Dr Louise Newson: [01:00:00] So this podcast is actually quite harrowing to listen to. I've got Jade with me who talks about her own journey of having postnatal psychosis and how she was given drugs but no hormones and how actually she's feeling better with hormone treatments. It's important that we think about the association of mental health and hormones postnatally and so many of these women are being denied or have even not thought about hormones. So it's a really important conversation, not just for you to listen to, but to share with others as well. So Jade, I've been very excited about this podcast for a while, and actually it's good timing because today in Closer magazine, there's an article about the Clancy case and postnatal psychosis, and I'm quoted throughout because, as you know, I get very sad thinking about all these women with postnatal mental health disorders. And no one's addressing the hormonal imbalance because there's a massive decline of hormones when we give birth. And for some women, they're more sensitive to this decline affecting their mental health very adversely. In the UK alone, there's 850,000 women with postnatal depression. Postnatal psychosis, a lot of people say it's 'only', in inverted commas, about one in 500 women, but they're the people that are being diagnosed. I speak to so many women who have never told their doctors because they don't want their babies taken away from them. So I'm just really grateful that you've come. This is going to be an emotional podcast and I don't actually apologise for it because it needs to be spoken about. So just tell me a bit about you if that's okay? [01:01:34][94.7]
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Jade Lloyd: [01:01:35] Of course. Where would you like me to start?  [01:01:37][2.2]
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Dr Louise Newson: [01:01:38] What happened?  [01:01:38][0.1]
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Jade Lloyd: [01:01:39] So I had my daughter in December 2020, and it was a three-day labour. So now I know it was a traumatic delivery. So I was induced and then it ended up in a forcep and ventuse delivery. So I immediately entered like motherhood, sleep deprived and just that immense feeling of guilt and failure. And I did feel really emotional. I kept crying when I was still in the hospital and I think it was just...  [01:02:14][34.7]
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Dr Louise Newson: [01:02:14] Well, you had lots of emotions going on.  [01:02:16][1.6]
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Jade Lloyd: [01:02:15] Yeah, yeah, it's just it's processing it but the midwives came to see me and checked that I was okay. And that did continue when I got home, but then it started to improve. And I was, I think it was just the being in the newborn bubble and it was COVID. So we weren't even allowed to go out. So no visitors were coming. So I think I just felt quite safe.  [01:02:40][24.5]
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Dr Louise Newson: [01:02:40] How old were you then?  [01:02:41][0.7]
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Jade Lloyd: [01:02:41] I was 26, nearly 27. And it was when my husband went back to work, I think that's when my mental health really started to decline. So I'd suffered with anxiety prior to having Penelope, but I'd really kind of got on top of that. And then when I had my six-week check, I went to the doctors and I told them, like it took everything in me to say, I feel really anxious. I don't feel okay. And I remember she was like, oh, why is that? And I was like well, I don't know, I was hoping you'd be able to help me. And I asked if there was anyone I could talk to and she just, she didn't even look at me. She just said, oh that's one for your health visitor. She was typing on her computer.  [01:03:32][50.7]
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Dr Louise Newson: [01:03:32] Really? Did she offer you any treatment or nothing?  [01:03:35][2.6]
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Jade Lloyd: [01:03:34] No, just told me to speak to my health visitor and mum was waiting for me in the car and I remember coming out and just saying, like, I just feel like I've been fobbed off. But my nature, I'm better at it now, but my nature before was to don't make a fuss. But I did speak to my health visitor, and I asked if there was anyone that I could speak to, so, you know, like a counselling service or something. But she told me that the NHS was really stretched and that I should seek, like, if I can afford private to go private. But the thing is, I don't, the difficult thing was, was that I didn't know what was going on. I didn't understand...  [01:04:13][38.1]
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Dr Louise Newson: [01:04:14] It's very scary.  [01:04:14][0.4]
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Jade Lloyd: [01:04:14] ...what was happening, yes. So I didn't know who to contact, who to ask for help. And then things started to get worse. I was starting to feel depressed. I then started experiencing suicidal thoughts. And that's when I was like, okay, I really need...  [01:04:32][17.8]
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Dr Louise Newson: [01:04:33] And had you ever had that before when you were younger?  [01:04:35][2.0]
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Jade Lloyd: [01:04:36] No, so it was only ever anxiety I had. So I'd never experienced depression or suicidal thoughts or anything. So when I had that first suicidal thought, it really scared me. And it was that feeling of like hopelessness, like everyone would be better off without me. I just felt like I was just a hindrance. And I was starting to experience what I now know was intrusive thoughts. And I've now been diagnosed with OCD with intrusive thoughts. So I feel like that was just intensified. So I was worried about harm coming to Penelope. I was worried that I was going to harm her and that was really distressing. But because I couldn't understand what was going on, I was too afraid to ask for help or to tell. There was no-one saying you know these are the thoughts you can experience like no-one was saying asking me those questions of what's really going on and so I did end up reaching out to like the NHS kind of counselling service and had a consultation with them on the phone and explained I was suicidal and they just said oh because you've got private therapy booked in and you've got family support we can't help you.  [01:05:43][67.5]
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Dr Louise Newson: [01:05:44] That's not very helpful is it?  [01:05:45][1.0]
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Jade Lloyd: [01:05:46] And I was just like, oh, okay and I remember just feeling really just depleted. I was like, I'm telling everybody that I'm not okay and no-one's helping.  [01:05:56][10.5]
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Dr Louise Newson: [01:05:56] And how many weeks was Penelope then?  [01:05:58][1.6]
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Jade Lloyd: [01:05:59] So at that point she was probably like two, three months.  [01:06:01][2.2]
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Dr Louise Newson: [01:06:02] Okay.  [01:06:02][0.0]
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Jade Lloyd: [01:06:02] Yes, and I then, I wasn't really... I was my sleep was really being affected and it wasn't because she wasn't sleeping. [01:06:09][6.6]
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Dr Louise Newson: [01:06:08] It wasn't because of her, it was your sleep.  [01:06:10][1.9]
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Jade Lloyd: [01:06:10] Yes, I just, because of the intrusive thoughts, I couldn't switch off. And then it got, I had my health visitor would come out and see me and she came out and I asked her, I asked like, is this postnatal depression because this feels really bad and told her I had suicidal thoughts. And she just said, let's not put a label on it. And then told me within the conversation that I just needed a glass of wine, some chocolate and a bath.  [01:06:37][27.1]
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Dr Louise Newson: [01:06:38] You're joking!  [01:06:38][0.4]
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Jade Lloyd: [01:06:40] No.  [01:06:40][0.0]
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Dr Louise Newson: [01:06:41] That's a healthcare professional telling you when you are having these awful thoughts to just have a glass of wine and a bath? [01:06:49][8.2]
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Jade Lloyd: [01:06:50] Yeah.  [01:06:50][0.0]
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Dr Louise Newson: [01:06:50] So then what did you do?  [01:06:51][0.7]
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Jade Lloyd: [01:06:52] Well, I did it, it didn't work.  [01:06:54][2.1]
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Dr Louise Newson: [01:06:54] Well it might help for two minutes but it's not going to treat the underlying problem, is it?  [01:06:57][3.3]
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Jade Lloyd: [01:06:57] Yes. And I think that evening or a couple of evenings later, my husband did the night feeds and I had a full night's sleep and I remember feeling really like elated the following morning and now, on reflection, I think, that's when things were maybe becoming a bit manic and I then did reach out to my doctor or my doctor's surgery, and I said on the phone, I said, I think I've got postnatal depression, I really need help. And the doctor phoned me and prescribed me antidepressants over the phone. Again, because it was COVID, I couldn't see them. And then two weeks later was when things just started to get worse. Like I didn't feel the need to sleep and my doctor was checking in on me and I was saying like, oh, I'm absolutely fine. But I think it was very much like a rollercoaster. It was really high and then I'd feel really low. And I remember just one night just crying in bed, just sobbing and my husband just cuddling me and he just didn't know what to do. And yes, and then it was two weeks after taking the antidepressants was when I had my first proper psychotic episode. And, yes, that's when I was, that's when my family realised something wasn't right. I mean, I was in the middle of our bedroom singing John Legend's Ordinary People, like hallucinating that I was on stage and I was fully in that moment.  [01:08:30][93.2]
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Dr Louise Newson: [01:08:33] And you though you were actually, yes, can you remember that time?  [01:08:34][0.9]
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Jade Lloyd: [01:08:35] I remembered the hallucination and the feeling, and I remember my husband phoning my mum and saying it's like she's having some sort of psychotic episode.  [01:08:44][8.7]
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Dr Louise Newson: [01:08:45] It's very scary to witness isn't it?  [01:08:46][0.8]
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Jade Lloyd: [01:08:46] Yeah, and I was, I remember that fear on his face and that line snapping me out of it, but as quickly as I came out of that, I went back in and then it was just, it was just in and out, in and out and then that following day, my husband fought the doctors for them to get the perinatal team to come out to assess me and then I was admitted to the mother and baby unit that evening.  [01:09:10][23.8]
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Dr Louise Newson: [01:09:11] And were you sectioned or did you?  [01:09:12][1.4]
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Jade Lloyd: [01:09:13] Yes, so I initially went in there voluntary and, because I thought I was going on holiday and so I was packing my bags and then we got closer to the unit and that's when I started to become really distressed and I was telling my family that, because it was my mum, my stepdad, my husband and obviously Penelope with me and I saying like, I've made it all up, I'm okay, take me home. And they took me in there and then when they ended up leaving, the doctor phoned Tom, my husband and said, we don't think she's here voluntarily, we need to section her to keep her safe. Yeah.  [01:09:49][36.5]
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Dr Louise Newson: [01:09:50] And then you had psychiatric medications?  [01:09:51][1.6]
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Jade Lloyd: [01:09:53] Yes. So I think they immediately put me on olanzapine, an antipsychotic and a couple of, maybe another one to sedate me to help me sleep because I just was so manic. I just wouldn't sleep. So that was there. I remember them being like our main priority is to get you to sleep because I was, that week prior probably was functioning off of less than 10 hours sleep. So yes, and then it was, I think that definitely helped. But I was still in psychosis for two weeks in the unit before I fully kind of came back round. .  [01:10:33][40.6]
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Dr Louise Newson: [01:10:34] And then talk me through, since that time then, have you carried on with the antipsychotics and antidepressants?  [01:10:40][6.0]
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Jade Lloyd: [01:10:41] Yes. So I was on the antipsychotics. I'm still on the antidepressants today. I was on the antipsychotics after the postpartum psychosis for about, probably about two years. And then I really wanted to come off them because the side effects that I've had, like is that I gained four stone and..  [01:10:59][18.3]
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Dr Louise Newson: [01:10:59] You gained four stone? [01:11:00][0.6]
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Jade Lloyd: [01:11:00] Yes [01:11:00][0.0]
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Dr Louise Newson: [01:11:00] Which is very common actually with the antipsychotics isn't it?  [01:11:04][4.1]
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Jade Lloyd: [01:11:04] Yes, because I just didn't feel full and I just kept on eating and I think because I was so depressed as well it was like a coping... [01:11:10][6.6]
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Dr Louise Newson: [01:11:11] And they also affect your metabolism as well, don't they? So it's not just what you eat, it's the way you metabolise everything as well.  [01:11:18][6.8]
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Jade Lloyd: [01:11:18] Oh, okay, that's interesting.  [01:11:19][1.5]
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Dr Louise Newson: [01:11:19] No-one explained that to you?  [01:11:20][1.0]
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Jade Lloyd: [01:11:20] Well, no, and when I have asked somebody in the healthcare profession, they said, oh, it's not metabolism. It's just that you're, something about my brain, not telling my stomach that I'm full. But that was a really hard thing because it was a constant reminder like when I looked in the mirror, that it was a reminder of being ill and I really...  [01:11:39][18.3]
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Dr Louise Newson: [01:11:39] And you wanted to be well.  [01:11:40][1.0]
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Jade Lloyd: [01:11:40] Yes, it was really hard. And so I came off the antipsychotics, I think it was in the summer. And then I did then end up having a relapse about six months later. And I didn't even know that that was a possibility either. So that was the real shock to everyone. [01:11:58][17.8]
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Dr Louise Newson: [01:11:59] And did you have to go back into hospital?  [01:12:00][0.9]
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Jade Lloyd: [01:12:01] No, I managed to stay at home. So I had the crisis team looking after me. In a reflection, maybe it would have been best if I was in hospital, just because that was really difficult for it to be at home, but also it was almost like the first time when I was In the unit, I was hid away. And so there wasn't that element of shame or like what did I do?  [01:12:25][24.0]
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Dr Louise Newson: [01:12:25] You didn't have to try and be something different.  [01:12:26][1.5]
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Jade Lloyd: [01:12:27] Yes, whereas when it was family around and friends, then when I was recovering, it was that real shame of feeling like, Oh, my God, that's so embarrassing. Like, what did I say? What did I do? And it's a bit like hangxiety. And I think like what did I say? So yeah, that was challenging.  [01:12:48][21.7]
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Dr Louise Newson: [01:12:49] And when you were on the olanzapine, did you have your periods?  [01:12:51][2.2]
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Jade Lloyd: [01:12:52] Yeah.  [01:12:52][0.0]
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Dr Louise Newson: [01:12:53] And did you notice any difference in how you were when your periods came back after having the baby?  [01:12:57][3.9]
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Jade Lloyd: [01:12:58] The only thing for me, because they quickly put me, well not quickly, I think maybe six months postpartum, they put me on the non-hormonal coil. And it was when my period started coming back, I was really struggling with the, like, it was so heavy. So I was like leaking through tampons and pads. And yeah, so that was my experience with that side of things.  [01:13:25][26.9]
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Dr Louise Newson: [01:13:26] And over the time, did anyone talk to you about any hormonal imbalance at all?  [01:13:30][4.2]
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Jade Lloyd: [01:13:30] No. The only thing that was mentioned about hormones was when I came out of the psychosis in the unit and I asked my psychiatrist, why has this happened to me? And she mentioned that they don't know why exactly, but they know it can be like sleep deprivation, traumatic delivery, hormones and genetics.  [01:13:49][18.5]
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Dr Louise Newson: [01:13:50] Okay, so you can't change the first two, and you can't change the fourth, because your genetics, sadly, we can't change, but hormones, did they not say anything about treating with hormones?  [01:14:03][12.7]
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Jade Lloyd: [01:14:03] No, it was never once mentioned.  [01:14:05][1.6]
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Dr Louise Newson: [01:14:06] What do you think about that?  [01:14:06][0.6]
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Jade Lloyd: [01:14:07] I mean, because I had never really heard about, you know, hormone treatments, I'd only ever really, my experience was with my mum going through the menopause. And then it wasn't until mum had been to your clinic and she would talk to me about hormones. And then I was like, oh, that's interesting. But I'd never really...  [01:14:30][23.3]
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Dr Louise Newson: [01:14:31] Joined the dots really...  [01:14:31][0.1]
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Jade Lloyd: [01:14:31] No, and then obviously we then spoke about that and it did open up my world to it. And I was thinking, well, it kind of makes sense. Like, why are they not looking at this? And it was, it was even when I was, so I go back and volunteer at the mother and baby unit. And there was a mum that had been there for almost a year. I think she was there over a year in the end. They tried everything with her postpartum psychosis and nothing was working. And then after going back in, like throughout that time, I'd then since spoken to you and I'd went back in and I was thinking, why, I wonder whether they've actually talked about hormones? Have they looked at her hormones? And it's really interesting. I don't understand why it's not, why it's not talked about or considered.  [01:15:22][51.5]
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Dr Louise Newson: [01:15:23] It's crazy, isn't it? So I was never taught about it either, because it's postnatal depression, postnatal psychosis. So immediately it gives it a label for a psychiatrist. So when I was doing psychiatry, I taught about all the psychiatric drugs. And if you're not taught anything, you don't know what you don't know until you learn it, do you with anything in life? And then several years ago, a decade or so, I just put two and two together and I was with a really eminent professor and he was giving bioidentical hormones to people with postnatal depression and postnatal psychosis. And I said, why are you doing that? He said, Louise, in medicine, you treat the underlying cause. And I went, oh, okay, I need to think a bit more about this. And then I read the work of Katharina Dalton, this incredible pioneer, who was a GP who qualified the year the NHS was launched. And she used to prescribe a lot of progesterone to women with postnatal psychosis. And then, these women now are in their 70s and 80s, and I've spoken to some of them. And it's just incredible that you hear their response, but also you understand this big drop that occurs. All it is, is balancing those hormones back. And I spoke to a professor of psychiatry who specialised in postnatal psychosis a few months ago, and he's now retired. And I just wanted to hear his take on it, because sometimes older people have lived through these different sort of phases. And he said, oh yeah, I did read about her work, but she was only a GP, so we never listened to her about hormones. And I said, oh, did you ever prescribe hormones? He said, dear Louise, he said nothing worked for these women. I said well what did you do then? He said well, I would just put them to bed and then we would wait. I said well what would you wait for? He said we would for their periods to come back. And when their periods came back, they often improved. I said, okay, did you not then think maybe giving those hormones that come back with periods might've helped them get better a bit quicker? And he went, oh, that's very interesting, but no, we didn't. And that was the end of the conversation. And I thought in medicine, people are very binary and rigid. You know, we've always done it this way therefore we will continue. And what's happening more and more now I think is that women are working it out and so I'm not saying you can't give the psychiatric medication and when you're having a psychotic reaction and you're at danger to you know yourself or others, of course those drugs can be very useful, but having them in the longer term when there's a hormonal imbalance doesn't feel right.  [01:17:50][146.6]
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Jade Lloyd: [01:17:51] Yes, because I think the recovery as well, that was the really hard part. And it was, you know, the girl that I met in the unit, she wasn't in the psychosis anymore. But she was clearly struggling. And you know, I'm no doctor, I don't know, was there a hormonal imbalance. But surely I'm like even just maybe a test to see? [01:18:15][24.0]
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Dr Louise Newson: [01:18:15] Well, often in medicine, we give what's called a therapeutic trial. So, you know, and even every day when I prescribe hormones, I'll never say to a woman, I can cure you of your joint pain, your migraines, your this. I don't know how much is a hormonal imbalance. But I can say your story, what you're telling me, maybe blood tests as well, show that you have a hormonal imbalance. And I'm going to try and balance your hormones and let's see how you improve. You can still carry on with other medications. So are you're taking hormone treatments? [01:18:43][28.2]
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Jade Lloyd: [01:18:45] Yes, because we had my bloods tested and it showed that they were low. So I, yes, I take testosterone, progesterone and the estradiol. I've been taking them for about three months now and it was when I had my first period, so normally I'm really, really, I'm very in tune with my periods and when they're going to happen. So it's very textbook for me in terms of like, I know that the week before this is how I'll feel and and X,Y and Z, but I remembered the, when my period came, I said to my husband, like, I've just come on my period. He was like, oh, really? And I was like I've had no symptoms.  [01:19:32][46.6]
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Dr Louise Newson: [01:19:33] That's good.  [01:19:33][0.2]
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Jade Lloyd: [01:19:33] Yes, and I was, because it's normally like I get really hungry and I get really irritable and I said to him, I was like, I wonder whether that was maybe the hormones have just balanced me out and yeah it has been like, there's been spotting, like my periods are definitely trying to adjust and there's been spotting and like my periods maybe have like lasted a little bit longer, but overall I've felt really good and when I went, so I did go to my doctors because I paid for the hormones to trial them. And I thought, okay, if I've trialled them, then I can go to the doctor and say, I've been taking them, they've made me feel better. So I did to my doctors and it was still early days. I said, I've just started taking them but my hormones have been tested. I sent her the blood results. But the first thing she said was, well, it's not normal for a 32 year old to be put on hormones. And I was like, Oh, okay. And then I was trying to explain like why I was doing it and obviously, I had postpartum psychosis, I ended up having a relapse, like, it is in my, I think it's in my genetics. And yes, she was just like, she just she had this guard up and it really frustrated me as well, because she could see that it was from your clinic. So she was like, oh, I see it's Dr louise Newson. And I was like oh, yeah, yeah. And then she said again, it's not normal for 32-year-olds to be put on hormones. And I said, okay. And she goes and to be honest, I don't really know much about hormones and I'll have to refer you to our gynaecologist team and then they can kind of assess it and then we'll let you know. And I was like okay. And then she, I remember as I left, she just went, well, I hope it all works out for you. And I was like, oh...  [01:21:41][127.8]
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Dr Louise Newson: [01:21:41] So she didn't take over any of the prescribing? She didn't say she'd prescribe?  [01:21:45][3.9]
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Jade Lloyd: [01:21:46] So it was then referred to the gynaecologist team. And then I got a text saying, like text email from her saying that like, they've said that there's no, I can't even remember exactly what it said, but basically we can't prescribe you.  [01:22:01][15.0]
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Dr Louise Newson: [01:22:02] So they hadn't spoken to you, they just, you just got a...  [01:22:05][2.7]
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Jade Lloyd: [01:22:05] I just got text to say, we can't prescribe you these going forward... [01:22:09][3.4]
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Dr Louise Newson: [01:22:10] So let me just get this clear, did they prescribe olanzapine  for you?  [01:22:12][2.7]
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Jade Lloyd: [01:22:15] Yes, so it's, well, it's from the community mental health team, but I pick it up, it goes through my GP, yes.  [01:22:20][5.2]
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Dr Louise Newson: [01:22:20] Yes, so your GP didn't say we don't agree with this treatment or you couldn't be on it. So I find it's really confusing for people as well because, you know, if you have a treatment that's working for patients, the first thing I do as a doctor is think, well, what is that treatment? And is it doing any harm? Because you're always balancing benefits versus risks. I wonder what your GP would have asked or said to you if as a 32-year-old if you'd asked for synthetic hormones and contraception. I don't think she would have refused that for you. Whereas the evidence for the benefits for mental health or risks on mental health for contraceptives is not there because no one's done any studies. So there are more risks of having synthetic hormones because we know they are associated with the risk of heart disease, clot stroke, even cancers. It's a low risk, but it's there. But there aren't any risks for bioidentical hormones that you're having. But also all you are doing is supplementing your hormones. You're not replacing them and you're feeling better.  [01:23:25][65.0]
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Jade Lloyd: [01:23:26] Yeah.  [01:23:26][0.0]
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Dr Louise Newson: [01:23:26] And you've got risk of a severe mental health condition. And also you have got family history of hormonal imbalances affecting mental health quite badly in your family, haven't you?  [01:23:37][10.9]
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Jade Lloyd: [01:23:39] Yes. So they haven't really asked about that. The team at the mother and baby unit, like the perinatal team, were very much aware of all of that. But yes, no, my GP, because I have changed my GP since having the psychosis, so she's relatively new. And I had high hopes when I first met her because she was really engaged with the, wanting to understand what I'd been through and saying we're always here if you need us. I never complained, but I actually wrote, I got the feedback form and I complained.  [01:24:16][37.8]
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Dr Louise Newson: [01:24:17] What did they say?  [01:24:17][0.6]
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Jade Lloyd: [01:24:18] I just didn't hear back. But she's a partner at the practice.  [01:24:20][2.8]
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Dr Louise Newson: [01:24:21] So how does that make you think for other people that have had postnatal mental health who are wanting to consider hormones?  [01:24:28][7.0]
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Jade Lloyd: [01:24:29] I think it's quite scary. It's difficult because I don't know enough about it, but I think in life, it's always nice to be given choices, and I think sometimes as well, you're prescribed, like when I was prescribed the antidepressants and I wasn't actually seen, it was just all over the phone. And when that day I was admitted to the mother and baby unit and my husband phoned the doctors to say, you know, we believe she's in psychosis and they just tried to say well I can prescribe antipsychotics, you can pick them up and just make sure she's not on her own. And my husband was like, no, she needs to be in a hospital, I cannot keep her safe, she'll die. And I don't know, I think it's. You know, they are so quick to be like, you know, it was a 10-minute phone call and then they just prescribed me antidepressants. But since working with the charity Action on Postpartum Psychosis, I remember one of the first conversations I had with them. They said that there is some, like some people say that maybe if you prescribe somebody an antidepresent and they're showing signs of psychosis, it can trigger a psychotic episode. So I'm like, gosh, like. Why are doctors not aware of this? Because that's so incredibly risky.  [01:25:58][89.0]
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Dr Louise Newson: [01:25:58] Yeah, I think, I mean, a lot of it boils down to education for healthcare professionals and sharing uncertainty because a lot people say, well, there isn't enough evidence for hormone treatments for postnatal mental health disorders. And that was one of the big criticisms of Katharina Dalton many years ago, because she didn't have randomised control studies, because she would treat the patients she saw. She would not leave patients who are psychotic to say, oh, have a sugar coated placebo and let's see how you get on. Because she was there as a clinician, more than a researcher, but she wrote up patients and said these have improved and it makes sense. But what's really interesting is if you dig deep into the research looking at the effects of antipsychotics and antidepressants and postnatal depression, postnatal psychosis, there isn't good research. No one's done randomised placebo studies. So it's a real double standard, but often in medicine, you treat the underlying cause. And if there is any hormonal imbalance, giving hormones can be life-saving and life-improving. And we see in the clinic a lot of women who are 20, 30 years older than you who have had a similar story with postnatal psychosis and it often can recur with other pregnancies and births. And then they become menopausal. And then we treat them with hormones and they say, I wish I had this 30 years ago because my life would have been very different. And so as long as in medicine we're not harming people or doing anything against their will and sharing uncertainty, then it's the only way to get the conversation moving forward. So I really hope by people listening to this podcast, they know that there are options and, you know, Katharina Dalton used to give progesterone either at the very late stages of pregnancy or as soon as the baby was born in people that had a history of postnatal psychosis. Because I've spoken to a lot of women who were too scared to have another baby because they, because, which I get, but giving progesterone to those women at a high dose would prevent psychosis in the future. So there are always options. And thinking about hormones is really important. And actually olanzapine can block hormones. It can cause a chemical menopause because it affects prolactin which then affects FSH levels, which is a hormone that our brain produces to regulate progesterone, estradiol, testosterone. So a lot of people on olanzapine and other antipsychotics will then have lower hormones in their body, but psychiatrists don't even address that either.  [01:28:35][156.5]
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Jade Lloyd: [01:28:36] That's crazy. So if someone was, you know, experiencing thinking they were starting to experience postpartum psychosis, and they wanted to explore the option of hormone treatment, like how would they go about that? [01:28:50][14.2]
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Dr Louise Newson: [01:28:50] So knowing someone who's experienced with hormones and, you know, as a GP, as a general practitioner, I've done a lot of psychiatry. I've done a lot of mental health. Psychiatry training is really important when you're dealing with any mental health disorder. Sadly, gynaecologists usually go straight into gynaecology so they haven't got any psychiatric background, they haven't had any mental health training. A lot of general practise is mental health as well. So, because, often working in an acute situation, people still might need psychiatric medication, but you could still start a high dose, often of progesterone, often progestorone, sometimes as suppositories, rectally or vaginally, could be really transformational. And then as with you, measuring estradiol, testosterone levels can be really useful, because in young people, it's nice to have the baseline blood test, I wouldn't just start someone on testosterone without a baseline blood test, and then watching the response. But the sooner people get help, the better. So it might not be the person, it might be their family. Speaking to people like in our clinic or others, working closely with those that are experienced can make a huge difference to people.  [01:30:03][72.4]
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Jade Lloyd: [01:30:03] Is there any, like, negative side effects?  [01:30:06][2.5]
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Dr Louise Newson: [01:30:07] No.  [01:30:07][0.0]
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Jade Lloyd: [01:30:09] Is there not?  [01:30:09][0.0]
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Dr Louise Newson: [01:30:09] No, I mean it's all about the right balance and type. The other thing about hormones is they only work the day you use them and progesterone actually only works for a few hours. So I'd always say to people, if it made you worse, because there are some people that find initially they can, then it's not going to last for very long. And if people have got a mental health condition, they usually have someone with them as well. But it's about getting the the right dose and the right type of hormone and so giving people the confidence that it's not going to build up in their body. It's not like giving a Depo of something that's going to be in the body for a long time and trying it and seeing is really important. And they can still be used when people breastfeed as well because they have the same structure as our own hormones. So it's really just topping up those missing hormones. And I've had some people with postnatal mental health disorders, I've prescribed hormones for them and then as soon as their periods come back, then they don't need those hormones. So it is not always a long-term treatment. It's just really depending on the individual. And they don't reduce fertility, they can improve fertility as well if they're given the progesterone in two out of four weeks. So yeah, there's lots that is very simplistic that's forgotten, sadly. So I'm very grateful you coming on. There's a lot we need to do just for awareness really. And it's great that you're doing this volunteering as well and educating others. So I going to end with three take-home tips. So three things that either someone listening, if they develop postnatal mental health disorder, they can do or their family because it's usually advocates. What three things do you think people should know more about the condition and the association with hormones to try and improve the future for these women?  [01:31:49][100.1]
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Jade Lloyd: [01:31:49] I think it's knowing the signs to spot. And I think with everything in the media at the moment, like the difference between depression and psychosis. So it's knowing that, you know, psychosis is typically like, if somebody is like really manic, or they might not, they're not sleeping, but they don't feel the need to sleep. The hallucinations, hearing, seeing things, delusions, paranoia. And I think it's spotting those signs and then knowing where to go with that. And it is really advocating and not taking no for an answer. Like I think, it's having that confidence to push. I guess like in terms of the hormone element, it's, having those conversations with the health professionals and questioning them about it because it doesn't sound like they would necessarily bring it up. So... [01:32:44][54.7]
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Dr Louise Newson: [01:32:45] Absolutely, I think that's really important.  [01:32:46][1.2]
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Jade Lloyd: [01:32:47] Yeah, yeah. And then it's knowing as well, like the helplines that are out there. So you've got PANDAS, they do like a WhatsApp service, peer support, then you've got Action on Postpartum Psychosis. They do peer support and you can always contact them if you're worried and you're not quite sure if that's what your loved one is experiencing. And then, it's knowing as well that there should be, I don't know if it is what, you know, in the whole of the country, a designated perinatal mental health service that look after people with mental health illness. So it's knowing what's out there. I think that's what I struggled with. I didn't know what was out there. [01:33:31][43.9]
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Dr Louise Newson: [01:33:31] And that's so important, isn't it? So getting help, feeling supported, having the conversation about hormones as well.  [01:33:37][6.0]
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Jade Lloyd: [01:33:38] Yes and I think it's being truthful about what you're actually experiencing. I always say to people, I can't guarantee they're not going to take, I can't sit there and go, they're not going take your baby away, but that's not what they want to do. They want to get you better and most health professionals know that it's an illness, like it's a postnatal illness, that they want and that they will help you and you will feel better coming out of it.  [01:34:03][24.8]
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Dr Louise Newson: [01:34:04] Thank you so much for your time, Jade. It's been a great conversation.  [01:34:07][2.4]
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Jade Lloyd: [01:34:08] Thank you for having me and thanks for everything you're doing and for helping me.  [01:34:11][3.0]
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Dr Louise Newson: [01:34:12] Thank you.  [01:34:12]