Hi, I just wondered if you could tell me if psychosis can return due to stress if you don't have another baby?
I had my daughter in 2021 and had postpartum psychosis have fully recovered and no longer on medication since 2022. At my mental health review with my GP doctor he said that stress can bring on psychosis again in people who have had postpartum psychosis. Is this the case?
I am going through a stressful period at the minute and wondered if I need to be mindful of this. When I spoke with the nurses and APP support when I had postpartum psychosis they said it would only return (possibly return) if I had another baby. Thank you
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Slide12
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Thanks for your message. I'm sorry that you're experiencing some stress at the moment.
It's quite a tricky question to answer as each person is different. I know many people who have stayed well after pp, and didn't experience a relapse, and others who have. Each person is different, with different history of mental illness, or life situations, and also possible different reasons that may have caused their relapse.
We do answer this question on our website under frequently asked questions. 'Am I likely to have an episode of psychiatric illness at other times?'
'The long-term outlook after an episode of PP tends to be very good and women recover fully. However, some women who have had PP will have further episodes of illness unrelated to childbirth.
Just over half of women with postpartum psychosis will experience an episode of depression, bipolar disorder or related illness at some point in their lifetime. (This estimate includes women with and without experience of mental illness before their PP episode, and so the risk may be lower for women whose PP episode was ‘out of the blue’.)'
Then there is also some more information about possible risk around perimenopause.
For myself personally, I was well for 12 years, not on any medication, but then experienced a relapse last year. It was a particular situation, I was physically very unwell with an awful virus that really affected my sleep as well, and this is what triggered my episode. It didn't feel as traumatic as the first time, and I am recovering well.
For me, I think it's important not to spiral into anxiety about possibly becoming unwell again, but at the same time be realistic and know that I am at risk and therefore need to really look after myself as much as possible. For myself it's particularly making sure that I sleep well, and am doing everything I can to protect my sleep (there's some great tips on the NHS website about managing insomnia that I try to follow).
I hope this goes some way to answer your question. Know you can ask more questions, and I'm sure you'll receive more answers from others here.
Hi, that's really useful thank you... I did also wonder about perimenopause as I feel like I have a few symptoms and I wondered if that could be a trigger, so thank you x
There's also some information about PP and the links with menopause on our website, including an excellent video that Bipolar UK did if it's helpful to read.
do we know… is it still possible to have a relapse even if taking mood stabilisers like lithium? I was warned about perimenopause too and at 45yo it is something I think about. I’m currently taking olanzapine which i assume would protect me from psychosis?
This is presumably too complex a question and one I should put to my psychiatrist!
Yes a psychiatrist would be able to answer your question much better, but I imagine the fact you're on medication massively protects you from relapse. When I had my relapse I wasn't on any medication, and taking the anti psychotic is what got me better, in terms of the psychotic symptoms.
I am not a health professional but would like to share my experience with you.
My PP was in 1988 so quite a while ago. I know we can’t pin point quite how and why it comes on but stress and difficult marriage coupled with no sleep really didn’t help. Plus moving away from all friends and family.
I recovered and went on to have a new relationship and two more girls with no PP. All my circumstances were different. I had a good marriage, easy labours, family support and I just slept after having the babies. My mum made this possible! This was 1996 and 1999.
Anyhow, life moves on and things get tricky. I have never had psychosis again but I have had times when stress levels were raised, sleep reduced and I knew I was feeling very low. When these times come along my first priority without sounding selfish is to care for myself. Early nights, nice baths, walking , swimming and cycling plus I found talking therapies really really helpful CBT and I journal exactly how I am feeling . As a Christian I find prayer and Bible reading helpful along with prayers from my friends.
I am nearly 65 and have come through the menopause , really taking care of myself when I feel a bit down. Usually something going on with one of my Girls or concerns with aging parents and such. Or life changes that I didn’t see coming!
I know we can’t help what comes our way and I did feel unwell when my thyroid went out of balance during lockdown so for me another hormonal shift . The medication helped with that.
So I think reading over my reply to you, take care of yourself doing things that lift the mood whether that’s music, art, films , nature, good food , exercise and sleep. I acknowledge I am not looking after little ones at this time !
I'm sorry things are stressful for you at the moment.
I had my episode of PP in 2002 after the birth of my son. At the time the only advice I got as regards possible relapse was to make sure I got enough sleep. They said that if there was ever anything that was keeping me awake that I should see my GP and ask for sleeping tablets. So it might be worth keeping an eye on how much sleep you are getting at the moment.
After my PP I went on a relapse prevention course because like Ellie said everyone is different and they don't really know if you will have another relapse or not. This gave me and my partner things to look out for, like early warning signs that could indicate I was becoming unwell. I don't know if this sort of thing is still offered or whether you would find it useful or not.
I was not warned about perimenopause and found the video that Ellie mentioned from Bipolar UK really helpful.
I saw your post and wanted to reach out and share my experience with you. I’m sorry to hear you are experiencing some stress and it is great of you to reach out and ask these valid questions.
I had PP back in March 2020 after the birth of my son and made a full recovery by November 2021. I also came off my medication completely. Like you, I was told that there would be a possibility (50%) chance of PP coming back if I had another baby. We decided we would not be having anymore so felt that it would not return and that we were low risk.
Unfortunately I did have a relapse in February 2023. It was a build up of stress (work and family related) plus lack of sleep. It took us by surprise and I ended up being back in hospital. Looking back I could see how a mixture of things could have contributed. I had no good sleep routine, eating less and no exercise. My brain was always in work mode and I was never off my phone. I knew I hit a bad point when I couldn’t control my emotions and needed to see the GP so I could take some time off work. They gave me some sleeping tablets but it did not work at this point and it was too late. I had psychosis.
I was also diagnosed as bi-polar and this time I have a care plan in place and have done lots of reading and research into this condition. I have important phone numbers that I have saved and provided to my family in case there is any concern in my mental health. Last year, we had no idea who to reach out to. I was discharged from the mental health services and I felt that my GP did not fully appreciate that I was getting to a crisis point. But I know not all GPs are like that. And because I was also off my meds, I had no protection. I went back on olanzapine but at a higher dose this time and it got me better.
Each individual will have a different experience but from what I went through it was due to stress and lack of sleep. We all experience some form of stress but individually, we cope at different levels. It is good of you to pick up on your feelings and being mindful. I do like to keep a journal or mood diary so that I can track how I am each day and if I notice any triggers.
How are you finding your sleep? What do you like doing to relax?
Hope this was of any use to you and that your stressful period passes soon.
Hi Slide12, You've had lots of good responses and mine is similar to the one above. And in many ways I'm similar to you in that I too had my first and currently only child in 2021 and experienced PP out of the blue.
I was shocked, in denial for a long time and hated all the sedating medications I had to take (olanzapine in MBU & then aripiprozole for ages), which also made me gain 2.5 stones. After 18 months the psychiatrist agreed I could come off. I was relieved, went back to work gradually (but looking back was much more fragile than before, and found the job less enjoyable and more stressful). At this time I had no medication for approx 12 months & thought I was in the clear.
The announcement in summer 2023 that there would be a major restructure to school and significant change to my job was the start of the major stress/anxiety/ lack of sleep spiral downwards. I felt like I couldn't work there anymore. But finding a new job overnight in September as a teacher wasn't an option either. (I am a teacher, but had a job as a tutor for a school on roughly the same pay & conditions). My headteacher refused to have a sensible conversation about my concerns.
I tried to do what work had asked me for about 6 weeks. But I became more and more anxious and it started to stop me sleeping at night. Although I didn't have an 'episode' I had a week of practically no sleep (maybe 1-3 hours per night).
Initially I was given zopiclone and promethazine to sleep.it wasn't enough.
The specialist put he on low dose quitiapine which I wasn't keen on as it's in the anti psychotic drug family. (However 100mg isn't sedating to me and hasn't made me gain significant weight).
I still struggled with sleeping, went back to the GP and I was given lorazepam for a month, which really helped me to sleep.
I'm now more stable, but don't feel at my best as I'm currently not working, don't feel I can go back to my old job, but don't know what an alternative is or could be that would fit around nursery and would be meaningful.
I wish I had have been more open to starting medication earlier as my GP suggested it when I was anxious before the summer. But I just thought I was in control this time and didn't think I'd stop sleeping and start to feel "buzzy" again.
Ultimately, the anxiety and lack of sleep were familiar signs of early episode behavior. I think we caught it in time, but I now feel like I need to watch this in myself forever.
It's not a great analogy, but I feel like a broken vase. I was already a fragile person before the episode and would cry at the drop of a hat. Then I was stattered, glued back together and now there are scars and it wouldn't take much to break this fragile, patched up vase again..
Dearest Dolly292, it’s Rachel here I’m part of APP’s peer support team. I just wanted to write and say thank you for your hugely kind, honest and articulate account of what has happened for you in your recovery and returning to work. It’s so good of you to share, and I’m sure it will help others to know they’re not alone in feeling certain ways after PP.
I too had PP back in 2016, and I can definitely relate to your broken but repaired vase analogy. In Japanese culture vases and ceramics are repaired, often with gold making them imperfectly beautiful and strong in other ways, it’s an art form. I read this quote a while ago, which resonated with me about the repair of ceramics in this way:
“Not only is there no attempt to hide the damage, but the repair is literally illuminated... a kind of physical expression of the spirit of mushin....Mushin is often literally translated as "no mind," but carries connotations of fully existing within the moment, of non-attachment, of equanimity amid changing conditions. ...The vicissitudes of existence over time, to which all humans are susceptible, could not be clearer than in the breaks, the knocks, and the shattering to which ceramic ware too is subject. This poignancy or aesthetic of existence has been known in Japan as mono no aware, a compassionate sensitivity, or perhaps identification with, [things] outside oneself.”
— Christy Bartlett, Flickwerk: The Aesthetics of Mended Japanese Ceramics
I try to live with compassion and sensitivity to myself. Knowing that my PP whilst a part of my life, doesn’t define my being. It’s ok, to feel fragile at times, it’s part of what makes us human, it’s in doing and acknowledging this feeling we can build our toolkits to take great care of ourselves.
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