History of psychosis: drug and other questions

I am almost due with my first child and I really want to breastfeed. I
have a couple of questions, and I hope some of you could answer some of
them.

I have a history of 'mental illness'. I have been hospitalized five
years ago, and absolutely hated that. I never want to have to go there
again. So far, I managed to keep out of hospital. Most of the time I
lead a pretty normal life, when I notice I lose my grip with reality and
I start to feel worse I go to the doctor's and get medication (Zyprexa
(Olanzapine), an anti-psychotic and/or Oxazepam, a sedative). I take the
medication for a couple of days or weeks, and things usually go better.
It probably does not sound ideal, but it works for me. During pregnancy
I have not taken any medication. Sometimes this was a little hard, but
I managed okay. I am a little afraid however that this is partly thanks
to the pregnancy hormones.

My questions a
- I read on Dr. Hale's forum on
http://neonatal.ama.ttuhsc.edu/discu...tml?1057862601
that he considers Zyprexa relatively safe. He also says the child gets
about 1.05% from what the mother gets. I still remember my first doses
of Zyprexa: they totally knocked me down, I really became a zombie. So
I am a little worried that 1% is still rather much (considering the
baby is about 3% of my weight). Could anybody (perhaps someone with
access to Hale's book) elaborate any further on this?
- Are there other anti-psychotics and/or sedatives that are perhaps
better studied and are considered safe for breastfeeding?
- I read in a book by Sheila Kitzinger that 'happiness' is also
transferred through mother's milk. Does that mean that I should not
breastfeed if I feel down/depressed/scared etc.? If the baby gets my
scared feelings, I'd probably better formula feed?
- As a follow-up on the previous question: would you recommend to pump a
stash in advance, so that if needed dad can give a bottle?
- (A bit unrelated) Do I have to be concerned about vitamins? I would
like to take extra vitamins because I do believe that makes me feel
better. I never take more than the dosage on the bottle, but sometimes
this is way more than the RDA (especially with water-soluble vitamines
like B&C. I know to be careful with fat soluble vitamins like A and D,
and do watch out that I do not get more than the RDA from them - or is
that still too much?).
- Any tips on coping with psychotic symptoms without medication are also
welcome, of course. I know about the 'make sure you get enough rest'
(but also excercise) and 'eat well', but if you have any more ideas,
please let me know.

I do realise these are a lot of questions, but I would be very grateful if
anyone would answer at least some of them. There is nobody around here that I
can ask these questions, most people refer me to my doctor, who thinks I have
the wrong priorities by worrying about breastfeeding.

Thanks in advance for any advice you might have!

almostmom wrote:

I am almost due with my first child and I really want to breastfeed.

Yay! I'm really glad to hear that. And I'm really happy for your baby.

I have a couple of questions, and I hope some of you could answer
some of them.

I'll do my best.

I have a history of 'mental illness'. ... Most of the time I lead a
pretty normal life, when I notice I lose my grip with reality ... I
take the medication ... probably does not sound ideal, but it works for me.

Does anyone lead an "ideal" life? On the contrary, I think you should
be proud of yourself. You take care of your health and take
responsibility for your well being.

During pregnancy I have not taken any medication. Sometimes this was
a little hard, but I managed okay. I am a little afraid however that
this is partly thanks to the pregnancy hormones.

It's certainly a reasonable hypothesis. The "Baby Blues" and worse
seem to be fairly common responses to postpartum life. Do you have a
good physician from before, for after the birth? An internist or
family physician or psychiatrist who can help you keep an eye on your
mental health and give you something that works for you and is safe for
your child if you become ill?

- I read on Dr. Hale's forum ...

I'm glad you know about Hale. Maybe you should get a copy for
yourself, to carry to your doctor's office.

- I read in a book by Sheila Kitzinger that 'happiness' is also
transferred through mother's milk. Does that mean that I should not
breastfeed if I feel down/depressed/scared etc.? If the baby gets my
scared feelings, I'd probably better formula feed?

Aack! Kitzinger really wrote that sentence wrong! Your body actually
"transfers" antibodies and vitamins and minerals and fats and
nutrition, etc, through (within) your milk. Your body doesn't transfer
happiness like a substance. After a breastfeeding session you do not
have 598 grams less happiness in your body and your baby has 598 grams
more! When you breasfeed, your baby becomes happy. S/he is happy to
be close to you, happy to be cuddled, happy to be loved, happy to feel
secure, to drink something extremely yummy, to be warm, comfortable and
to have a full tummy (among other things, I'm sure!) By breastfeeding
you don't TRANSFER happiness, you CREATE it.

So please breastfeed even if you get the baby blues or even postpartum
depression. Please breastfeed even if you stub your toe, even if your
great aunt says you gave the baby a terrible name, even if the orange
juice spills all over the fridge and you don't notice and everything is
sticky and gross and hard to clean when you find it 6 hours later.
Please breastfeed even there is a scary thunderstorm, or a scary
close-call car accident, or a scary movie. You won't transfer your
emotional state through your milk. Actually, if you are nervous,
frightened, or miserable, and you sit down and put your feet up and
cuddle your child close and nurse her/him, I would expect you'll not
only calm your child and help your child feel a lot better, but you
might even feel a little better yourself. (The thunder is really loud
but I can still take care of all of my little one's needs, dangit!)

- Do I have to be concerned about vitamins?

I'm still taking prenatal vitamins and my youngest child is 14 months
old. The label says it's good for "pregnant and lactating women", I
believe that I ought to take some sort of multivitamin, it has enough
folic acid (just in case!), so I just stuck with that. Easy peasy.
For me, anyway.

- Any tips on coping with psychotic symptoms without medication are also
welcome, of course. I know about the 'make sure you get enough rest'
(but also excercise) and 'eat well', but if you have any more ideas,
please let me know.

Ummm, stay away from toxic, nasty people? Rest, exercise and a good
diet sound like excellent ideas, I don't have any other ideas.

... my doctor, who thinks I have
the wrong priorities by worrying about breastfeeding.

Oh, now I have advice: get a doctor who understands the importance of
breastfeeding!

Good luck with everything, almostmom. You sound to me like you are
going to be an excellent, responsible, careful mother.

---
--- Vicki in Indiana

Married my dear husband Joshua on May 21, 1995.
Ima shel ds, born 11/16/99 and breastfed for 22 months;
and Ima shel dd, still nursing. Born at home, 05/19/02.
http://www.geocities.com/vyxter/
An ounce of mother is worth a pound of clergy. -Spanish proverb
Baby names I like: Theodore, Corinne, Lionel, Adele, Timothy, Amelia,
Chloe, Orlando.

Okay, the section below needs to go into the preface of a book about
breastfeeding. Or maybe on every nursing mom's fridge. It brought tears
to my eyes, it's so true.

-Shannon

"Vicki S" wrote in message
. edu...
Your body doesn't transfer
happiness like a substance. After a breastfeeding session you do not
have 598 grams less happiness in your body and your baby has 598 grams
more! When you breasfeed, your baby becomes happy. S/he is happy to
be close to you, happy to be cuddled, happy to be loved, happy to feel
secure, to drink something extremely yummy, to be warm, comfortable and
to have a full tummy (among other things, I'm sure!) By breastfeeding
you don't TRANSFER happiness, you CREATE it.

So please breastfeed even if you get the baby blues or even postpartum
depression. Please breastfeed even if you stub your toe, even if your
great aunt says you gave the baby a terrible name, even if the orange
juice spills all over the fridge and you don't notice and everything is
sticky and gross and hard to clean when you find it 6 hours later.
Please breastfeed even there is a scary thunderstorm, or a scary
close-call car accident, or a scary movie. You won't transfer your
emotional state through your milk. Actually, if you are nervous,
frightened, or miserable, and you sit down and put your feet up and
cuddle your child close and nurse her/him, I would expect you'll not
only calm your child and help your child feel a lot better, but you
might even feel a little better yourself. (The thunder is really loud
but I can still take care of all of my little one's needs, dangit!)

Vicki S" wrote in message
.edu...
Your body doesn't transfer
happiness like a substance. After a breastfeeding session you do not
have 598 grams less happiness in your body and your baby has 598 grams
more! When you breasfeed, your baby becomes happy. S/he is happy to
be close to you, happy to be cuddled, happy to be loved, happy to feel
secure, to drink something extremely yummy, to be warm, comfortable and
to have a full tummy (among other things, I'm sure!) By breastfeeding
you don't TRANSFER happiness, you CREATE it.

So please breastfeed even if you get the baby blues or even postpartum
depression. Please breastfeed even if you stub your toe, even if your
great aunt says you gave the baby a terrible name, even if the orange
juice spills all over the fridge and you don't notice and everything is
sticky and gross and hard to clean when you find it 6 hours later.
Please breastfeed even there is a scary thunderstorm, or a scary
close-call car accident, or a scary movie. You won't transfer your
emotional state through your milk. Actually, if you are nervous,
frightened, or miserable, and you sit down and put your feet up and
cuddle your child close and nurse her/him, I would expect you'll not
only calm your child and help your child feel a lot better, but you
might even feel a little better yourself. (The thunder is really loud
but I can still take care of all of my little one's needs, dangit!)

That is truly beautiful, it sums up exactly how I feel and what I was trying to
express.
Karen Ann
Mommy to:
Ashley 11-13-90
Meghan 3-10-97
Hayley "Chunky Monkey" 3-27-03

I think some of the advice you have been given is a little glib. If you
have a history of psychosis, you need to be very vigilant and make sure
that you are under the care of a psychatrist both now and after the baby
is born. You simply cannot rely on yourself to tell you when you are
getting seriously ill. That's the insidious nature of mental illness. It
will delude you into thinking you are "fine" when in reality you might
be putting yourself and your child in danger.

The first weeks of motherhood are incredibly stressful (and rewarding)
for most women. You need to make sure that you have adequate support
post partum. Are you married or involved with the baby's father? Can
your mom or other realtive come and stay with you for the first few
weeks. You do not want to be in a situation where you have no support.
You need someone to help you out and provide a "reality check"

I would buy a copy of Hales from amazon so that you have a ready
reference if you need medication. (It's less than the cost of a week of
formula) It's not what you want to hear, but breastfeeding needs to be
lower on your priority list than other aspects of your health. Your
child needs a mother who is as mentally fit as she can be. It's better
to be formula fed by a mom who has a grip on reality than breastfed by a
mother who is in post partum psychosis.

Best wishes to you, you sound like someone who has done a lot of
thinking about what will be best for your baby. please let us know how
things work out.


Marion Baumgarten

Vicki S wrote:
I have a couple of questions, and I hope some of you could answer
some of them.

I'll do my best.

Thanks! Also for the other quick responses. It is really helpful.

During pregnancy I have not taken any medication. Sometimes this was
a little hard, but I managed okay. I am a little afraid however that
this is partly thanks to the pregnancy hormones.

It's certainly a reasonable hypothesis. The "Baby Blues" and worse
seem to be fairly common responses to postpartum life. Do you have a
good physician from before, for after the birth? An internist or
family physician or psychiatrist who can help you keep an eye on your
mental health and give you something that works for you and is safe for
your child if you become ill?

Yes, I have a good doctor, but she is extremely cautious, and really
'medical-minded'. Usually that works great for me, but now with my
pregancy I feel that she worries too much about me, and too little
about the baby.

- I read on Dr. Hale's forum ...

I'm glad you know about Hale. Maybe you should get a copy for
yourself, to carry to your doctor's office.

I found someone that I should be able to borrow it from. I am
interested in the material anyways, so I think I will get my own copy
too.

- I read in a book by Sheila Kitzinger that 'happiness' is also
transferred through mother's milk. Does that mean that I should not
breastfeed if I feel down/depressed/scared etc.? If the baby gets my
scared feelings, I'd probably better formula feed?

Aack! Kitzinger really wrote that sentence wrong! Your body actually
"transfers" antibodies and vitamins and minerals and fats and
nutrition, etc, through (within) your milk. Your body doesn't transfer
happiness like a substance. After a breastfeeding session you do not
have 598 grams less happiness in your body and your baby has 598 grams
more!

That is very beautifully put. And thank god it does not work that
way, I would hate to see my baby as some sort of happiness-sucker. But
I got the impression that the hormones of 'positive feelings' do get
in the milk, so I worried about the hormones of negative feelings.

When you breasfeed, your baby becomes happy. S/he is happy to
be close to you, happy to be cuddled, happy to be loved, happy to feel
secure, to drink something extremely yummy, to be warm, comfortable and
to have a full tummy (among other things, I'm sure!) By breastfeeding
you don't TRANSFER happiness, you CREATE it.

Though that sounds really nice too. And I also thought that the WHO
recommends breastfeeding for people in awful situations (3rd world
countries/war situations etc.), and I imagine those people feel way
worse than I do.

So please breastfeed even if you get the baby blues or even postpartum
depression. Please breastfeed even if you stub your toe, even if your
great aunt says you gave the baby a terrible name, even if the orange
juice spills all over the fridge and you don't notice and everything is
sticky and gross and hard to clean when you find it 6 hours later.
Please breastfeed even there is a scary thunderstorm, or a scary
close-call car accident, or a scary movie. You won't transfer your
emotional state through your milk.

Though I must admit that the states of mind I was thinking about are a
little worse than those.

Actually, if you are nervous, frightened, or miserable, and you sit
down and put your feet up and cuddle your child close and nurse
her/him, I would expect you'll not only calm your child and help
your child feel a lot better, but you might even feel a little
better yourself.

I think/hope so too. There is an egoistic part in my reasons for
wanting to breastfeed.

(The thunder is really loud but I can still take care of all of my
little one's needs, dangit!)

And the counterpart is that I think it would make me feel more
terrible if I felt really down and on top of all that I could not even
breastfeed my child.

- Do I have to be concerned about vitamins?

I'm still taking prenatal vitamins and my youngest child is 14 months
old. The label says it's good for "pregnant and lactating women", I
believe that I ought to take some sort of multivitamin, it has enough
folic acid (just in case!), so I just stuck with that. Easy peasy.
For me, anyway.

Thanks, I also thought that if it would be a problem I would have
heard about it more, but you never know.

- Any tips on coping with psychotic symptoms without medication are also
welcome, of course. I know about the 'make sure you get enough rest'
(but also excercise) and 'eat well', but if you have any more ideas,
please let me know.

Ummm, stay away from toxic, nasty people?

That is excellent advice

... my doctor, who thinks I have
the wrong priorities by worrying about breastfeeding.

Oh, now I have advice: get a doctor who understands the importance of
breastfeeding!

That's not so easy around here, especially since I was so happy to
find a female doctor, and since doctor's who really support
breastfeeding are scarce. She is not 'against' breastfeeding, she is
just the kind of doctor that does not know much about it. Like so many
doctor's that had their education 20 years ago, I am afraid.

Good luck with everything, almostmom. You sound to me like you are
going to be an excellent, responsible, careful mother.

That is so sweet of you to say, thank you!

almostmom wrote:

Marion Baumgarten wrote:
I think some of the advice you have been given is a little glib. If you
have a history of psychosis, you need to be very vigilant and make sure
that you are under the care of a psychatrist both now and after the baby
is born. You simply cannot rely on yourself to tell you when you are
getting seriously ill. That's the insidious nature of mental illness. It
will delude you into thinking you are "fine" when in reality you might
be putting yourself and your child in danger.

Thanks for your concern. However, I think it is not quite as bad as
you describe. As I said, in the past five years I have come to know
myself, and the symptoms that lead to psychosis. I *have* been able to
tell when I was getting ill, and the medication I got worked
wonderfully. I do understand that a lot of people do not have that
luxury, unfortunately I know quite a lot of them. But for me it works
and I actually got more ill in the hospital (this is one of the
reasons I do not want to go there ever again.)


Good- just remember that things might be different those first few weeks
postpartum. I didn't mean to sound harsh- but I feft that the other
posters were saying all you had to do was sit down and put your feet up
and rest. It's not that simple.

I have never been on welfare for the last five years, I have always
been able to support myself. I do not say this because I am proud of
that, but to backup my claim that I think it is not as bad as you
describe. I think most of my collegues never noticed anything 'weird'
about me, and I do not call in sick more than other people.

Good Lord, I did not mean to imply that. I think people who have
overcome mental illness are some of the strongest people I know. I won't
go into my history because I don't want to violate the confidence of
some of my family members, but the sheer energy and will I have seen
puts any marathon runner to shame. You should be proud of yourself.


I think that my experience with psychosis gives me an advantage over
all those woman who all of a sudden develop a PPD or PPP, and do not
know what is happening to them. I think that is more dangerous.

You're probably right about that. On a simple practical note, I found
that some planning ahead was a great stress relleiver. Meals made ahead
and put in the freezer. If you have the money, this is the time to hire
a housecleaning service, etc.

Marion Baumgarten

Shannon wrote:
breastfeed if I feel down/depressed/scared etc.? If the baby gets my
scared feelings, I'd probably better formula feed?

AAAAAAaaaaaaaahhhhh! If depression and happiness were both transferred
through breast milk, what a state the world would be in!

You do have a point there.

Although the baby may react to your moods, this is because you ACT happy or
depressed, not because your milk is any different. And, considering the
long-term (bad) side effects of formula, the baby is waaaaay better off being
breastfed.

One of the reasons that I want to breastfeed is that my sister, who was
completely formula fed, had all kind of allergies and asthma, while I
(breastfed until six months) do not suffer from any allergies at all. I know
that it might not have to do anything with breastfeeding, but I want to do at
least all that I can to prevent the allergies. I remember how hard it was for
my parents to have a child that was sick and had to go to the hospital so
often, and I remember how awful it was to see her so small, and so very sick so
often.

- As a follow-up on the previous question: would you recommend to pump a
stash in advance, so that if needed dad can give a bottle?

Don't pump for the first month, at least. Spend that time getting used to
the baby. If you have to look for a pump, an Avent Isis, Medela Lactina or
Medela Pump in Style seem to be the most popular.

Thanks. I think I will buy a pump in advance then, but not use it until
necessary.

- Any tips on coping with psychotic symptoms without medication are also
welcome, of course. I know about the 'make sure you get enough rest'
(but also excercise) and 'eat well', but if you have any more ideas,
please let me know.

Can't help much there, except let everyone in your medical care and family
team know your history. Keep in close touch with them postpartum. The
hormone swing can cause all sorts of things that are very easily dealt with
if caught early on.

My doctor and husband know about it, of course. But I am a little afraid to
give too much attention to it and that they will 'over act'. I am really afraid
that they will take my baby away from me at the first sign of baby blues, and I
want to prevent that with all means possible. I know it may sound like a
stretch, or even delusional, but I have seen it happen with people I know, and
after that I have read about it, and it scares me more than anything else.
(Please note that I have a very supportive and caring husband, it is not that
the baby would be neglected or worse if I do get the 'baby blues')

I do realise these are a lot of questions, but I would be very grateful if
anyone would answer at least some of them. There is nobody around here
that I
can ask these questions, most people refer me to my doctor, who thinks I
have
the wrong priorities by worrying about breastfeeding.

That's a hard one. Clearly, if you are unable to care for your baby because
of treatable mental illness, then you MUST care for yourself first. That
said, breastfeeding is very important to your baby's health, so if you can
treat your symptoms with something BF friendly, than its a win-win.

So that is why I came here

If you must take a non BF friendly med, well, it's for people like you that
formula was invented for after all. Wait - that sounded flip - it means
that if that's really the case, your child will not starve, and will lead a
very healthy life thanks to modern technology.

I do find it comforting that formula is available and at least better than 20
years ago, but at the same time I do hope that I do not need to use it.

Thanks for your advice!

iphigenia wrote:
I really can't add anything to the wonderful posts by Vicki and Marion, but
I'll look up Zyprexa for you:

Thanks!

It's an L3 (which really isn't too bad, a lot of antibiotics and painkillers
routinely given to nursing women are L3s, though those are generally for
acute rather than chronic use).

That is not too bad, for me anti-psychotics are sort of painkillers. If things
get really bad, they help get grip on reality again. I am thankfully not one of
those people that immediately 'loses it' when they quit their meds. My rather
stable home environment helps a lot with that of course.

The alternative Hale lists is Haldol, which is an L2, possibly because it
appears to have been more broadly studied WRT transfer to milk. However, the
relative infant doses of Haldol are estimated at 0.2-2.1% to 9.6% of the
weight-adjusted maternal dose.

9.6% sounds like an awful lot to me, but it is good to know that even an
extremely strong drug like haldol is relatively safe for breastfeeding.

Do you (or anyone else of course) know if it would help if I take the
medication immediately after a feeding and then pump and dump the next one? Is
anything known about the 'half time' of these drugs or of drugs in general?

Marion Baumgarten wrote:
Thanks for your concern. However, I think it is not quite as bad as
you describe. As I said, in the past five years I have come to know
myself, and the symptoms that lead to psychosis. I *have* been able to
tell when I was getting ill, and the medication I got worked
wonderfully. I do understand that a lot of people do not have that
luxury, unfortunately I know quite a lot of them. But for me it works
and I actually got more ill in the hospital (this is one of the
reasons I do not want to go there ever again.)

Good- just remember that things might be different those first few weeks
postpartum.

I know. That is why I started to research things a bit.

I didn't mean to sound harsh- but I feft that the other
posters were saying all you had to do was sit down and put your feet up
and rest. It's not that simple.

I do appreciate your concern, and I agree that unfortunately it may not be that
simple. However, I also think my particular situation is not quite as bad as
you seemed to think.

I have never been on welfare for the last five years, I have always
been able to support myself. I do not say this because I am proud of
that, but to backup my claim that I think it is not as bad as you
describe. I think most of my collegues never noticed anything 'weird'
about me, and I do not call in sick more than other people.

Good Lord, I did not mean to imply that.

Well, you didn't. I just get defensive very easily I think.
My doctor suggested an abortion on my first visit. When I made clear that I did
not want that, she wanted to have me in the hospital soon, just in case.
So while I do realise the risks of me getting a PPP, I also feel like I should
defend myself with regards to this mental illness thing. Proof that I can
handle it.

I think people who have overcome mental illness are some of the strongest
people I know. I won't go into my history because I don't want to violate
the confidence of some of my family members, but the sheer energy and will I
have seen puts any marathon runner to shame. You should be proud of
yourself.

Thank you. I wasn't fishing for compliments, honest.

I think that my experience with psychosis gives me an advantage over
all those woman who all of a sudden develop a PPD or PPP, and do not
know what is happening to them. I think that is more dangerous.

You're probably right about that. On a simple practical note, I found
that some planning ahead was a great stress relleiver. Meals made ahead
and put in the freezer. If you have the money, this is the time to hire
a housecleaning service, etc.

That is a good idea. I am really glad that my husband will be there the first
month, that gives some relieve already, but I agree that those practical things
are often a great help. I wish health insurance would cover them, it costs way
less than medication and hospitalization

Sorry that this got a little off topic.