Hi all, for those of you who went on to have another pregnancy and birth after your initial experience with PPP - I have a few questions. My psychosis happened a year ago. I’ve been fortunate enough to remain well. Next year my husband and I will be trying for another baby. My psychiatrists are confident that they can keep the psychosis at bay by starting antipsychotics immediately after birth. Actually we are going to start a low dose of olanzapine (2.5mg) at the 35th week of pregnancy. I will also be kept in the maternity ward for 5 days (I’m in the US so no MBU’s here) and then will see a therapist and a psychiatrist on a weekly follow up. My worry is what if I have bipolar disorder and actually need medications the whole pregnancy? I read that for people who have had PPP and Bipolar there is a risk of psychosis relapse not only after birth but also during pregnancy. I have not been diagnosed with bipolar. As far as we know so far I have only had this one isolated psychosis post birth. But I understand that sometimes women can have a bipolar episode years after their initial episode. So they don’t get diagnosed with bipolar until way later. So my question is how do you know? And how did you make the decision on whether to take medications in pregnancy or immediately post birth? Did you worry at all when you were pregnant? How did it turn out?
(I will of course discuss all this at length with my doctors but I’m just curious how you all derived at your decisions).
Of course my main anxiety is the safety of my daughter at all costs. When I’m pregnant next year I’ll be home with her and my husband who thankfully works from home. I appreciate in advance you all sharing your stories.
Written by
EquineBeauty
To view profiles and participate in discussions please or .
I would say that when you want a child in the future pre-planning the birth with the dr and discussing medication options would be good. You would look at different options and then agree together a plan. Certain medication may not be safe during pregnancy so the doctor would perhaps change this medication or decide for you to be off the medication. All this would be discussed and you would participate in the discussion and not be left out. I hope this reassures you.
When it comes to having another child after experiencing mental illness the first time, forward planning would be a good step forward. Perhaps thinking about food (making/freezing food in advance), who will look after your child if you are unwell (potentially grandparents etc.).
I hope the next time you are pregnant and have a baby you are healthy, happy and illness free xx
Hi Zebunisa, thank you so much for your reply. Yes we do plan on having a very solid plan on how to manage my pregnancy as well as post birth. My mother-in-law will stay with us for 3 months after delivery and my mom will take my daughter to live with her for about a month. I will ensure that I get a good night’s sleep every night as lack of sleep was a big contributor to my psychosis.
I’m looking forward to the appointments with my psychiatrist to discuss medications either in pregnancy or later.
I had a second child after PP and am happy to share my experience and thoughts.
I experienced PP in 2012 - no prior mental health issues and so far no mental health issues since... I was told the risk of having a further episode of PP after my second pregnancy was around 50%. Those with a diagnosis of bipolar as well as a previous episode of PP would be at higher risk still.
It's such a lot to think about isn't it. I don't think a diagnosis of bipolar would be given after one episode of illness (though this might not be right and might also depend on the detail of that episode) and I guess we can only plan around what we know our medical history has been to date. None of us know what the future might hold.
It's definitely something to discuss with your doctors, and understanding what care and support you'd receive antenatally could be something to talk about as well as the plan for later on.
For me, I had consultant-led care antenatally just for my mental health which included extra appointments where I was asked about my mood. I was fine but hopefully had there been any changes in my mood during pregnancy, support would have been put in place quite quickly.
I opted to take a low dose of antipsychotic medication after the birth. I didn't feel I needed to start medication in late pregnancy, mainly as the onset of my PP was about 3 weeks after birth rather than earlier. There was also the option to take a 'watch and wait' approach but I decided this would make me way too anxious.
It was a worrying time, but I tried to be as informed as I could be like you are doing, then we planned for the worst and hoped for the best. It was a very different experience knowing I was at risk of PP and those supporting me knowing this too (rather than having no clue what PP was and it happening out of the blue) and having that knowledge and support in place.
There is some helpful information about planning pregnancy when at risk of PP on the APP website - app-network.org/postpartum-...
I hope it helps to hear others' experiences. I am very happy to share anything that might be helpful so feel free to ask any questions
Hi Jenny, thanks so much for your reply. I read your story in another post and I’m thankful for your sharing more details.
I have not been diagnosed bipolar as I’ve had no prior mental health history and my episode did not include any mania. I of course hope it stays that way. So far we are planning on staying off medication most of the pregnancy but starting late in pregnancy as my psychosis happened on day 5 after delivery. Like you I would definitely take the medication for awhile immediately after birth as the wait and watch approach would be way to stress-inducing.
We have a solid plan for after the birth including relatives staying with us and helping out with the newborn as well as my daughter who will be almost 3 at that time. And you’re right - this time we are all prepared and know what to look out for, should I become unwell again. This actually gives me some peace. I have that PDF from APP saved on my phone 😅
I hope my experience will be as smooth as yours. Thank you again for sharing your story
Hello EquineBeauty. I don’t usually reply to posts but your story sounds so similar to mine that I had to. I had one severe psychosis post the birth of my eldest. It took my husband and I a long time to decide to have our second because it was so bad. There is a 3.5 yr gap between our kids. The decision made by us, with our health professionals, was to have a small dose of olanzapine ready in case I started to feel weird. I didn’t need it at all in the end and deciding to have our second child was the best decision for us. We were told there was a 50% chance of it happening again but our thoughts were. 1 - at least this time we knew about PP, whereas we had no clue the first time. 2 - we knew the signs and could manage if it came to it, so we were in a much better position whatever. A huge thing for me was lack of sleep so I made sure that I slept no matter what. I had to be selfish in that respect.
I have not had a further psychosis and that was 13 years ago.
All the best to you and your family, I hope this helps.
Hello Fageras, thank you so much for posting and replying to me.
Like you, my psychosis was very severe, very scary. It was the only psychotic episode I’ve ever had in my life so for it to be so acute was definitely distressing. My husband and I have recently decided that we will have another child as my psychiatrists have been very encouraging that this can be managed the second time around. You’re right - this time around we know what the signs are so that’s one positive already. I will definitely be taking medications after birth but I guess I could have a low dose of olanzapine during pregnancy and like you said if I start feeling strange I can always start taking it, with my psychiatrist’s permission.
So happy to hear that you have two kiddos and have remained well all this time. That’s wonderful. I hope I will be the same as you. Thanks again for sharing 😊
I hope this finds you well. Such lovely news that you are planning to start trying for a baby next year. Gosh, it is a lot to consider, the level of planning and preparation that we have to go through is significant. And is not only the planning, but all the emotional aspect that we know involves as well.
I had pp in 2018 and went on to have another baby in 2021. The second time pp did not reoccur, though I did get depressed 2 or 3 months postpartum, I managed this at home with medication and therapy. I took medication in the last weeks of pregnancy, an anti psychotic as a mood stabiliser. I stayed a few days in the maternity ward to see if my baby had any symptoms of withdrawal and he was cleared so we went home 3 days after birth. I was under a perinatal mental health team during my pregnancy and 2 years postpartum. During that period I received a diagnosis of bipolar disorder. I manage it now with medication and I will probably be in it for life, but that has been my need since my second one was 14 months old, not before it.
Jenny wisely says we can only make judgements based on our history and we can't predict the future. We are not in control of every single variable, but we can certainly take measures to reduce the risk to what is as reasonably low as possible, with good chances of a very good outcome at the end.
You sound like you have already covered many bases around supporting your sleep, which is very important. Does your mum live nearby? It is really good to have the support from family and friends. In not very long you will find your rhythm in your newly sized family and will thrive.
Take good care, let us know how you are getting on
Hello Maria thank you so very much for your reply. It helps to know other women made the decision to grow their family and with proper precautions remained well. I certainly hope I will as well. The plan is to take medication at end of pregnancy and a year postpartum. The hospital said they’ll keep us for 5 days after birth to watch over me and look for any signs of withdrawal in baby.
I’m curious to know about your bipolar diagnosis - did you have a bipolar episode after 14 months after the birth of your second child? What prompted the bipolar diagnosis? Did you have any history of mental ill health before PPP? (I’m sorry I know these are personal questions, feel free to answer all that with which you’re comfortable). With your episode outside of the postpartum period - were you able to notice the signs that something was wrong? How is the bipolar management now? Do you find the medication quite effective at managing it? (I’m currently on Lamictal as a mood stabilizer just in case; docs said they will keep me on this for a few years as a precaution.)
So since you didn’t receive the bipolar diagnosis until after your second child was born - they didn’t put you on an antipsychotic for your entire second pregnancy, just towards the end correct?
I’m trying to prepare for any contingency, but you’re right - it’s nerve wrecking that we don’t know every possible outcome and can’t predict the future. I will do best I can to prepare with information I have now with my mental health. My mother in law promised she will help for awhile too after the birth.
I will be reaching out to you ladies on here for support throughout my pregnancy and definitely after birth. I’m so glad I found this group. No one else can relate.
I have no problem asking, I would be doing the same as you. I had a couple of depressive episodes before pp, they were treated at home, I took antidepressants for one of them and did therapy too. It affected my work so I needed to take some leave. When I had pp I was not aware of it, postpartum depression was on my radar and I was expecting that I would probably suffer from it.
My diagnosis of bipolar did not come from a particular episode. The team that diagnosed me knew me for 4 years by then, they had been following me during my pp and I was put under them when I had my second baby. I believe with reviewing my previous history and the presentation of my pp 3 years ealier they felt comfortable making the diagnosis.
You are right I was not under antipsychotic medication during most of my pregnancy. But I just wanted to let you know that I also know mums with a diagnosis of bipolar disorder that predates their pregnancies and they have been able to manage it with the help of their provider to be able to remain well during the antenatal period.
I find my medication does work at the moment, not long ago I changed drugs as the antipsychotic was making me very sleepy, and it has been a period of adjustment and some trial and error. I still have not so good days, but I also started therapy and I think that will help me manage things effectively.
My depressive episodes were quite obvious to spot, I was very teary through the day and I felt worthless, I had no joy in things. Since my bipolar diagnosis I had a mixed episode (small mania combined with depression) where I stopped sleeping and had racing thoughts and felt restless but at the same time was very very sad and felt a lot of paranoia. Luckily I did not need to be admitted to hospital that one time and we managed it with medication. Since then my medication has helped me in staying well, but it is not only that working on solitary. Relying on techniques I have learned in therapy in the past, support from other mums who have had pp and family support are also a big part of my managing of bipolar.
Please share how you are getting on, I am glad this forum has helped you feel less alone, it is a very special community
Hi Maria, thanks so much for your reply. Sorry for my belated response- I have been home sick with strep throat and crazy high fevers for 3 days! I wasn’t sleeping well because of the fever and was worried what that would do to my mental health, so I was taking sleeping medication as well. All the meds have been making me feel very cloudy but I think I’m finally on the mend. No more fevers since last night.
Anyway. Thanks so much for sharing your story in detail. I had depression in my life before as well. Once after my father died, but I think it was largely grief. I didn’t take medication then. And then once after I had Covid. This depression was very sudden and I was very anxious and depressed at the same time. I had to take antidepressants and anti anxiety medication and luckily it went away after a few weeks although I took medication for 6 months out of precaution. Then in about month 4 of my pregnancy I became depressed again and stayed pretty severely depressed for the rest of my pregnancy. I wasn’t eating well. All I could manage was sleep. I should’ve taken antidepressants in pregnancy but I was worried what they would do to baby so I refused. That was a mistake. I’ve been diagnosed with Major Depressive Disorder. And that could’ve contributed to me developing PP 5 days after birth.
I’m glad to hear that your medication has largely worked for you and that you have therapy techniques to help you stay ahead of the episodes and keep well. It’s encouraging to know that even with a bipolar diagnosis you can manage your moods and stay well. It’s also encouraging to know that moms who were diagnosed bipolar were able to stay healthy throughout their pregnancy without taking medication the whole time. That was my biggest worry. I don’t want to take medication unnecessarily, but I certainly don’t want to develop PP in pregnancy; that would be worse. Glad to know that under the right care it can be managed. I guess I can always have the antipsychotic prescription ready (during pregnancy) if I need it. I’m still on an antidepressant now as well as a mood stabilizer just in case and will stay on those for a few years.
Thanks so much again for sharing your experience; looking forward to staying in touch with you and this group. It has been a Godsend.
That sounds awful, I am so sorry to hear, do not worry about replying, its if and when you need it really. I am glad you are on the mend, but it sounds like quite the ordeal. Good that you were able to protect your sleep with medication; sleep medication has a bad effect on me as well and gives me bad headaches apart from making me very groggy.
Thank you for sharing your story. I am sorry to hear that your father passed away and as you grieved you felt depressed. And that you had an episode of depression/anxiety after Covid and during pregnancy, it is not an easy thing to go through, and just the scale of what was happening in the world at the time of Covid was enough to test our mental health. It is a very good sign that you responded to antidepressant medication so quickly. And to an extent, it is positive that you have been given a diagnosis after your episodes as that will make providers be more on the alert for you. Although it would be so nice to not have know all this terminology, right?
I mean to say that I know mums with a previous diagnosis of bipolar who were able to manage their pregnancies supported by their doctors, but that in many cases this meant medication during pregnancy. Bipolar can show signs or not during the course of time, professionals call it being on remission when your mood is stable. It helps to be prepared for periods of stress, whenever it is possible to predict those.
I am early days in my diagnosis, and I believe I still police my mood quite jerkily, it is difficult for me to tell the difference between a crappy day and a sign of relapse. Like when you are involved in a car accident and you become very alert and worried behind the wheel. I am working through that fear with the help of a therapist, and I was just wondering if this is something that you may want to consider.
Take advice from the team that is following you and do discuss your concerns with them, they are best placed to guide and support you.
Take good care, I hope your recovery from strep throat is quick and that you feel better soon, do write here whenever you have questions or just want to share
I was definitely very groggy between the paracetamol and the cough medication and the sleep medication! Sigh! Hopefully these antibiotics will kick in soon 😅
So yea, I definitely would’ve rather not known all the mental health intricacies and diagnoses. Especially because it sort of came out of the blue - right after Covid (apparently Covid had that affect on about 25% of people developed depression as a direct consequence of having Covid) and I didn’t really deal with any mental health issues in my youth or my 20’s. But here we are.
I do work with a therapist and she is teaching me how to keep a mood diary - to recognize whether I’m just having a stressful time or if it’s depression reoccurring. (For me depression looks like feeling numb, no joy or even sadness just numb, no desire to eat just sleep all day and no ability to concentrate on even the simplest tasks.) So I will continue working on that. And will definitely keep a mood diary while pregnant.
I sympathize with you on the analogy of a car accident when it comes to a mental health episode - it’s sudden and yet we are supposed to catch it as early as possible to prevent the symptoms from becoming worse.
Thank you for clarifying the management of bipolar during pregnancy - I do understand that for a lot of women medication is vital in staying well. I’m not oppose to it at all. I will discuss with my medical team what they believe is best given my medical history - to medicate me in early pregnancy or not.
I hope you stay well and that the therapy and management strategies continue to improve so you’re able to stay ahead of your mental health. It sounds like you have great support from family too which is great. Congratulations on being a family of 4! No matter the price it was still all worth it right? I always say - even with everything I went through - I would do it again just to have my daughter. Take care of yourself and talk soon 🤗
I hope that the antibiotics sort out the infection quickly for you and that you are back to feeling yourself. It is specially difficult to be ill when you have a little one that will be needing attention.
Glad to hear you are working with a therapist at the moment and that she is helping you keep a mood diary, it is a very useful tool to have, and a very good idea from your part to keep one during pregnancy. Its kind of a balance between being prepared and also enjoying the moment. I was looking forward to the birth of my son (the second one) very much, and that was thanks in no small part to having a good support network that reassured my worries and allowed me to voice my concerns.
Your mum and mother in law sound fantastic and it is so good that you are welcoming all their help. I also had my mum staying with us for quite a few months, and despite her being elderly and not capable of going out by herself she was a massive help with my youngest at home.
I wish you all the best in the next few months, do keep us up to date and as always feel free to chat with us any time. Take care,
In my second pregnancy I chose to start Olazanpine towards the end of my pregnancy and took this for about 6 months. I also began lithium for a year after birth. I felt a little elated in mood at the beginning and was quite active but no episode of PP. I have had psychosis once in pregnancy and my father is Bipolar, but 20 years after my episode of PP I haven't needed any diagnosis. I am currently 30 weeks pregnant with my third baby and hoping to do the same medication plan.
Hi Cheryl, thank you so much for your reply. It does help quite a lot knowing that you have gone through this twice and about to do it again and you haven’t had any further episodes. That’s great news! So from your story I’m assuming your first pregnancy - you had psychosis in late pregnancy or right after birth? And this is what made you choose olanzapine late in pregnancy? This is my plan as well. From what I’ve read is it’s relatively safe for the baby to take olanzapine especially in third trimester. So happy to hear you have remained well all these years and congratulations on your third baby! Will be praying for your safe delivery and postpartum experience. Take good care of yourself and your babies.
Thank you for your positive words and prayers 🙏💗 Yes in my first pregnancy I experienced psychosis after birth with an admission to an MBU. I was admitted for 3 months. My consultant said it was safe for the baby taking the Olanzapine in the third trimester. I was so worried about experiencing it again that I wanted to do as much as I safely could to prevent it. It certainly helped me reading everyone's positive stories about going on and building their families.
Sounds like you have a great support network and we are always here online for any further advice or support you may need. Very exciting times ahead. Wish you all the best also 🙏✨️
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Had a second child and no PPP
PPP Book
Second pregnancy update
Im terrified of developing PPP
