Hi all, first time I am posting here. My wife was diagnosed with PPP a couple of weeks after we had our first baby. She spent about 1 month in an MBU and was then discharged. While there she was started on aripripazole and after her discharge she’s been tapering off the medication. A couple of weeks after her discharge she gradually fell into depression and as a result she was put on anti depressants(from memory she took aripripazole for another 3-4 months after discharge and then moved to anti depressant). She got better and we were ready to put it all behind us when she experienced a relapse (this happened just under a year after her first episode).
Now she is back on aripripazole, sinking in depression - the specialist told us that she was taken off medication too quickly first time around so we are taking it slower this time.
I’ve tried to research this online but I have not found any clear answers (no stats but no anecdotal information either).
What is the outlook long term of this? They say that patients can make full recovery from PPP but does that mean with continued treatment? I feel like antipsychotic medication is quite debilitating (lots of side effects). Do patients recover to the point where medication is no longer needed?
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I'm so glad you've found us and reached out for shared experiences here. My name is Ellie. I'm one of APP's national peer support coordinators, and experienced postpartum psychosis myself in 2011 after the birth of my son.
I hope that others will share their experiences too.
I'm sorry to hear your wife had postpartum psychosis and has also experienced a relapse. Did something trigger her relapse do you know? Did she have some additional stress, or perhaps struggling with sleeping? I know lack of sleep has such a massive impact often.
From speaking with lots of people, this does happen for some people. There's some information on our website under frequently asked questions - 'Am I likely to have an episode of psychiatric illness at other times?', which details a bit what we know so far, from research and people's experiences.
Everyone's experience is unique and different. There are some people who go on to receive a Bipolar diagnosis after postpartum psychosis. From what I've heard from sharing with others, often people who go on to receive a Bipolar diagnosis have experienced depression and/or mania in the past as well, as well as their postpartum psychosis experience. I've heard from some people say that the Bipolar diagnosis makes some sense to them, looking at their historic mental health experience. A lot of people who have a Bipolar diagnosis do take medication ongoing, but others reduce and come off medication as well, and remain well. Each experience is so individual.
Other people experience postpartum psychosis, and then fully recover, come off medication, and never have another mental health relapse.
To share my own experience if it's helpful, I experienced postpartum psychosis 13 years ago. Like your wife, I experienced depression afterwards too. I slowly reduced my anti psychotic medication, after about 6 months after the episode, it probably took about a year to come off it though as it was a very gradual reduction each month. From what I've heard from others, psychiatrists usually recommend staying on the anti psychotic for 6 months, before reducing. I was on the anti depressant for much longer, for nearly 2 years I think.
I did remain well, without medication, for 12 years, then unfortunately nearly 2 years ago I did experience a relapse. This was because of a unique set of circumstances - some stress (my mother had died a few months earlier, and I became unwell the first Christmas without her while I was staying at my dad's for Christmas). However I was also first very physically poorly with an awful virus, which became a bad chest infection. I was so physically poorly that I couldn't sleep, coupled with being away from home and my usual doctor, and Christmas public holidays etc, and I didn't get antibiotics very quickly until it was too late, and I became mentally unwell again with a psychotic relapse.
However, this relapse for me wasn't as traumatic as the first time. I took the anti psychotic medication for a year, and have come off it again now. I came off it very gradually again, after getting guidance from my GP, reducing each month. I am still on a low dose of an anti anxiety / anti depressant but will come off that soon too.
I have not been given a diagnosis of anything (other than my first episode of postpartum psychosis). But I do see myself as being at risk of psychosis, I know that my mind can go there, if I don't look after myself well - I particularly make sure I sleep well as I'm sure this is my main trigger. I have a good bedtime routine, etc.
This is of course just my experience. I thought it may be helpful for you to know that I experienced a relapse, but have managed to come off medication again afterwards, and remain well, that just because your wife has experienced a relapse doesn't mean that she needs to take medication forever necessarily, though for some people they find that they do need it ongoing.
I also wanted to let you know that we have a lot of support for Dads and co-parents, if you haven't found it already. Simon, our partners coordinator, is really happy to connect with you, as well as some of our Dads and co-parent peer support volunteers. You can contact Simon on simon@app-network.org
Once a month we have a Zoom call for Dads and co-parents, just to meet each other and share experiences. Simon can send you the information.
Information about our support for Dads and Co-parents is here:
Thanks Ellie, really appreciate your reply and very reassuring to hear about your journey. We do associate it with sleep as well. Her first episode was triggered following a couple of days of no to little sleep. It was really difficult for us the first few weeks as it was just myself and my wife and our baby would wake up very often throughout the night. So the sleepless nights accumulated and we’ve asked for help from family too late as she was already experiencing psychotic symptoms. The second time it was also sleep related, she had an acute cough (barely sleeping due to constant coughing). She also has quite a stressful job(junior doctor part time). On top of this I made a huge mistake as I decided to attend a friends wedding thinking she was well enough to take care for our baby while I was away(one night) but this further contributed to her stress so when I returned she was already struggling to fall asleep and we immediately became aware of the symptoms so we restarted her on aripripazole hoping we can avoid a full blown episode. Given how well she recovered the first time we felt a bit too confident so we were not cautious enough. She does not have a history of mental health illness hence why we hoped/thought it was a one off thing. We also did not plan/will not have another baby to ensure we keep the risk to a minimum and we will be cautious going forward. The hardest part for me was first to get to know more about the illness especially while still in a shocked state but also quite difficult to mentally plan ahead - in terms of what to expect. The uncertainty about the treatment the diagnosis I would say it is even more difficult than the stress and pain experienced during the symptoms/episode itself.
Thanks for your reply. I'm glad it was helpful to hear my experience too. It sounds like your wife had something similar to me in some ways, with her relapse, in that she had some stressors, but that physical health affecting her sleep had a big impact. Of course you need to seek help and guidance from a psychiatrist, but from everything you've shared, I do think it's likely she'd be able to come off medication etc again in time.
It is hard as the statistics that 50% of people do go on to have some kind of other episode of mental ill health, does not differentiate between women with bipolar /ongoing mental illness, and those who had PP out of the blue, so it's likely that the risk would be lower for those who have pp 'out of the blue' with no other diagnosis.
The thing I would say is that recovery from the illness is really good, there are so many of us here at APP who can give you and your wife hope that she will come through this, fully recover, and be fully herself again. Yes, the illness does change you, I mean it changed my life (I changed my job, and now work for APP for example), but I know it's sounds strange and hard to believe when you're in the middle of it, but it hasn't all been in a bad way at all. For example, I have met some amazing people through APP, and it has given my life so much of a deeper meaning and experience, through connecting and sharing with others who have been through this illness too.
Do let your wife know too that we are here for her as well of course, and she can connect with us for peer support too, if and when she'd find that helpful.
I do hope your wife recovers from this latest relapse, and do connect with Simon if you'd find it helpful to link with other Dads and co-parents.
So sorry to hear about your wife suffering with PPP and relapsing.
Just talking from my own experience, I had PPP last November and was put on an antipsychotic (Olanzapine) and then a mood stabiliser (Lithium). I completely agree with you regarding the side effects of an antipsychotic. I came off of them in February time and started to feel myself again.
I am still on the mood stabiliser, I’m going to discuss in the new year with my GP the option to try and reduce / come off this if possible (as suggested from discharge of perinatal service). But ultimately, if I have to, I will continue to take for the rest of my life (I believe people with bipolar take this for life).
Hopefully you and your wife can discuss any treatment and medication options that work best for her.
Congratulations to you and your wife on the birth of your baby. What a star you are reaching out here to help your wife! PP is such a traumatic illness for partners to witness, feeling helpless and worried when it strikes and the future.
I had PP many years ago before mother and baby units. I was treated under mixed general psychiatric care. I did relapse and regrettably missed the first Christmas with our newborns (two sons, six years apart) as I was admitted to hospital. Eventually I made a full recovery from both episodes but severe depression followed. Thankfully my depression lifted over time. My late husband must have struggled as there was so much stigma in those days around mental health and very little support.
Just to chime in with another link for you to PP Soup, at ppsoupdotcom.wordpress.com described as a nourishing mix of all things postpartum psychosis. Written a few years ago by a mum who suffered PP with input from other mums and professionals. You will also find a BBC Radio4 Woman’s Hour Radio documentary “Unravelling Eve” there but do take care reading as mums share their experiences when PP hit.
Long term there is so much to look forward to but when you’re in the thick of ‘it’ I know that is of little comfort. I’m sure the zoom call with other dads will be reassuring. We are all here … you’re not alone! Take care 🌻
I had PP in June 2023 and was put on Olanzapine. I also spent around a month in an MBU, and as soon as I was discharged, I started to wean off the antipsychotic as I hated taking them. I did this on my own so considerably faster than recommended. I completely stopped during August 2023, so was on it for a little less than 3 months total. I did not experience depression and have remained well since, and have been working full time for over 6 months in a competitive field.
Hello, I don't have a lot of time to post today but wanted to take a moment to respond to you. I'm a 22 year survivor of PP and although it has been a long and hard road, I wanted to tell you that I'm very well today and my husband and I are stronger than ever. I'm touched that you posted about your wife's situation and well done to you for trying to understand it, because it's something you really can't fully understand unless you've experienced it.
The short answers are:
1. Everyone is different.
2. It could take a while for her to be fully normal again, but given time she will be well.
3. She may have to manage some aspects of her mental health for the rest of her life.
4. There isn't a lot of research out there, and you've done well to find someone to talk to about it.
In my own case, it took about three years for me to stabilize and I had relapses. However you should know that I was improperly diagnosed, and lived in an area where the care I had access to was somewhat less than the best. (I'm in the USA.) After that initial three year period, I did much better, and after a period of stability was able to stop antipsychotics altogether. I still take a mood stabilizer and an antidepressant, see a psychiatrist and therapist regularly, and I expect that will be the case for the rest of my life. I think my case was more severe than most, partly because I was misdiagnosed and lived in a state of psychosis for quite a few months before I was treated. I'm told that this really affects the brain, and if I had been treated more promptly, it may not have been as severe. I'll never know.
I agree with you that the antipsychotic drugs are quite severe, with a lot of side effects. My quality of life and health has greatly improved since I've gotten off them. But your doctor is correct, she cannot do it too soon, or the symptoms will come back.
Since you say she is experiencing depression, my suggestion would be that you can try to help minimize the causes of depression for her. Getting plenty of sleep, exercise, and a nutritious diet with a full amount of protein, Vitamin D, and fruits and vegetables can help greatly. Make sure she is getting time to herself and help with the baby and the house. Get outside and exercise as much as is possible for your locale. Sunshine and fresh air are super helpful. Those factors all in themselves affected my depression greatly. I was stuck in the house alone with two young children while my husband was traveling, and because I was nursing the baby, I got little to no sleep, no time to myself, and little to no exercise or time to get outside.
All of those things above can be managed, medication can be managed, and in time she will feel well again and you will enjoy life together. Your child will be fine as long as they are with loving people, whether that is yourself or others. Give her as much help as you can to facilitate her recovery. It will be difficult for you, but don't despair. I love my husband twice as much for the fact that he stuck with me during those difficult times, and he would be the first to tell you it was very hard for him. We didn't have family or good resources, and it was a very lonely road. You are starting out with so much more - good treatment, and this forum. Have faith, and remember always - This too shall pass. PP is a temporary condition.
Thank you all for your support and for sharing your experiences. Although not there yet I can see she is making the effort to battle depression so I am appreciative of that. I hope we can have a bit of luck for her to stabilise and to at the very least get a few years without relapse. I am on the one hand grateful for the available treatments but at the same time it is frustrating to know the stage we are at when it comes to diagnosing and treating the various mental health illnesses that ppl suffer from.
Firstly I'm so sorry your wife has suffered with ppp, it really is such a scary thing to go through both for the person suffering and their loved ones around them.
This is purely only my opinion, I'm not a medical professional myself but I do believe that she was taken off too quickly. I believe ppp can occur up to after a year of birth so it may have been better to have had your wife on medication up until a year and then start tapering very slowly from there but you weren't to know that and could only go by the advice of medical professionals. I understand with Olanzapine which may be the same as aripripazole that when tapered too quickly you sometimes get insomnia which is what happened to me when I tapered Olanzapine. I also came off at 2.5mg which is the lowest administered dose in the UK. I couldn't sleep for two weeks before I reinstated becoming worried I would become unwell again. Do you know if this happened to your wife?
I'm so sorry your wife relapsed, that must have been so scary for you all. Again this isn't a professional opinion but I understand from research I've done over the years that antidepressants affect serotonin and dopamine - too much of either of these things can actually cause psychosis from what I've read. I was offered an antidepressant but after some research I decided against it as I was so scared about the potential side effects.
I understand the depression your wife has fallen into, this will likely be from the antipsychotics as they block dopamine and serotonin which are what helps regulate your mood. I too suffered from depression after my episode and I understand many others have too.
I have taken a long time to get off antipsychotics mainly because I didn't have guidance from medical professionals to come off properly up until recently and also because I lost my sleep the first time around this time I've gone so slow and I am actually cutting my pills smaller using a pill cutter to take smaller doses - I'm currently at 0.625mg (a quarter of a pill) - I'm not sure if this is something you can do with aripripazole.
I'm 3 years postpartum.
I'm only just now starting to feel more like myself and it's been a long, hard road. I'm taking Magnesium L-Threonate to help with my sleep whilst tapering and Vitamin D. I was advised to take Omega 3 Algae however this negatively affected my sleep so I stopped taking that and my sleep thankfully returned to normal.
Your wife will get there with your help and support and that of professionals. It would help if you could get her some talking therapy to help her come to terms with what has happened, I know this helps me. Please keep a close eye on her as depression can eat away at you.
Please do look into the antidepressants as they may not necessarily be best suited to your wife - this is different for everyone. I believe from research these can potentially cause a relapse for some as they don't agree with everyone. Please stay away from weed or anything like that as again this can cause a relapse.
I hope she gets through this soon. It sounds like she has a wonderful Husband by her side every step of the way.
Sorry for the long reply.
Sorry - I just wanted to add that there are usually withdrawals coming off antipsychotics so please try and support her as best you can through these. It will be hard on you both as she may not be the best version of herself. I know for me I had increased anxiety, even lower mood and fatigue. You really need support during these time whilst your brain adjusts to being without medication.
My Wife had PPP in 2016 after my son was born. Between therapy and medication and a few stays in mental health units it was probably a good 5 years before she was signed off from the therapists. She is still on lots of medication and although it's easy to say from the outside looking in it does get better. What helped me was kind of gauging where we where when it was at its worst to how thing are now 9 times out of 10 it was always better than rock bottom so you're still moving forward
You've shown up for your family that's something to be proud of, it will get better i hope she feels well soon.
Sorry to hear about your wife's PP and her relapse.
My wife had PP last February and has been advised to remain on antipsychotic medication (olanzapine) for 2 years postpartum. She's on a very low dose now.
It was hard once she came out of the MBU as she was on a very high dose - falling asleep on the sofa straight after taking the medication and not waking up until mid-morning. She also felt no emotions which really ate at her.
The difference came when reducing medication from a medium to lower dose earlier this year. She felt more 'herself' and was less lethargic.
It's a double-edged sword as on the one had the medication really helps with the PP recovery but, as with every medicine, there are side effects. It's always a balance weighing them up and despite doctors advice it is ultimately your wife's choice what she feels is best for her recovery.
So to answer your questions.
The prognosis is very good. Everyone is different so the right 'cocktail' will need to be found for your wife (if it hasn't already) and time to taper the medication. I understand that some women will need to be on a low dose of anti-psychotics for a long time, if not forever. It's whatever works best for them, you, and the little one.
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