Postpartum psychosis

[ellymouse]

Hello, i was diagnosed with psychosis two years ago and depression when i was 15. I was referred to a specialist unit and started on respiradone to which i had no response. the only antipsychotic i found worked for me was seroquel but i took myself off it when i found out i was pregnant. i hadn't really done any research on seroquel up until that point, it worked thats all i needed to know. but when i found out i was pregnant i started trawling the internet (much to my psychs annoyance!) and was really disturbed by the stuff on seroquel plus the fact it knocks you out and i mean it knocks you out which is no good with a baby to get up for. so i tried no meds but that didnt work (but i was under a lot of stress at that time) and i got really sick again so they put me on sulpiride. its not as good as seroquel but it levels me out and gets rid of most of my symptoms.
my psych asked me if i wanted to breast feed and i said yes, he's recommended i dont and that they really up the dose postpartum as he says i'm really high risk to relapse. i was really shocked and said that i felt quite strongly that i wanted to bf and would come off meds if neccesary and he said if his wife was pregnant and had my history he would bottle feed and dramatically up the dose.
sulpiride is considered low risk by hale but my psych says he wont recommend it and now i feel really low as i've always wanted to bf my children. also i think he's worried i'll sue him if there are abnormalities.
so does anyone have any experience/ advice on postpartum psychosis, sulpiride, safe antipsychotics to bf on or relapse of psychosis? anything at all that anyone knows or just advice would be so helpful, feel i cant talk to psych cuz he's bein so black and white on this one.
sorry this is so long too!

You need tiktok. My belief is that if you are on those meds now, they will pass through the placenta to your baby anyway, so advising that you don't bf is besides the point.

Your breastmilk does not go via your bloodstream so therefore it is less likely to be contaminated.

You sound as though you have been treated harshly and without respect. I'm very sorry about that. I recommend you insist on a second opinion. I was refused hayfever meds whilst pregnant by arsey chemists and doctors who thought they knew best whilst I was struggling for breath because the allergy was blocking my airways. I did my own research and discovered that the only reason they didn't want me to take the meds is because it might make the baby sleepy and they didn't want me to go into labour with a sleepy baby. Ideally you don't want to take any meds whilst pregnant but you have to consider the risks. Keeping you safe is ultimately keeping your baby safe.

Hopefully someone else will come along with some good advice for you.

sulpiride sounds pretty dodgy if wiki is anything to go by. Can they not change your meds to a more bf friendly one once the baby is born?

Hi Elly, I was on olanzapine for a while after I had my DD, but this was after I stopped breastfeeding so not sure if it's ok or not.
I was told if I ever was to have another baby they would "monitor me very closely" and give me drugs whilst I was still pregnant to try and prevent relapse.
I completely disagree with this, and there is no way I will be taking psychotropic medication in pregnancy, and I have every intention of BF next time, as my problems last time affected the bonding process with my DD.
I believe it is your right to BF if you so wish and no health professional should say "no you can't". I intend to resist medication if I can.
My only fear is if they section me and medicate against my will.
I hope you find an answer x

i asked my psych about bf friendly meds and he wouldnt tell me anything as he said the manufacturers dont recommend it, when i asked why he said there just weren't enough pregnant women with psychosis to make it worth they're while and they dont want to be sued. so i asked his personal opinion on the safest and he said he couldnt tell me in case i sued him!
I DONT WANT TO SUE ANYONE! its true!
so i bought hales mothers milk, bfing on meds with my own money but am finding it hard to navigate as i dont have a degree in chemistry! i just want advice but no one profesional will give it me me, its so frustrating!

You are within your rights to refuse treatment. If they do talk about sectioning you here's a guide to the Mental Health Act.

Many GPs are unnecessarily aggressive because they think they are right all the time and the more vulnerable you feel, the more they push you to do what they want.

Insist on a lower strength medication whilst bfing. You can only try, if you start to get ill again you can always go back to your meds and stop bfing. However you must put yourself first. If by insisting on bfing you are incapable of taking care of yourself and the baby you have to ask yourself what is more important? Your baby is not likely to turn around in 20 years time and blame the lack of breastmilk for all the shortcomings in their lives.

Bfing is lovely, but if your health suffers then you must quit. There are more important aspects of being a mum.

Definitely get a second opinion because you should be offered alternatives to allow you to breastfeed.

Ah now this is when I love the internet, because information on how these meds affect your breastmilk are freely available.

It really bloody irks me when GPs refuse to give a patient the information they need to make an informed choice.

breastfeeding and psyhchiatric drugs
Drug safety during breastfeeding

Hope this helps!

thanks rhubarb! just found a site that says conventional antipsychotics are considered safer then the a-typicals so will have to ask about them too.
i know if i get even the slightest bit ill i'll have to stop and really up the dose quickly at the first symptoms so i dont get to the point where i cant look after my baby, just want to try bf for as long as possible.
he's not a gp, he's a trained psychiatrist specialising in early intervention psychosis so you'd think if anyone could give me advice it'd be him! you should be able to sign a waver saying you wont sue so they can tell you what they know!

You have the right to information that allows you to make an informed choice regarding your own health and that of your child. I think it is disrespectful of him to deny you that and totally out of order.

thanks, the thing about sulpiride and the seroquel i was on are a combibefore is that they work as a combined antipsychotic and anti-d so not sure if a antipsychotic without the anti-d would help as respiradone had no effect on me, guess i'll just have to ask psych again. its so difficult to know what to do.

ellymouse.. you need some good support from the mental health team right now. Yes you do have a higher risk of PND or postpartum psychosis because of your history but that DOES NOT mean that you HAVE to take drugs that you are not happy with. Take a look at here and do some proper research of your own including talking to people over the telephone... print out as much relevant info as you can and make an appointment to see your Psych Dr.

Do you have a cpn? Now is the time to be formulating a care plan for following the birth... You need to make informed decisions about your care and be properly supported to do so.

Remember Drs are usually badly informed about BF.. I was when a Consultant Psychiatrist last week said to a breastfeeding mother that breasmilk was overrated... The air was blue in the office afterwards..

Dont be fobbed off.

Ellymouse I know next to nothing about these things, but two questions come to mind:

Will the strong meds work quickly if you need to start taking them?

and

if you relapse will you see sense and stop bf and take those drugs knowing that on balance that's probably best for baby (or do you lose that kind of insight when you are really ill)?

if the answers are yes they work quickly and yes I will take them then it would be worth giving it a try surely?

I wish you all the best and a total absence of bf ignorant doctors

thing with all drugs is they cannot ethically test them on pregnant women so they cannot be labelled as safe.

I have to be honest and tell you how breastfeeding made me feel. It may be totally different for you, but you should be aware anyway...

My mental health is fine when not pregnant/breastfeeding. When I was breastfeeding, the hormones produced caused me to feel a lot of anxiety. This lifted immediately as I stopped breastfeeding (when baby was 12months). My mum also had PND after I was born. When she stopped breastfeeding me when I was 9m, the PND went away extremely quickly.

Is your doctor trying to tell you that breastfeeding can be quite powerful in causing/agravating mental health problems? Because if he/she is, it can be true in many cases. It isn't true in all cases, it is just some peole react to the hormones like this.

Do you have a local LLL group. In one of their recent magazine (breastfeeding matters) editions there was an article by a mother who had suffered psychosis prior to being pregnant, then post partum psychosis but with her 2nd child she dealt with it differently and was okay (iirc).
Might be worth a read? HTH

ellymouse- do you have a specialist perinatal mental health team in your trust? Perhaps your psychiatrist/mental health worker could refer you on? They can be very helpful with medication/pregnancy/breastfeeding issues and can advise you and your team about how best to support you. I am a (generic) mental health worker and have had several clients who successfully breastfed while on antipsychotics- a low dose of haloperidol worked very well for one woman. The chance of a relapse postpartum for people who've had psychotic episodes IS unfortunately quite high, so it does make sense to get some specialist advice and put a good care plan with lots of support in place. Good luck.

I really feel for you OP
I believe breastfeeding is such a big part of being a mother.
I also believe breastfeeding and attachment parenting, staying close and in sync with baby prevents postnatal depression, just my own personal view.
Your doctor makes up only one person's opinion, he may no0t understand how important BF is to such a maternal woman.
It's your decision, they can't make you take meds unless you're sectionable.
I dislike it being assumed that a woman will have a breakdown because of birth, some women do after every child, doesn't mean you're one of them.
If it was me, I would tell him that I'm going to give breastfeeding a try, and you can watch me as close as you want, if he can't be supportive with that can't you get another doctor who will respect your decision?
Also I think any drug youre taking would have to be a god aweful one to make breastfeeding less safe than bottlefeeding,. bottlefeeding increases leukimia and sudden infant death syndrome rates amongst a never ending list of other things.

in response to woodyandbuzz

I feel i must add that from the people i've spoken to PND has kicked in for them when they stopped breastfeeding, as breastfeeding can give a wonderful calming 'in love' feeling to mother and child.

But everyone's different..

newtohere1, as someone who has suffered with ante-natal depression - including thinking at one point that my baby was a demon that I had to cut out of my stomach - I would say that if she is in danger of relapsing then she should bottlefeed.

It's the best of solutions, but what would you rather have, a mother who is a danger to herself and her child or a bottle fed baby?

Some mothers cannot breastfeed for a variety of reasons, it's just one of those things and I don't think that going on about infant death syndrome and leukemia is fair or accurate. The majority of bottlefed babies grow up to be happy and healthy.

This is a difficult decision for the OP but I would urge her to remember that her own health is just as important. You need to be mentally sound and healthy in order to deal with a newborn, because if there is one thing bound to bring on anxiety it is caring for a newborn. I'll admit to getting very angry with mine in the middle of the night when they are crying for no good reason and you've only had 2 hours sleep in 2 days.

Go ahead and try to find a balance, but I would not recommend that you just come off your meds so you can breastfeed. I'm no expert but you sound pretty bad without them, so try to find a middle ground and if that doesn't work, please don't put your health at risk by stopping treatment. You can take consolation in the fact that you made an informed choice and that you did your best.

Ellymouse I am a great fan of breastfeeding - have done it against the odds with ds in NICU etc for 11 months - but I think newtohere's post was very unhelpful.

Fact remains that millions of people the world over grew up perfectly fine on formula milk and there is ever such a lot more to caring for and bonding with your child than breastfeeding. If you fall really ill please bottlefeed knowing that in the circumstances you do what is best for your baby!

PND is a bit different from postpartum psychosis, though, newtohere. Not necessarily any less serious (though it often is) but different. The risks/benefits of ceasing to take medication during pregnancy and breastfeeding are likely to be very different for a moderate depressive illness, for example, than for a moderate psychotic one, though the divide isn't always neat and straightforward, of course.

Whatever you decide re taking/not taking meds, please, please get a good care plan in place elly, especially if you have ever been treated in hospital. You might want your crisis plan to explicitly state that you would prefer intensive support in the community from a home treatment team but in the event of a relapse requiring inpatient treatment you want to be offered a place in a mother and baby unit, for example. Or that you want your partner/mum/friend to look after the baby for you. Or whatever it is that you would like in that eventuality. I really hope everything will be fine and lots and lots of women with your illness history don't relapse but I think it does not hurt to think what you want to happen in a worst case scenario.

I think rhubarb's post is very good.

I never got angry with my child for waking up, because when he woke up in the night i just had to lift my top and fall back asleep :-)
thankgod i could breastfeed, it meant being able to sleep which is extremely important at such a time, i only sat up in bed at night to change his bottom.
If you can sort out sleeping arrangments so co-sleeping is safe AND you can breastfeed, that's a great way to get a good night's sleep from day one, it's certainly my way trying to avoid getting postnatal depression.

My mother spent 6 months on a psychiatric ward after all 3 children and always tells me 'make sure you keep breastfeeding' as she's convinced she got very ill as soon as she had to stop BF her first, after that they just drugged her up (saying she couldn't breastfeed) as a precaution.

She fully supports how I am with newborns because she;'s made the association with lack of sleep and not BF too.

That's just my story though that I want to share to try and help others, i'm not here to argue.
I was bottlefed and am perfectly healthy (apart from suffering childhood ashma and eczema which is now said to be related).

willsurvivethis

I agree you do the best you can for your baby, you look at what you CAN do, and you do the best.
I try not to judge others because I don't know their story.