Unsure whether to try breastfeeding with no 2, given that I'll be taking olanzapine as a preventative. Advice on toxicity etc appreciated

I'm 18 weeks pregnant with no 2 after post partum pyschosis with my son two and half years ago. I think I'm definitely going to take olanzapine afterwards, but unsure whether to breastfeed or not for fear of the effect breast feeding had on me before and toxicity for the baby.

I felt so guilty that it was such a disaster last time (which I think was one of the triggers), but I did not have much milk and it made me feel a bit high every time I tried to do it. My hormones were definitely all over the place, and my milk never came in properly. I never got that weepy low a few days after the birth when the milk came in, and just started getting higher.

So I want to at least give this baby the colostrum (but not sure if to start the olanzapine straight away or wait for a few days until I have done that). And then whether to breastfeed during the day and give the baby bottle at night, but don't want to risk toxicity in the baby. I am definitely going to give the baby a bottle of formula at night, so as to sleep.

My psychosis came on fully within about 7-14 days after the birth, I was really manic for a few days, then delusional. I was sectioned for a week in a general ward which was terrifying, and then 3 months in a MBU. And I had severe depression after, but luckily an antidepressant brought me back to normal. I have been fine since.

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  • Hi Joanna,

    Firstly, big congratulations on your pregnancy, how wonderful! It sounds like you have a good plan in place re. your care afterwards & there's plenty of time to fine-tune your care plan.

    Breastfeeding is such a big issue for any new mum & even more so to us who've had PP. I can really understand the guilt you felt last time & the damage it can do. I persisted with breastfeeding with my first (didn't have a 2nd); I think it really contributed to my illness & I really wish I'd stopped far sooner. But I know many PP women who did breastfeed successfully first & second times. It's such a personal decision to make & it's one I'd want to make just for ME - without all the added external pressures from everywhere that are put on mums. Hopefully some other lovely ladies will come on soon & share their experiences of breastfeeding & meds second time around.

    There's lots of really useful advice about medications with information about breastfeeding here: choiceandmedication.org/ncmh/

    Just select one from the 'Medications' drop down on the right-hand side. Also, the 'Printable Leaflets' are very good from the left-hand menu.

    Also, don't forget the second opinion service if you'd like further expert advice: app-network.org/what-is-pp/...

    Good luck with everything & let us know how you're getting on.

    A x

  • Your experience is so similar to mine. I also decided to start on olanzapine immediately after the birth of my second son. I was terrified of the psychosis happening again and was certain I didn't want my eldest son witness me being sectioned again. I was told told that I shouldn't breast feed because the drug would pass through to my baby. Therefore the decision was out of my hands. I did feel guilty for a while, but taking the medication was the best decision as I did not have another episode of PP. My sons are 3 and 5 now and both very healthy happy little boys. I too have fully recovered and been discharged and off meds over a year now.

  • Firstly congratulations Joanna, I myself am about 8 weeks pregnant with my 2nd child. Giving up breastfeeding due to olanzapine last time was devastating as it was always something which meant so much to me personally. I've been seeing a psychiatric nurse at my doctors surgery for just over a year now (since being discharged by the community mental health team) & he is confident with regular contact during pregnancy & after the birth we can avoid medication this time around so hoping no meds will be needed. That said lack of sleep was a big issue so am thinking of speaking to him & my midwife to find out IF I need any help sleeping if there's anything I could have that would still be safe for breastfeeding & that if I'm well enough still let me wake up enough for night feeds. Was just wondering if anyone on here knew anything about sleeping meds & breastfeeding?

    Sorry Joanna this doesn't really help with your question. I would like to reiterate what Andrea said though which is when it comes to the final decision think about what's best for you. My aim is to feed as long as I can manage but I also plan to buy some cartons of ready made formula in case we feel the need to go to combination feeding or switch to bottles entirely.

  • Thanks ladies for taking time to respond and sharing some of your stories.

    The whole issue is a bit confusing, because I've read mixed reports about safety. I guess no none is going to stick their neck on the line and say it's 100% safe for baby, or do any testing in breastfeeding mums & their babies.

    Most studies/sites say the baby needs extra medical attention afterwards if you do breastfeed on olanzapine to ensure it does not get floppy/that it develops normally/is not unduly sleepy/poor weight gain etc. I think that in itself is enough to worry me and trigger panic after the baby has come.

    I have also read on here (not sure how true it is) you should express twice in the night after you have taken the olanzapine, so you are discarding the milk with more of the medication in it. Again that seems stressful. I want to keep things straightforward. i hated expressing, I used to get the tiniest drop after an hour of pumping, which I found beyond frustrating.

    I always believed in breast feeding, and as all my family members did it successfully, thought it would be so natural and was quite anti-formula. So the guilt was awful afterwards, particularly when I was discharged from hospital afterwards and used to meet my NCT friends with their babies. I already felt a bit alienated because of my experience and when they sat around breastfeeding and I gave my son formula, it made me feel quite depressed and like I was failure. Which really is stupid I know, but i guess you can't help your feelings. (But then I was depressed anyway). My sister who had a second baby last year said most people with no 2 breastfeed for less, or mix feed anyway as they are so knackered from having two, so it might not be such an issue.

    I think I'm secretly hoping my consultant says it's best not to breastfeed, and make the decision for me (like Sherbetdip) and that I should just take the medication and then I don't have a choice!! Generally indecisive anyway. But so far, my consultant has said it should be fine (but that contradicts the reports I've read). I will know more when we put together our care plan together next time and I dig a bit digger. I may see if I get a second opinion too thanks!

    There are some serious pluses about formula though (sleep, no worry about drugs, partner can help) and it didn't do my son any harm!

    Did anyone else get an adverse reaction to breastfeeding? Every time I breast fed (when I was beginning to get unbalanced) it gave me a funny elated feeling, and made me lightheaded and floating, like I could fly? It wasn't pleasant!! And it started freaking me out, at first I thought I was physically ill with some weird condition and was panicking more and more before I truly lost my mind.

    I think I'm definitely not going to do watch & wait and respect that, I can totally see the attraction of avoiding drugs, but I don't think it's right for me. As mine came on quite quickly and suddenly, and I think I have to do everything I can for my son and family (who are already worried) to show I'm minimising risks. I will also feel more relaxed if I know I am taking some control. But then again, that's a personal choice. I am not mad on drugs and their side-effects, but it did save me last time!!

    Sorry for the waffling on!! It's great to have a site like this. I also used it when I was in bits in the summer trying to make the decision whether to go ahead or not, and it really helped! xx

  • Hello Joanna,

    I suffered PPP in November 2009 after the birth of my daughter. I was breastfeeding her while in the MBU and stopped when she was around ten weeks old because I was concerned regarding the effect of olanzapine in my milk. I should point out I had been placed in olanzapine as a breastfeeding mother and was advised it was the "safest" drug for baby at that point. I was too ill to research fully and make an informed decision and that's why I chose to stop nursing.

    I now have a five month old baby and went on prophylactic olanzapine the night he was born. I was advised my the perinatal consultant that olanzapine was safe and was ok to breastfeed on but I decided to do more research on the subject. I contacted the Breastfeeding Networks Pharmacist who sent me information in the effect of olanzapine on lactation. From looking at the information I received I decided to breastfeed my son, I had been advised that a dose of up to 20mg olanzapine (which is the maximum anyway) would be safe to feed. I was on a 5mg starting dose which was upped to 7.5mg when I displayed a few symptoms of hyper awareness. My son has had no adverse effects from the drug and I have truly enjoyed my experience if motherhood this time around.

    I am a HCP and appreciate science etc and found the information on olanzapine and lactation quite hard to digest but I feel I made the correct choice for me. That is the important part, it's your choice. I felt the minimal risks outweighed the massive benefits to breastfeeding. I didn't pump and dump my milk at all although I was warned that there was a small possibility that baby would be sleepier if taking a feed in th early hours after my night time tablet. I felt this was a small risk and wouldn't adversely affect baby anyway and may even encourage sleep! It didn't! I have the worlds worst sleeper!

    If you have any other questions feel free to ask. I definitely recommend contacting the BFN yourself so that you have that information to hand to make an informed decision.

    One other thing I would say is that if you are taking olanzapine To prevent the psychosis it is important to start immediately post birth as there are certain trigger days that have a higher incidence of PP occurring and by taking the medication straight away these risk are reduced.

  • breastfeedingnetwork.org.uk...

    Here is the link to the BFN drugs in breastmilk page where you can contact the pharmacist.

  • Hi Joanna

    Just to say I totally understand your feelings on the express & discard in the night method. This was the 'workaround' suggested to me in 2011 with my second little one. I too decided that it would be far too much extra pressure and exhaustion to add. I had a few days without Olanzapine to breastfeed and 'watch & wait' but then started it at 7 days.

    The main thing is that you have some options, and also that you give yourself permission to choose whatever option feels best for you even if that means deciding at the outset not to breastfeed. Not breastfeeding was kind of hard emotionally, but definitely the absolute best for me at 7 days.

    Naomi

  • Thanks postpartum problems for sharing that. I appreciate your advice, I was deliberating waiting a couple of days before starting olanzapine (although my consultant wants me to start at 5mg straight away). So I'm going to do it from the first night, why take a risk.

    Regarding breastfeeding, I have contacted the BFN for their advice- thank you for that tip. If there is a lot of doubt as to safety, I would be too cautious to take a risk, but I'll see what they say. And have contacted Dr Ian Jones regarding a possible 2nd opinion.

    I know I definitely want to give the baby colostrum- that bit is important to me. Sherbetdip- did you do this?

    And I also know I want to mix feed, as I'm paying for a maternity nurse for the first 2 weeks post delivery (expensive, but I think worth it) so I can guarantee some sleep and she will give the baby the formula at night. (I definitely don't want do the expressing thing- so good to know you didn't have to do this).

    I remember the NCT organisation being anti mixed feeding as they said it doesn't allow you to establish your milk production properly. And I don't want to do anything that upsets my hormones at such a delicate time anymore.

    Any thoughts on this in relation to post partum psychosis? Is it safer to just either breastfeed, or just formula feed does combining the two unbalance your hormones more?

    I'm also concerned about the weight gain (3 stone on olanzapine last time) but then I was on the highest dose of 20mg and had to eat unhealthy hospital food for 3 months which hopefully won't be the case next time!!

    Thanks again

  • Hi Joanna,

    I decided not to breast feed at all, so no my second son did not get my colostrum. I too was very pro breast feeding first time around and was devastated that I had to give up after only 10 days. I comforted myself in the knowledge that at least he had got the colostrum and for a short while afterwards. However I am convinced that the pressure of feeding along with unbalanced hormones was at least partly a trigger for my psychosis. The experience left me hugely traumatised. I too felt high and spaced out when feeding. Especially through the night alone. For me, I decided that I wanted to remove all identified trigger factors. As I said in my last post this left me feeling incredibly guilty that I had given a better start to my first born. However both my children are healthy, developing normally and are hardly ever unwell.

    This is your choice, and perhaps there is more evidence on transmission of antipsychotics through breast milk now than when I was pregnant in 2009.

    That said, personally I would make the same decision again.

  • Thanks very much Sherbetdip. Your story is so similar to mine. Weirdly it's good to know (although I hugely symphathise) that you also felt odd from breastfeeding. I've googled on line and never found anyone else say that. It was such a bizarre sensation and I didn't tell anyone at first (and suffered in silence) as I could not understand what was going on. It was indeed highly traumatic and the guilt factor is high the way things turned out.....

    Although- so many women don't breastfeed at all, and don't feel pressured to do so. I guess when you have been fairly high achieving in other areas, it feels horrible to fail at something that should be so 'natural'

    Did your milk come in 2nd time around? And did you get the day 3 blues and feel weepy with your 2nd child?

    Hormones have such a major impact. I have always suffered severely with PMS since they started- terrible lows and huge irritability for a week of every month, so I have always been sensitive to hormonal change. So I expected to feel quite low after the baby whilst my body was adjusting, but I just don't anticipate going high or delusional (it's so scary the first time around).

    So glad you did not suffer the 2nd time and your kids are thriving! (Funny enough my sister's kids who were breastfed have terrible eczema so there is no guarantee with breastfeeding).

  • I do think the pressure we put on ourselves, especially as first time mothers is immense. The desire to do everything according to text book and get everything "right". Of course, under normal circumstances, breast feeding is most beneficial for mother and baby. For me, this was not the case. In a strange way I was relieved that I was told not to feed. The idea of going through the same was horrendous to contemplate.

    My milk did still come in, and I had a few rather uncomfortable days, but it soon subsided.

    I didn't suffer with any weepiness in the immediate post partum period. In fact I was overjoyed with happiness.

  • That is reassuring to know :) Thanks. I am happy for you it all worked out so well. I wish in a way my consultant would just make the decision for me and advise against it, given how bad it made me feel. She has said I can try and see what happens, but it is being quite non committal on this subject and vague about toxicity issues.

    But I think I'm moving towards the decision to not breastfeed. I think if you managed to breastfeed easily the first time around with post partum psychosis, then it's probably a no brainer to give it another go. But the thought of breastfeeding brings back negative connotations and stress and it was definitely one of the triggers (the day my milk finally came in - after just minimal amounts - on the second week was the day I went into full blown psychosis), and I want to minimise any risks understandably. I also don't know if mixed feeding will just complicate already complicated matters!!

    It's great to have this forum to explore and discuss these subjects.

  • I agree, this forum is a great place where we can all discuss and share our experiences. I am finding it very interesting and informative. It have found the answers to many unanswered questions which have helped me come to terms with my experience.

    Good luck with everything Joanna, I truly hope you have a positive experience, as I did, second time around.

    If you ever want to talk please feel free to contact me.

  • thank you appreciate that

  • Hello ladies! Might I suggest checking with pdoc if you can switch to Seroquel (quetiapine). I took it during most of my pregnancy and for many months after giving birth whilst still breastfeeding. I had a bad reaction to olanzapine. Baby was and is now all good, almost 5 now. I would take Seroquel again if needed next time.

  • Hi there, I'm in much the same situation and have been stressing the past few weeks about the whole breastfeeding situation. I'm now 31 weeks pg with my second child. I suffered PP with my first daughter 4 yrs ago and although I was lucky enough to have home treatment with the Crisis mental health team, I would never want to risk repeating it, especially as it took 3 months to get a diagnosis. I know that there's a 50 per cent chance of recurrence, so I have decided to take the medication immediately after birth.

    I was on risperidone the first time round, so they recommended that this time too, as it works for me and I know what the side effects are (slight sedation). I asked if it was safe to breastfeed and was told that little is known about the risks of breastfeeding with antipsychotics, and that the type I need to take is a new medication so even less is known about it. Also, I found the whole breastfeeding experience stressful the first time round, I had some high feelings after breastfeeding but mainly paranoia, guilt and even feelings of rage about not being able to produce enough milk or my baby not latching on properly. I gave it up after 3 weeks and then felt incredible guilt, paranoia and self-doubt about not being a good mother and having to give up. As a result, my doctor has advised I don't breastfeed and just take the medication (a) because of the risks of the medication with breastfeeding and (b) because of the stress which breastfeeding caused me the first time round.

    But that said, he still left the choice in my hands, so I deliberated a lot about whether to have a longer stay in hospital without medication in order to breastfeed for a few days, then start the meds after that. But I have now come to the conclusion that would not work for a number of reasons: I would need a lot of support to breastfeed at all, it would be upsetting if I was unsuccessful and it could be difficult to stop it abruptly (it caused me considerable stress having to stop last time) and I don't want to risk worsening the illness by not taking the medication either or to be in a state of indecision about when to start the medication. I really think that making that decision in advance will relieve an incredible amount of pressure for me, and I'm even more convinced now I've read everything you have all said!

    Thanks everyone, this has really helped me work out what's best for me and has at least taken one tin off my mind...with any luck I will get more sleep tonight (sleep deprivation is becoming a bit of a problem these days...too many fears and anxieties about the birth, PP, coping etc!)

  • Good for you. Best of luck with your baby!! I have made the same decision as I said, no breastfeeding either and medication as soon as I give birth. Just to keep it simple and not risk stressing myself out with the struggle to breastfeed, and the emotions around it, plus the sole pressure of being the feeder.

    I will feel a bit guilty about not giving baby no 2 my milk, but it's not the end of the world. Plus I have fibromyalgia (a chronic pain disorder) on top, and extra pressure on my skin is incredibly painful so breastfeeding was especially painful.

    Good luck Cooke x

  • Hi Joanna, just to add to others comments about olanzapine and breastfeeding from my experience of PP in 2009. A lot of the things you talk about in your post really strike a chord with me. I too believe that difficulty feeding my baby myself, the associated weight loss from birth weight (and all the stress that brings, extra monitoring etc) was one of the triggers for my PP. I'm a bit hazy on timescales but I was only put on Olanzapine after something else didn't work and by then had had to switch to bottle feeding anyway. I was sectioned and separated from my baby, so my husband had to take on all caring for our baby (with his family helping) - which of course meant bottle feeding.

    I too had massive feelings of obligation and guilt about breastfeeding and firmly believed it was the right thing to do, with all family etc having done it no problem. There's such a push on it isn't there? Who knew it would be so difficult for me but I firmly believe it's not right for everyone. And where PP is concerned I think it all has to be balanced with the risks to both mother, baby and others if there's another way - bottle feeding.

    My little boy is happy and healthy and bottle feeding really hasn't harmed him. I know that when the nurses in hospital were advising my husband about formulas (I was in no fit state!), they talked about one in particular that seemed to be recommended, which was Aptamil. I have no idea whether it is "better" than any of the other brands out there to be honest, but it might be worth looking into. And this was a few years ago, so things could have changed.

    Anyway, hope all goes well with this pregnancy and it's good to hear you have made an informed decision that sounds to be right for you and your family. All the best with it all, and as others have said, if you'd like to keep us updated we'd love to hear how you get on.

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