Severe depression blips every 24 days -post partum

[Chaource]

Hello,

I was just wondering if anyone had experienced severe depression blips every few weeks and then felt well and the same cycle repeated again? If so, what treatment worked?

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Hello, my twin sister developed severe post-natal depression 7 months ago.

Before she had a baby she had severe PMS symptoms just before her period and was very affected by contraception (e.g. morning after pill). Had ADHD type mood swings - sometimes feeling more high and excited and sometimes feeling low, but she never had severe depression before.

She has a 9 month old baby. She first couldn't sleep for 10 days 6 weeks after birth and then felt low and would then feel better. She then went to a mother and baby unit after trying an antidepressant (it made her feel very low and suicidal).

She the took an SSRI and was better for a few weeks (she was very positive) and then she severely blipped. She has since changed her medication to Venlafaxine and was, until recently, on Olanzapine. Since this big blip she has felt suicidal or made an attempt every few weeks for about a week she feels very low then starts to recover and feel well (quite like her old self) for 2.5 weeks or go, and the cycle repeats - she blips and feels severely depressed and suicidal. She tends to feel very low before she blips. She is currently sectioned in an inpatient mental health hospital, but I was wondering if anyone else developed these cyclical patterns post-partum, and had any thoughts about treatment?

We are not sure if it is hormone (linked to her cycle, although she still has not had her period) or may have developed bi-polar?

[EquineBeauty]

so I’m not a psychiatrist obviously but having learned what bipolar symptoms are from my doctors - they say that people with BD “cycle” so they can have high or good mood for a few weeks and then depression. And antidepressants by themselves usually don’t work. Most symptoms won’t improve unless patient is also put on a mood stabilizer. Is she on a mood stabilizer also like Lamictal or even Lithium? Can you ask her doctors?

After my PP I was put on an antidepressant, an antipsychotic (Olanzapine) and also a mood stabilizer (Lamictal). I’m off of the Olanzapine now but still on the other two.

[Chaource in reply to EquineBeauty]

Thanks yes she was just on Olanzopene - so we can ask about this.... so worried she is so low... and I can't really get a second opinion when she is in inpatient care

[EquineBeauty in reply to Chaource]

Olanzapine is an antipsychotic. I was talking about Lamictal - a mood stabilizer. Is she on a mood stabilizer?

Usually you’re put on all three -

Some sort of combination of antidepressants, antipsychotics and very importantly a mood stabilizer - as she is “cycling” between high and low moods.

It takes some time to find the right “cocktail” of medicines but once something is found that is compatible she should start to improve

[Chaource in reply to EquineBeauty]

No I don't think so - so i will ask about this. I think the doctor said Olanzapine also acts as a mood stabiliser so it is interesting you say they are different. I will ask about this.

[Chaource in reply to Chaource]

Thank you so much for your response x

[EquineBeauty in reply to Chaource]

Olanzapine does help stabilize mood but is primarily an antipsychotic. Lamictal is actually an anti seizure drug but in patients who exhibit bipolar like symptoms it acts to regulate mood. It’s yet another layer in addition to the olanzapine to help her get to normal.

Thinking of you. Glad you’re reaching out here. Keep her in the hospital as long as needed until she is back to normal. Wait until they find the right mixture of medications and until she is stable on them before bringing her home. She will get better. It will just take time. Stay strong.

[Chaource in reply to EquineBeauty]

Thanks so much. The current doctor is now also thinking to give her ect. Not sure what you think but it may help to stabilise her while they figure out the right medications and make her symptoms hopefully less severe? Thanks

[EquineBeauty]

yes I have heard of ECT. When drugs don’t seem to be effective they suggest ECT. I’ve heard it does wonders for people who don’t respond quickly to drugs.

It might provide much needed relief. I heard the side effects are headaches and May be some short term memory loss but it comes back. So that’s a small price to pay to start feeling better.

Also if she does get several rounds of ECT and then they put her on antipsychotics, mood stabilizers and antidepressants - make sure she stays on those for at least a year. Some doctors take patients off too early - like 3 months and then you relapse. Obviously discuss all this with the doctors, but that has been the overwhelming opinion on here. 1 year at least post incident - stay on medications. After she leaves the hospital she will need to see a psychiatrist regularly, for at least 2 years to monitor her moods and discuss medication tapering.

[Chaource in reply to EquineBeauty]

Thanks so much - that is really helpful - really appreciate this x

[EquineBeauty in reply to Chaource]

Will write more in a little bit. Feeding my girl right now.

Hang in there. Your sister will get better. Since she has been unwell for so long (several months right?) it might just take some time

[EquineBeauty in reply to Chaource]

So I read more of your original posts. (In my opinion) it sounds like your sister didn’t have full on psychosis but came close. (Psychosis is a break from reality, delusions, hallucinations, hearing voices, believing things that are not true - for example that you are the incarnation of Jesus or something like that; a lot of times the delusions are of religious nature but not always, sometimes women think that someone is out to get them and there is a world conspiracy against them… etc. very delusional magical thinking that can be dangerous; you can look up symptoms and examples of post partum psychosis if you want but just a warning - it’s distressing.) A lot of us - prior to the full blown psychosis itself will exhibit some symptoms - a common one is inability to sleep. (I didn’t sleep for 5 straight days at all and then had psychosis) You know you need to sleep - by you just can’t and/or feel like you don’t want to. Some will experience mania - high elated mood, fast talking, doing lots of things at once … and then all of a sudden a drop in mood (severe depression). And then go on to have psychosis. It sounds like your sister never quite got to the psychosis part but got stuck in this bipolar-like cycling of moods - the depression being quite dangerous as she has felt suicidal. I’m glad to hear that the doctors are trying everything including the ECT. I hope either that or combination of medications help soon. I personally think that the mood stabilizers will be a good addition - but obviously listen to her doctors first and foremost.

She is still in her first year postpartum so in danger of experiencing psychosis so I personally would think that staying on some sort of preventative antipsychotic medication is best - but again I’m not a doctor so May be they think she has something else? You mentioned that they took her off of olanzapine - did they put her on another antipsychotic? Or May be they’re just waiting to see if ECT works first…?

(I’ll just state again what worked for me but every person is different … so the docs will probably keep trying different things for her and see what she best improves on; I was on Olanzapine 15mg, Lamictal (mood stabilizer) - 100 mg and Zoloft 50mg; I did this for a year and recently came off the Olanzapine, but am still on the other two as a preventative.)

Also I’ll give some of my other opinions - this is just what I have gathered as far as information regarding these disorders ever since I had my PP (and also experienced severe depression afterwards). It sounds like your sister is quite sensitive to hormones (from what you have described in your previous posts.) If she is still breastfeeding - I heard of a few women who relapsed after they have gone off of medication and then ceased to breastfeed. So perhaps after she gets out of the hospital - you can discuss with her doctors of how to go about ceasing breastfeeding safely (May be while she is still medicated?) Similary during perimenopause - the APP website has a document that says about 30% of women who had PP can relapse during this time. Seems to me like that’s hormone related as well. So May be again, discuss with doctors about possibly taking a course of medications during perimenopause.

Of course this is all just my opinions and my personal plan of self care going forward. But I’d thought I’d share anyway in case it helps anyone else.

First things first - she needs to get stable. She is at an inpatient hospital so rest assured she is in the best place. She needs to be constantly monitored by professionals. Hopefully ECT will provide much needed relief. Then a “cocktail” of drug combinations that are compatible and work for her. Once she is stable for some time she can go home and be under a care of a psychiatrist for at least two years (May be lifelong depending on her diagnosis) - they can slowly taper down her drugs over a course of time. While she is the hospital - perhaps you can reach out to the OBGYN (gynecologist) and they can refer you to a good perinatal psychiatrist? I’m in the USA - and it took me 3 months after my hospitalization to find a good psychiatrist who I’m happy with to maintain my care. I don’t know if it takes as long to find one in the UK… but perhaps your family can do some research - ask around at the hospital, or the GP Or gynecologist office - where to get a referral to a psychiatrist who has experience with perinatal disorders once she is discharged. It’s a long journey but hopefully she’ll get some immediate relief soon and it will only be up from here. Hang in there and make sure you get rest also.

[Lizzo30]

Seems like your sister was mentally unstable when her period started my sister was the same Dr Katherina Dalton was an expert in this kind of hormonal problem her books are available on ebay

[Rachel_at_APP Partner APP]

Morning Chaource, it’s Rachel here I’m part of the national peer support team at APP.

I just wanted to write and say I think you’re so brave and amazing for being there to support you sister like this. Frankly PP is devastating for the whole family not just the person experiencing it. I’m sure at times you’re feeling so so upset by this yourself, I hope you’re ok, as ok as you can be.

My sisters were both a huge comfort to me when I was poorly with PP. Juggling their own lives, chatting with my mum, my husband and visiting me too - it was all a lot and was no easy thing. So I hope you’re ok. I’m hoping that you’ve got support around you too as you navigate this tricky time. Sending best wishes, Rachel x