From the Guidelines
Olanzapine is a suitable treatment option for postpartum psychosis, with a recommended initial dosage of 2.5 mg per day at bedtime, which can be increased to a maximum of 10 mg per day, usually twice daily in divided doses, as it is generally well tolerated. When considering olanzapine for postpartum psychosis, it's crucial to weigh the potential benefits against the risks, particularly in the context of breastfeeding and the need for close monitoring of both the mother's and infant's health 1. The treatment of postpartum psychosis with olanzapine should be part of a comprehensive approach that includes psychiatric monitoring, psychosocial support, and consideration of hospitalization if safety concerns arise. Key considerations include:
- Monitoring for side effects such as sedation, weight gain, and metabolic changes
- Assessing the compatibility of olanzapine with breastfeeding, with careful observation of the infant for signs of excessive sedation or feeding difficulties
- Regular follow-up appointments to evaluate treatment response and adjust dosing as necessary
- The importance of a multidisciplinary approach to manage postpartum psychosis effectively, ensuring the best possible outcomes for both mother and child.
From the Research
Olanzapine for Postpartum Psychosis
- Olanzapine is one of the antipsychotics used in the treatment of postpartum psychosis (PPP) 2.
- A study found that olanzapine and quetiapine seem to be the most acceptable antipsychotics during breastfeeding 2.
- The use of olanzapine in the prevention of postpartum psychosis and mood episodes in women with bipolar disorder has been investigated, with results suggesting that olanzapine may be effective in preventing postpartum mood episodes 3.
- However, more research is needed to determine the efficacy and safety of different antipsychotics, including olanzapine, in the treatment of PPP 2, 4, 5, 6.
- Current evidence suggests that antipsychotics, including olanzapine, may be responsible for sustained remission in PPP, and that treated PPP has a higher pace of improvement of mental status, with a rapid discharge from the hospital 2.
Treatment and Prevention
- There are no specific guidelines for the treatment of PPP, and more research is needed to develop effective treatment algorithms 2.
- Risk assessment and treatment of PPP should include consideration of the woman patient, as well as the mother-infant dyad and the larger family 4.
- Women's health care providers and systems can improve the care of women at risk of and experiencing PPP by better understanding their needs and offering patient-centered discussions and options for care 6.
- Improving the prevention and treatment of PPP can have a broad impact for women, children, and families 6.