choices are being respected as long as we have our full capacity in decission making and mental health is not drastically deteriorating as it was in my case after the birth of my son in 2010, when suffering with PPP. In this case decisions had to be made for me and I was injected with drugs.

Health professionals who act as humanists hopefully reassure that there is a a variety of options for diverse choice making for meds and therapy avenues and or therapeutic opportunities.

Thus, understanding the importance and meaning of the individual's Life quality, subsequently striving towards a tailor-made toolkit to combat obstacles of physical and/or mental health condition and/or for pain relief, reduction of anxiety etc. whether it is a combination of meds and alternative therapy or only therapeutic. The option has to be involvement of the patient and subsequently a choice, one is happy to proceed with...and obviously flexibility is of importance and if necessary support for weaning off meds via a support programme.

I still experience that I am one of a few with BP1 who did not opt for stereotypical meds such as Lithium and/or mood stabiliser as suggested in my case by a Psychiatrist.

I guess what I want to say is that stigma and self stigma has got to be reduced and we ought to strive for a more none-judgemental approach, whereby individuals have a voice and a choice for their own well being. Self management with optional recovery plan, when time allows!!! We ought to feel comfortable to exchange our lived experiences.

Take care Astro Sue, and it is very admirable that you got through this traumatising experience, and being a single mum! Another survivor!


Hello, Congratulations on your twin pregnancy!!! I'm glad you posted and that you are doing well. I'm a twin mum of two girls and had Post Partum psychosis that came on 6 weeks after the birth. I don't have any experience of bipolar so have different circumstances but can relate to the things that happen in twin pregnancies as well as after the birth. I'm glad to hear you are getting mental health support now. I had gestational diabetes late in in pregnancy as you are more at risk with multiples. You are growing two babies and that's a massive amount of strain on twin Mummies bodies. It was a real pain not being able to have cake! Or lots of carbs but it probably made me healthier. I didn't have diabetes after birth and my babies were also fine. Im thinking as you say you have lots to consider and being in the best possible place will definitely help. Twins often come earlier, 38 weeks is considered full term so you might talk/ think about that in terms of timing. Twins also are more likely to spend some time in special care, not always but if they do it can be stressful. The sleep deprivation of one baby is a lot with two everything is more intense. Do you have live in support planned for after the babies are born? Breast feeding can work with twins if you can get them on at same time, I got myself in a right tis trying to express on pump and feed and breast feed which meant I suffered even more lack of sleep with hindsight I wished someone had slapped me, provided formula and sent me to bed. That's absolutely not to say you will have trouble feeding it more to highlight that it's easy to focus on what you think is best for your babies at the cost of looking after yourself, and at the end of the day your babies need a well mum more than anything. What's doable / manageable for single pregnancies doesn't necesserliy apply to twins, you will have two babies to look after and the demands are massive. So get your support organised, sleep sleep sleep and take all the support you can. I realise I've gone a bit off topic just I don't often meet twin Mummies and we are a special lot :) . I would speak to your healthcare professional about all your fears, maybe best to chat it through with them as they might be able to give you further information that could help. do you have a twins consultant you could also talk too? I can understand about feeling you don't want to take meds but cautionary approach sounds like less risk perhaps? Wishing you all the best in rest of pregnancy, go easy on yourself get as much rest as possible. Hope to hear how you are getting on soon and what you decide to do. Best xx

Hi Sienna,

Congratulations on your pregnancy! I’m a Bipolar mum of three and I had PP after my first.

I was on quetiapine but ended up with PP anyway. At that point I switched to Olanzapine.

I’d say that personally, quetiapine knocked me out at night which can be good but worried me about caring for my children. Olanzapine doesn’t knock you out as much but I did have some bad side effects; feeling like I desperately needed to stretch and move around a lot. Psychiatrists prescribed me pills to help.

I think that any decision you make can be changed if need be, so whatever path you choose will be the right one.

Try and not worry (very hard) and focus on the beautiful babies you’ll have xx


Dear sienna2505,

such wonderful replies from many mums and of course being reassured.

Time to reflect and evaluate, but hopefully less worries on choice making.

Lots of good advise, links and exchange of lived experiences.

In my case I only found out that I have had Bipolar 8 years after my son was born and PPP (2010). I am not sure whether my disposition changed to bipolar or whether I have had it since I was a teenager and start of menstruation as I always struggled with mood swings, but also leading a very adventurous life :-)

Take good care and enjoy your pregnancy & nesting. :-)


Hello sienna2505

Congratulations on your twin pregnancy 😊

I hope you found the personal experiences and links here helpful. Just wondering how you are and whether you have received professional reassurance about taking Quetiapine? Thinking of you and hope you are well ... take care xx

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