Puerperal Psychosis & related illnesses

Treatment of Puerperal Psychosis with drugs

Treatment of puerperal psychosis with drugs is very effective. The drugs prescribed are able to stop voices and to counteract false beliefs, but they need to be taken regularly and at the doses your doctor or consultant prescribes.

Drugs are only part of the normal treatment for women with this condition: there is also plenty of support available both at home and in surgery. Women with puerperal psychosis are not prescribed drugs and left on their own.

What are the drugs?

The most commonly prescribed drugs to treat psychotic conditions are shown below. One thing to bear in mind is that whilst these drugs are used to treat puerperal psychosis, they are also used to treat other conditions: schizophrenia and bipolar disorder. Puerperal psychosis shares similar symptoms with schizophrenia, but they are not the same condition.

The first name is the brand name, the second name is the drug name. So if you've been prescribed, say, Abilify, you're getting the drug aripiprazole.

All the drugs listed, with the exception of haloperidol are classed as atypical antipsychotics. They're called this because they don't act in the same way or have the same side effects as typical antipsychotics, like haloperidol.

Which drug is right for me?

This is really a question for your doctor, who will prescribe the medication he thinks best. But, as in any condition, if you find you're having unpleasant side effects with one, discuss it with your GP or consultant and they will probably try you on something else, adjust the dosage or prescribe something additional to counteract the side effects.

Sometimes it just takes time to find the right drug for the right person. It's best to go with the opinions of the professionals in these (and most) circumstances.

How do they work?

Atypical antipsychotics

This depends on the drug. Unlike antidepressants, the atypical antipsychotic drugs act in different ways, but at its most simplistic level, they reduce the activity of your brain where it has been heightened. The atypical drugs most frequently prevent a neurotransmitter (a chemical released by your brain) from working by blocking its action. The neurotransmitters are generally serotonin and dopamine.

Different drugs have a different selectivity, which is why it can take time to find the right drug. Amisulpride, for example, is very effective at blocking dopamine activity where needed, whereas Quitiapine is better at blocking serotonin activity.

Why block serotonin? I thought it was the happy hormone!

This is true. Indeed, antidepressant drugs typically act to increase the activity of serotonin. However, serotonin particularly is well associated with hallucinations. The drug made famous by the Beatles, LSD, mimicks serotonin in certain areas of the brain, and that has extremely well documented hallucinogenic effects. Therefore by blocking serotonin at these points, drugs can control hallucinations.

Why block dopamine?

Drugs like amphetamines, which act to increase the levels of dopamine in the brain, can cause hallucinations. Thus by taking a drug that reduces the activity of dopamine, hallucinations caused by too high a level of it can be controlled.

Typical antipsychotics

Drugs like haloperidol are called "typical antipsychotics" because they've been used to treat these conditions for well over 30 years, thus they share certain characteristics.

Haloperidol, like some atypical drugs, blocks dopamine action, but much less specifically. In some patients, this can achieve the desired effects, but because the drug is less specific, the side effects can be more pronounced.

How long do they take to work?

Generally speaking some time is needed before the full effects of these drugs can be enjoyed, the full effects being control of the psychosis. Some drugs, like amisulpride, appear to act much faster than drugs like aripiprazole, which can take up to two weeks to take full effect. Your pharmacist or GP will be able to give you more detailed information, but the important thing is to bear with the drug while it starts to work.

If you've been taking these drugs and feel they're not helping, be honest and tell your GP or consultant. That's what happened in my case, and the resolution was a different prescription which worked much better.

How long do I have to take them for?

This depends entirely on the patient. I was told the text book said one year, but I was also told at that point that text books err on the side of caution. It's very important, though, that you do not stop taking the drugs just because you feel better. By stopping suddenly, you can experience a withdrawal and possible a slip back into the original condition, which isn't good for anyone.

If you feel you've been taking drugs long enough, discuss it with your GP or consultant, and they can decide with you the best way forward.

Are they addictive?

No, they are not, but some patients can experience a withdrawal so GPs and consultants generally prefer to wean you off the drugs to avoid this, and to ensure that your original symptoms don't come back.

What are the side effects?

If you read the leaflet, it can be frightening, so if you have any concerns over side effects or if you're experiencing them, tell your GP.

The most common side effects are sleepiness, insomnia and feeling less alert. Some drugs can cause excess salivation - you may dribble a little and some muscle trembling, typically around the face. It must be said, though, that these effects are less unpleasant than the original symptoms, and can pass with a little time.