Should a woman who has experienced PP... - Action on Postpar...
Should a woman who has experienced PP with no prior history of mental illness be informed that it can be associated with bipolar?
this is a difficult one. For myself not being told was good because I would have been looking for the onset of bipoar so my recovery was not hampered by it. But in my work within mental health I value service users being treated with respect and part of that would be being honest truthful and realistic
This question is so personal to me. I don't know the exact answer as it may be different for everyone. But, in my case, if I would have learned earlier on in my years of struggle postpartum, it may have helped me realize sooner that there was a possibility that I was struggling with something longer-term than postpartum psychosis.
I may have denied that bipolar was going to happen to me but since I was ultimately diagnosed with it several years postpartum, I may have been able to come to terms with it and get it under control sooner sparing much struggle.
I think the main thing women with PP need to know is that they are not alone, they are not to blame and with proper care and treatment they will get better no matter what, even with a history of mental illness.
Thank you for asking this question as many still are unaware of the bipolar and PP connection. Education is the first step in overcoming such a horrific illness as postpartum psychosis.
I had no history of mental illness, developed PPP then, 2 years later was diagnosed with bi-polar disorder when I had a second bout of mania. The team treating me are certain I didn't have bi-polar before my pregnancy but that I developed it as a result of a series of preganncy/birth related traumas.
I would have found the information that you could develop bi-polar later in life, following PPP, extremely useful as:
- my husband and I would have known to look out for the signals;
- we would have known that the "incredibly good feeling" I had while on antidepressants following on from my first post-mania depression was dangerous (I ultimately had a second manic eposode fueled by cymbalta);
- we would have been able to make better decisions about how to deal with my health;
- we would have got me in to see a psychologist and other types of care sooner.
I was diagnosed with bipolar about 18 months after the start of PP. It`s difficult to say if knowing the connection with PP and bipolar would have helped. When I had almost recovered from PP and was medication free I did lots of stressful things all at once. I moved house, got married and went back to work. I tried to run before I could walk and wasn`t well enough to be back in work. When my contract was terminated on the grounds of ill health I became severely depressed and then started on anti depressants. These were increased and increased several times and eventually I came out of the depression and became manic. I often wonder if there`s a connection with anti depressants and if they can trigger mania.
I think it probably would`ve been useful to know that PP can be associated with bipolar.
I agree this is a difficult question & it's one we were chatting about recently. We decided that certain information was helpful/unhelpful to be informed of at different stages of PP, but what info you should be told & when, is difficult to pin down. I had PP out of the blue so being told about the bipolar connection just after diagnosis would've been very scary & way too much info, but learning about it (from the internet only!) at a much later stage, after I'd fully recovered was helpful as it helped me to understand PP far more.
I agree. I wasn't ready to hear about bipolar in the first 6 months following my PPP. It would have set me backwards a long way. My psyche was good at helping me recognize the signs of trouble, and later explaining to me that I likely had a lifelong illness. I've recently fought off a depressive episode with fantastic care (a gp and psychiatrist) and increases in lithium. The depression was I guess worsened by having to accept this new diagnosis, but I was relieved I had such great support. In summary, I deffimitely needed education, but it was done in a way that was sensitive to my recovering brain aswell as responsible for identifying warning signs.
Hi Sarah, Just to add that side effects of many anti d's are mania. That's why its important for women who have a history of PP, are not supposed to go on anti d's after delivery as it can trigger it. x
I think it is absolutely necessary to be told of the connection with bipolar disorder. I wasn't even told that I have postpartum psychosis the first time. So, everyone thought that I had a severe grief reaction and that it was the result of my baby dying. Noone counselled me or even spoke of my baby. It was as though it never happened. I found out about bipolar disorder 2 years later by another psychiatrist, that helped me geton with my life. I agree with louloubexs too, about the antiD warning.
Thanks louloubexs, I`ve often wondered if the anti depressants triggered the mania. If that`s the case I wonder if I would be ok without Lithium, I`ve been on Lithium for 16 years and have been well. I often think I may not need to be on Lithium but the risks of coming off it scare me. I tried coming off it six years ago and had a lot of stress at the time I`d just stopped taking it after gradually reducing it over a couple of months. I started having sleep problems which got out of hand and ended up having an episode of illness and went back on it. I wonder if it was a withdrawl mania and if i would eventually be ok without it. I also wonder if i hadn`t have had such stress at that time would I have been ok without Lithium but will never know. The way i look at it now is that I`m well on Lithium and will stick with it.
I think on balance I would like to have known. The timing would have been important but I don't see if this was taken into consideration that the advantages of not knowing could outweigh those of knowing. Maybe my view is skewed because I did go on to develop bipolar. Surely there is a right to know increased risk factors for other health conditions just as informing a patient about the association between high BP and cardiac event? Recovery is more than being unaware of risk. I was not informed but the attitude of others towards my hopes, expectations and goals was incredibly powerful in my recovery. Recovery practice was not the norm and I was told to give up goals to minimise stress without any view being voiced I may have a further mood episode. Surely it is such attitudes that need to change rather than not being informed as any other patient would be about risks. Surely views about future risks would also be informed by other risk factors such as family history rather than just sweeping it under the carpet? I don't know that I would have avoided the major episode where I was hospitalised and diagnosed by knowing of the increased risk but maybe it would have been easier for me to come to terms with. For others forwarned can mean avoiding an episode by knowing about the risk of taking antidepressants. Give me a relapse prevention plan developed in an empowering recovery orientated partnership than fingers crossed and head in the sand.
This is really interesting (if that's the right word). I knew that signs, symptons, behaviours etc of pp were most similar to bipolar. But I'm not sure I knew there was this definite link. And 3 years on, no-one has told me about it. I think the information is really valuable, especially the anti-depressant risks. Not something that has been part of my pp "journey" but thanks for sharing this info.
Whilst I was still in the MBU recovering from my "out of the blue" experience of PP, my psychiatrist told me it was highly likely that this would be the first episode of bipolarity. I was in no state to receive this information. My life was blighted with fear, for a considerable period after this revelation, that this would be the beginning of being bipolar. His advice that I avoid all types of stress, and get uninterrupted sleep was an impossible mission: we all know that having a baby will mean sleepless nights, and the shocks of life will bring untold stress. I asked about taking anti-depressants, but was told it would not be helpful. My wonderful CPN also advised me against taking even St John's Wort. I heeded the advice, as I was so fearful that I would be catapulted into mania. So endured a very bleak monotonous existence for months on end. I am still determined to stay off anti-depressants, although they were prescribed seven years after my experience of PP. I realise that having been throught PP, I am at an increased risk of developing further mental health problems, but I have been free from medication and just wary of doing anything that might overstimulate me. Just beginning to stick my head over the parapet.
I had a PP 36 years ago. About 4 months postpartum I was diagnosed as bipolar and my psychiatrist said I should go on lithium for the rest of my life. I believed that he was wrong, and that I was a healthy woman who had gone through a very traumatic birth experience. So I did not take the lithium. I have had no mental health problems since and gone on to lead a happy and productive life.
Sleep deprivation was the primary cause of my psychosis. I will say that menopause convinced me that hormones also played a significant role in my sleep issues. There have been times when I chose a less stressful lifestyle, and I exercise regularly. I have run my own very successful international consulting firm for the past 18 years, have traveled to all 50 of the United States and 20 countries, have climbed 10 mountains over 14,000 feet. I have had a wonderful marriage of 41 years and have two wonderful sons and two beautiful grandchildren. I am vice-president of Postpartum Support International and spend a lot of hours trying to support women with PP. I believe their motto, "With help you will be well." Well means different things for different women.
The main focus seemed to be, quite rightly, on getting well and moving forward. Maybe having the label Bipolar attached on top of the shock of being hospitalised with PP could cause more distress and potiential further damage to self esteem already at rock bottom. Follow up advice and education would go a long way towards coming to terms with PP and Bipolar, managing a previously unrecognised mood disorder and avoiding relapse.
