Any post issues after recovering from post partum psychosis?

[Tash_28]

Hi I have recently recovered from post partum psychosis. I was prescribed Olanzapine for a few months and tapered down to 2.5 mg. When I tried stopping it, I was suddenly faced with anxiety issues and had to go back on Olanzapine again for a few months. I have tried stopping it again but am faced with the anxiety issue again. I am not sure if this is withdrawal but is there anyone out there who faced a similar issue and what did you do? Please assist.

[hgallo Volunteer]

HiTash_28, I was prescribed olanzapine when I had pp and weaned off it in the year following. I've remained on anti depressants longer term. Can the gp suggest a longer term medication you could try for the anxiety? I can't day whether the anxiety is a consequence of coming of meds but I did have quite bad social anxiety for a couple of years after having pp.

Are there things that trigger the anxiety coming on? I used to very anxious about being in public spaces and it took a while to get past it. I'll have a look and see if I can find some advice on dealing with anxiety and put a link here for you. Stay in touch x

[hgallo Volunteer in reply to hgallo]

nhs.uk/mental-health/feelin...

[Varvarita]

Hi dear Tash_28! I think my anxiety was absolutely the worst around 5-6 months after PP, when i was finishing my antipsychotics (i was on Abilify). At first my doctors also thought that it might be linked to tapering off, but it turned out to be a separate issue . I wouldn’t say i had much anxious thoughts, but i felt like there is a bird in a cage inside my chest trying to get out, with trembling , i could physically feel it, my heart beating heavily, the chest hot, loosing appetite, unpleasant funny feeling in my throat, omg, this sensation was waking me up early, at specific time (like 6:47 a.m. sharp every day, i mean as if there is an alarm clock set daily). Eventually this anxiety gave me sleeping issues and insomnia and depression.

I tried different stuff to tame this anxiety from olanzapine to benzodiazepines, vitamines, meditation, breathing techniques, but nothing worked, i guess i was looking for solution for 4 months.

Finally i started Prozac(fluoxetine) and my anxiety and insomnia were gone within 2 months, but i was still a bit sad and depressed, and then i felt completely better after 3-4 months of Prozac. I had a course of 6 months daily 20 mg, and then i was slowly tapering off, without any withdrawal issues.

And now i’m off all meds for 8 months and i feel just good and even when i’m stressed and anxious about something it’s just normal ordinary anxiety which i used to have before PPP.

I wish you good luck in battling your anxiety! You are strong and great, my dear fellow-PP survivor mom!

[Treat2019]

Dear Tash_28

I’m sorry to hear you are experiencing this. I also had difficulty getting off 2.5mg, suffering anxiety/insomnia/ low mood despite being ok before the drop.

I personally think these are withdrawal symptoms which are well documented online. Once you e struggle once with a drop it’s then tricky to repeat this step again without worrying. But it truly did work in the end by just taking it slower at each stage & really making sure I was ready/in a calm period of my life.

I ended up getting a pill cutter & going down very slowly:

1.25mg for 2 weeks

0.725mg for 2 weeks

0.3125mg for 2 weeks (1/8 tablet- very tricky to cut but was possible)

At each stage I alternated between doses for a few days to ensure I could drop down. Some stages I definitely did for longer than 2 weeks until I found a time that suited a change.

After the battle of pill cutting I did discover you could get liquid Olazapine one the uk. It does however have a very short shelf life & is expensive but maybe worth a ask to the GP.

Eventually I also combined my final two drops with a course of acupuncture. It’s well researched to help with insomnia & growing evidence in MH. It certainly drops your BP & HR which when anxious are usually raised. I found it very relaxing, calming & it allowed me to repeat the final steps knowing I was doing something different.

I do hope this helps. Keep reaching out as I was lucky enough to gather this approach from members of this forum. All I can stay is if your medical team are happy & this is what you want, don’t give up. It can be really hard but totally worth it. Every time I made a drop I felt brighter, happier & more myself even though I thought I felt good before. I’m now totally back to myself & so glad I kept trying. Just be kind to yourself & give yourself lots of time.

I wish you lots of luck & feel free to message if you need anything else. I did lots of research into this!

xxx

[Tash_28]

Thanks everyone for your reply. I have asked the doc a few times about it being withdrawal and they always respond that there are no withdrawal effects to the Olanzapine since I was on such a small doze of 2.5 mg . I did suggest breaking the tablet down but this wasn't advised at the time. I was a bit worried about going back on the Olanzapine again and they have now suggested that I try quetiapine or sertraline.

[Treat2019 in reply to Tash_28]

Hi Tash_28

My Psychiatrist was really dismissive of withdrawal affects from 2.5mgs too. On the flip side she was therefore happy I play around with cutting up the tablets as she didn’t believe it was a high enough dose to affect me. I honestly do believe there are withdrawals effects, it’s just not been researched that much. There are some scientific papers, just not loads. I think it’s easy as a clinician to make judgements based on the best evidence, it’s what you are trained to do. But everyone is different & I believe it does exist. I found those that acknowledged this & supported me helped me to get off. My GP was great & really experienced. Although he did say he didn’t know anyone that had come off it! This group is a testament that it is possible, but everyone’s different & some people take time. If you need an alternative drug as you come off then this sounds sensible & just another way of doing it. I did find the anti anxiety drug I came off before Olazapine (Citalopram) much easier to wean down from. I hope it goes well. xxx

[Tash_28 in reply to Treat2019]

Thanks a lot for your response. Everyone has been helpful. I think I'm just confused now whether I should try a ssri now for the anxiety where I might have to be on it for 6 months and then wean off that or go on Olanzapine again on the 2.5 mg and then taper off like you did. Its a tough one.

[Varvarita in reply to Tash_28]

imho quetiapine might feel more of a step back in terms of side-effects and general well-being and mood, as it’s an antipsychotic anyway and i absolutely hated how lethargic and drowsy it made me feel. they claim that quetiapine is a unique antipsychotic which has both calming and antidepressive effect, but for me it worked as a huge depressant.

i also had experience with olanzapine and in comparison to quetiapine i preferred olanzapine. but it’s a lot of error and trial like with all

of these drugs.

and from my experience sertraline as a solution might feel “lighter”, as to me SSRI don’t have as much influence on general well-being as antipsychotics, the first 4-6 weeks however might be challenging.

i don’t know how to put it into correct words, but in my perspective, it’s just that antipsychotics are making us less of “us”, while being great, life-saving and indispensable tools , for a limited amount of time or for a specific purpose if taken long-time.

and SSRIs, if they fit, are helping to accelerate the journey to the point when it’s finally more of “us”,then one day you finally arrive at your destination and meet your old , pre-PP self.

[Tash_28 in reply to Varvarita]

Thank you for the detailed response. I did feel good on the olanzapine but felt like my focus, memory and concentration wasn't great. My doc said this would change in time. Do you feel a SSRI makes you feel more yourself while helping with the anxiety?

[Varvarita in reply to Tash_28]

with SSRI i only had side-effects like little tingling sensations in my legs, i was less tactile (i wasn’t really enjoying massage or hot shower like i would normally do), and a weight gain. but it didn’t alter my mood or concentration - with every pill i was feeling better, definitely could track progress each week, more myself, and anxiety was gone within 2 months. after i started a ssri i was keeping a diary where i wrote down how anxious i was on the scale out of 10 and how it made me feel, daily, and i progressed pretty quickly. and because anxiety is difficult to measure it was nice to have my notes to remind myself of a progress. i realised that ssri cured my anxiety the day i wrote in my diary that i wasn’t anxious at all during that day and it was just 2 months after starting ssri. depression took longer but it’s a different story. good luck dearest Tash

[alisonrw Volunteer]

Dear Tash_28

Thank you for getting in touch - I'm sorry you've been feeling anxious when you've tried to stop taking Olanzapine.

I was prescribed Olanzapine and took it for around 12 weeks after the birth of my son as I was vulnerable to postpartum psychosis due to previous (non PP related) episodes. I have also taken it in the past after becoming unwell and tapered off again.

Olanzapine has helped me a lot but I can remember feeling anxious during tapering off, including this most recent time a few months after the birth of my son. It helps me to fall and stay asleep when I take it and makes me sleepy during the day, so I think for me anxious feelings could be related to my body readjusting and becoming more alert again. On a lower/no dose it took me some time to be able to fall asleep naturally again and I experienced some nights of insomnia, which made me feel anxious during the day as I find it difficult to function day to day when I haven't slept well. I was also struggling with breastfeeding/expressing around the time of tapering off and trying to stop that at the same time which also threw me off balance too.

Things I have found helpful are keeping in touch with my GP/perinatal team and asking for their advice about tapering as slowly as possible. They may have suggestions related to how and when to take the remaining dose to make the final taper easier, as it gets tricker when trying to cut tablets. Having a relaxing bedtime routine and going to sleep as soon as my head hits the pillow (not checking phone or watching TV in bed). Gentle exercise in the day, fresh air and walks. I try to think of it as a time of readjustment for my body and rest when I can.

Are you in regular touch with your GP or a perinatal mental health team? Can you check in with them to ask if there's a way they can rule out other physical health issues that could be increasing anxious feelings? Are you worried about anything in your life more broadly at the moment or going through changes? Any life changes are difficult to deal with when tapering, so please be gentle with yourself at this time. Wishing you all the best and please keep in touch.

Best wishes

Alison.

[Tash_28]

Thanks again everyone. This is really helpful. I am actually thinking now of trying the SSRI instead of another anti psychotic. I have noticed that due to the anxiety my appetite has also really reduced and I am not sleeping great. Do you know if a SSRI like sertraline helps with that and does it help with the anxiety. I think my only concern with the SSRI is that it takes time to actually feel the effects.

[alisonrw Volunteer in reply to Tash_28]

Hi Tash_28

I'm sorry to hear that your doctor isn't recognising that there could still be withdrawal effects from a smaller dose. I did feel a difference even at lower doses you mention. Each time I've reduced medications I do feel my body took time to adjust, especially to the feeling of being more alert again, which made life in general feel more vivid but also overwhelming for a time. I feel for me that this is 'everyday anxiety' coming back, which Olanzapine had dulled. I feel that it wouldn't be possible to get rid of this completely. It is still uncomfortable though, but I find it comes and goes which is a relief. I suffer from very bad PMS which makes anxiety worse before my period too, so I keep a note of where I'm up to on that side of things to remind myself to try to take it easy.

I'm not able to give advice on medications but I can share my experience. I think this will be different for each person, but withdrawal effects are a very real possibility with any medication. There may be side effects to tapering from an SSRI too, would it help to discuss those with you doctor as to what would happen if you did take an SSRI for some time then felt ready to stop?

I'm sorry to hear that you're not sleeping well and your appetite has reduced. I experienced this too. Olanzapine made me feel hungry all of the time and I gained a lot of weight taking it. Once I stopped, my appetite also reduced and balanced out. Are you eating enough at regular times throughout the day, as well as a good breakfast? I find that I feel more anxious if I'm hungry, so I try to eat often even if I don't feel like it. I find sugar makes me more anxious too so try to avoid it if I'm not having a good day with anxiety. Sometimes if I'm awake at night I get up and have something small to eat, to make sure that I'm not awake because I'm hungry and can drift back off to sleep after.

I hope everything goes well and stay in touch.

Best wishes

Alison

[NicJK]

Hi Tash_28 I'm sorry to hear about your struggles with coming off Olanzapine. I am a member of basically all of the Olanzapine groups on Facebook, as well as being on Olanzapine myself for almost 2 years. Some people definitely seem to suffer withdrawals coming off this drug, including when trying to come off from 2.5mg. One recommended way around this is to buy a 0.001g scale and reduce by no more than 5% of your current dose every 2-4 weeks. It will take you a long time to come off but hopefully you won't go through withdrawals. Alternatively you can have the drug compounded into liquid or capsules and reduce by 5% of your current dose that way. I'm here to help if you ever need advice

[Olazapine1]

Hi TashHow is your taper going? I am also on 2.5mg of Olanzapine, having reduced from 3.75mg (my highest dose) over about 4 weeks. I was planning on reducing another quarter tablet this week but I'm getting some anxiety/low mood which is worrying me. I didn't have PPP, I was put on Olanzipine for my anxiety which was very bad ( had to be in hospital), as an extra on top of citalopram, lorazepam and propanalol. I had been feeling so much better my psychiatrist and I thought we'd start trying to wean off everything except the citalopram (one at a time!). But now I'm worried I'll never come off the olanzipine. It all feels like such a mess.

[Tash_28 in reply to Olazapine1]

Hi I wanted to check on you and see how you doing? Hope you are better. Did you manage to get off the medication?

[Olazapine1 in reply to Tash_28]

Hiya. I am quite a lot better thanks. I'm off the olanzapine but on quite a lot of other things instead! Im on pregabalin for anxiety. Trying to reduce my mirtazapine now, and diazepam. I'm also re starting hrt as I think that may be the root of the problem. I hope you are doing OK.

[Tash_28]

If I may ask what was the decision to get off olanzapine to get on other meds. I'm glad to hear you are doing a lot better. What is hrt which you think is the root of the problem? I hope the reduction works out. Are you working as well?