What medication is recommended or advised during pregnancy after having an episode of PP?

[Dolly292]

Hi all, I had PP after my son in 2021, almost 3 years ago. my husband and I were hoping to plan a second child in the new year.

Could anyone share their experience about what medication is recommended before during or after birth if you have experienced 1 episode of PP?

Ideally, I would love to take no, or very little medicine during pregnancy & after.... however I've been quite stressed recently, & I suspect a doctor wouldn't recommend no meds whatsoever.

So....I've been well, back to work & off all medication for almost a year (& thought I was in the clear & potentially ready to try for another child in the new year).....& then a work restructure really stressed me out in September /October....I couldn't sleep & the net result is that I'm now signed off work sick, & on a 100mg of quitiapine antipsychotic.

Whilst it's not the end of the world... & I don't seem to be experiencing any of the negative effects the other antipsychotics I had to take in the past (as yet no massive weight gain or heavy sedation).

(I do also wonder if the work stress + thinking of having another in the new year was too much that it caused me to be highly anxious+ not sleep).

But I now feel like I need some advice as I realise that major stress e.g. my son struggling to breathe when he was born (& it was touch and go, but fortunately he pulled through & is fighting for now) or a work restructure, which meant my job changed completely & I didn't feel strong enough to take on the high stress alternative job I was offered. These high stress incidents have the potential to cause me to loose sleep & become unwell....

Any advice welcome xx

[Jenny_at_APP Partner]

Hi Dolly292,

Thank you for posting. I'm sorry to hear you've had a stressful few months, big changes at work like that can certainly be a massive source of stress and anxiety - sleep is the first thing that's affected for me too whenever I'm feeling stressed or worrying about something. I hope the quetiapine is helping and you're feeling much better.

We can't advise around medication in pregnancy but I hope some shared experiences and signposting will be helpful

I took quetiapine when I experienced PP back in 2012 (I think 300mg modified release). I went on to have another child in 2016 and opted to take a low dose of quetiapine after the birth, which I then stayed on for 6 months (fortunately I stayed well). I didn't take medication during pregnancy - I wasn't on any medication prior to becoming pregnant and as my PP didn't start immediately after birth I didn't feel I needed to start taking it earlier, but this would be something to discuss with medical professionals. Everyone's situation is different with different considerations to factor in and staying on / starting medication during pregnancy will be the right thing for some women when weighing up the risks and benefits.

You can find information about the best use of medicines in pregnancy on the following website which might be helpful to have a look at - you can search on different medications: medicinesinpregnancy.org/bu...

We also have an insider guide for planning a pregnancy when at high risk of PP, written with the help of women who have 'been there', which has a section on medication: app-network.org/postpartum-...

Have you accessed any preconception counselling? Ideally you can be referred to talk to a perinatal psychiatrist (via your GP or mental health team if you are under one) and talk through your previous experience and risks etc. for a further pregnancy. This could include discussions around medication etc. You should be referred to a perinatal mental health team during pregnancy and have lots of support to put plans in place that give you the best chance of staying well. I opted to take quetiapine again as I knew it had worked well for me previously. It looks from the website above that it is considered safe to take during pregnancy, but definitely have those conversations with a professional and the team would continue to offer support around this.

I hope this helps a little. Do feel free to ask any questions and I'm sure you'll get other replies too

Wishing you all the very best and I hope you have a lovely Christmas.

Best wishes,

Jenny x

[Maria_at_APP Moderator]

Hi Dolly292, lovely to hear from you again, although I am sorry you had an episode of anxiety and no sleep in September/October. It is really hard when there are these changes at work that are beyond our control. I have found that my "stress bucket" is smaller after pp and some situations affect me in a more significant way than they used to. But it is a good sign that you identified it and asked for leave.

I had my second baby a couple of years ago after having pp with my first. Before getting pregnant I had a preconception counselling chat with a perinatal psychiatrist, which was very useful in terms of gathering more information around medication, and other safety measures that could be put in place to avoid pp a second time. Your GP or the team following you can refer you to it. I also found this site very helpful in terms of understanding medication choices:

medicinesinpregnancy.org/

Wishing you all the best, here if you have any questions

Maria

[Raybellene]

I also met with a perinatal psychiatrist who created a pregnancy and birth plan. I was going to start taking Olanzapine immediately after birth, but because the pandemic hit, I was very anxious and actually started taking 2.5mg for the last six weeks of pregnancy. From my research I thought that Olanzapine has less effect on the baby and less passes and through breast milk. It massively helps sleep. Only side effect I have is weight gain. I hope this helps, but do push for a meeting with a perinatal psychiatrist

[The_Wes_Anderson_Fan Volunteer]

Hello DollyI don't know the answers to your questions, but I live in Greater London and there are community Mental Health perinatal teams, who should be able to advise you and support on all these issues. Your GP should be able to refer you to your local team.

Good Luck Xx