hello,
I had PP almost 12 weeks ago and I constantly worry that I could get another psychosis. The APP guides suggest preparing for a relapse, but does that mean another psychosis? How likely a person who had no other mental illness is to have psychosis again? Does it only appear with high stress? Does it always connect with lack of sleep, so if I sleep well it won’t happen?
I will be grateful for your response.
Hi MumNez, welcome to the forum and congratulations on your baby. I am very sorry that you experienced postpartum psychosis, it is such a traumatic illness.
I had pp in 2018 after the birth of my daughter, I spent some time in a general psychiatric ward until I was reunited with my daughter in an mother and baby unit.
Regarding how likely are you to experience another episode of mental illness, there is useful information on the APP website about the risks around a future episode of illness:
"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’.)"
As you mentioned that your episode came out of the blue, the risk of another episode unrelated to childbirth is lower.
As to the causes of pp, it is sometimes described as a perfect storm with a combination of hormonal fluctuations, lack of sleep, genetic predisposition, history of mental illness, amongst others. Sleep is certainly important, and it is an early warning sign that my mental health is dipping when I struggle with it. I have a diagnosis of bipolar 1 as well as having experienced pp, so I try to be very careful with my sleep.
I think that when pp comes out of the blue, there is an added trauma of the unexpected and coming to terms to it. With a relapse many mums do say that having been there before makes a difference, without minimizing the experience. Knowledge is very powerful.
Do message us with any questions you have, this experience is very shocking for all involved, take very good care, do take things really easy in the early days, but there is light at the end of the tunnel.
Maria
I read this information. I was hoping for something more concrete. But I guess there is just not enough research out there yet. Thank you for your support!
Hello MumNez,
Sorry to read you’re worrying about this. I too have pondered this, it’s a totally legitimate thing to ask.
Everyone is different Maria has shared some really useful information and from her own experience too.
I had PP after this birth of my first baby in 2016, I had no previous mental health history prior to experiencing PP. A few years after my experience my husband and I went for pre- conception counselling with a doctor. In talking with him, he explained that given my own history - as I had experienced PP once, the risk for me of having a further episode of psychosis was 50% at any future point in my life. But of course there are things we can all do to help support ourselves and keep ourselves well.
I have been cautious with sleep, understandably, try to avoid stress although easier said than done sometimes! Have tried to be really reflective in how I’m feeling and chat with friends or family whenever I’ve needed to.
Everyone is different of course, do what might be quoted as a risk factor for one person might very well be different for others. If you’re at all worried, I’m sure you’d be able to chat through your concerns with the health professionals around you. Take care, Rachel x
Hi MumNez, I wish you all the best, I think it is very normal to feel wary about the uncertainty of a future episode of psychosis or other mental illness. I wish we could tell with certainty what exactly triggers it, but a combination of factors is the best we know so far.
Understanding what the early warning signs are for you and having a toolkit to draw from, is a really good way to manage it going forward. You have had great replies to this thread already talking about what works for some of us.
Take very good care,
Maria
I think what Maria might have been saying is that because there are so many factors going into people’s individual cases of PP, it’s impossible to predict whether or not a relapse will happen to you. I think preparing for it is wise advice, but that doesn’t have to be anything extensive. What I did was to educate my family members about what it looks like (my psychologist actually helped with this).
Some people have relapses, some don’t. I did, and struggled with episodes for actually some years. But it did eventually go away. Things like stress and not enough sleep made it worse. I’ve learned better self care. Having a new baby makes those things more difficult, especially if you’re breastfeeding.
Do the best self care you can as far as stress and sleeping. I was working at the time of my PP in a stressful job and ended up having to resign. It was a huge blow because I loved my job. But I just could not continue and maintain my health. Keep up with your medications and health care professionals. Exercise as much as you can and eat as healthy as you can. Have a plan for childcare if you do have a relapse. Part of my solution was to continue to send my kids to childcare during the day even though I was no longer working. It gave me a chance to sleep more, maintain the house and have a little time for myself. In the end I got through it and so will you.
Hello again! I know this is a personal question (and you don’t have to answer if you feel uncomfortable) but out of curiosity - when you did relapse - were you able to notice some warning signs? (Like the first time in hindsight) Were these episodes of depression or mania or full on psychosis? Was it similar to your first one or there was just no telling?
Hello MumNez,
you have done so exceptionally well in your recovery. After 3 months I was still sectioned and only towards the end of the hospital stage, where doctors finally established that only the traditional drugs defeated the ongoing hallucination. This was in 2010, when APP just started.
I am one of many women, who continued with mental health issues after PPP. Once diagnosed with BP in 2018 I finally found an appropriate path. The recovery is ongoing as bipolar 1 is chronical with a continues struggle of surfing the waves.
In general implementing life style strategies to manage well being at all levels (physically, mentally, emotionally etc.) is recommendable throughout the path of recovery. What can you do to have a happy feeling???
Being in a stress free environment has been a key factor to work towards my routine and establish new skills to cover my needs, when feeling poorly.
Instead of worrying about past re-occurrences I rather live with the momentum and focusing on my well being and striving towards goals in stepping stones...prioritising what is best for my developing skills and what makes me happy, including focusing only on human beings who do not judge or suck the energy out of me.
Wishing you health and happiness!
x
Hello Pikorua 
I will ask a personal question and please don’t feel obligated to answer if it’s too personal. Out of curiosity - you said that your PP happened in 2010 but you weren’t diagnosed with Bipolar until 2018 correct? If that’s the case how did they know? Did you have a relapse? If so, were you able to pick up on warning signs in yourself that something was wrong?
Hello Equine,
I recovered from PPP slowly, because of the trauma I suffered in a hospital (PTS), no MBU at the time in my area. I carried on to struggle with MH issues i.e. anxiety, Insomnia, lack of concentration and lots more over the years, but pretty much fought on my own and trying to establish own coping strategies.
Despite some of the support I received over the years during Partnership (NHS) in my area, it was not enough to tackle the root cause.
I received help from Cardiff University in 2018.
Luckily more is happening now via Open Mental Health within peri/post pregnancy and peri/meno-pausal stages. Research gap is identified, one needs to understand BP as a disposition and cause and affect after PPP. I believe I have had BP since hormones kicked in as a teenager, - in my opinion BP maybe one of many contributing factors for PPP. Quite interesting statistically how many women are diagnosed with BP1 after PPP.
Wishing you well.
x
Thank you so much for your reply. I am glad you were able to finally have an answer for the ongoing mental health issues and now with a diagnosis they at least know how and what to treat (BP).
I have seen statistics all over the place - from 30%-66% for a BP diagnosis after a first episode of PPP. That’s a huge range and of course concerning. This is a first time I’m hearing of “Open Mental Health” and I will search their resources.
Thank you so much for your reply and all the information.
Stay well and stay positive as well. Hugs to you across the ocean 😊
Equine Beauty, just to inform you that OMH is in the UK only. Thank you for your kind wishes...be kind to yourself, too.
Hi MumNez ,
It is quite normal to worry about relapsing early in recovery.
After I recovered (around 3 months in), it played heavily on my mind. I worried that I would never be able to tolerate stress ever again or that any period of poor sleep would trigger another psychosis. After having been recovered for more than a year, I don't worry about those things as much.
I know I am at risk, but there's not much point in worrying about it incessantly, that would just stress you out. You need to find a balance between putting things in place to minimise relapse and living your life.
I am working the same job I used to, living my life without worrying about relapse. But of course my health is my number one priority and if I noticed something worrying I would tackle it immediately.
My point is that worrying about relapse it's part of recovery, but you'll soon learn we cannot know the future. You just need to take care of yourself and that includes to not worry excessively.
I would not take the "50% relapse" metric to heart. I have briefly looked at the scientific reports and they don't convince me I have a 50% chance of relapse. Some articles put it closer to the 30% or even lower. But in the end those women aren't you and we can never know.
Good luck.
I have also read a recent (2021) 4 year follow up study and it said that about 33% go on to have a relapse of an affective episode (meaning depression or mania) while only 8% have actual psychosis. So there is that.
Older studies (1994) but with a 21-year follow up put the relapse risk as high as 66% - but my understanding is that this lumps together people with previous diagnosis of schizophrenia and bipolar as well. The ranges in these statistics are huge.
I of course worry too, but the disparities in these stats actually give me hope. Here’s to hoping no one experiences this again - but if we have to, that it’s caught early and the recovery time is shorter.
Stay well everyone
Xo
Relapse question
Postpartum Psychosis relapse?
Had a second child and no PPP
Relapse?
How long has recovery taken ? 
