The article outlines some of the difficult decisions for women who have bipolar disorder and then become pregnant. Research shows that medications often prescribed to bipolar women, such as Depakote, Tegretol and Lithium, lead to an increased risk for birth defects such as spina bifidaor cleft palate. At the same time, women who go off these medications while pregnant are highly likely to relapse.Additionally, bipolar disorder (diagnosed or undiagnosed) is a key risk factor for postpartum psychosis.
It seems to me the best thing a bipolar woman can do is work closely with an experiencedreproductive psychiatrist to create a plan that works best for her individual situation and to be carefully cared for during the pregnancy and postpartum. Plenty of women with bipolar disorder have children and positive outcomes.
For additional resources, the Massachusetts General Hospital’s Center for Women’s Mental Health has done a recent series on medications for bipolar disorder and their impact on pregnancy or breastfeeding that will be helpful for someone considering getting pregnant.
Valproic Acid [Depakote, Depakon] & the Risk of Major Malformations
What’s Safer for Breastfeeding: Lithium or Lamotrigine [Lamictal]?
Ah, crap, Katherine, this tiny little article made me cry. My PPPsychosis after birth of 1st son (and over the top concurrent triple measures to commit suicide when he was 2) is what FINALLY led to Dx (diagnosis) of Bipolar I for me. I was on Depakote (at the time it was for migraine prophylaxis) when I got preggers w/ him by accident and FREAKED out about the risk of birth defects so much that I called my neurologist and personally fired him for not warning me of neonatal risks. After meeting w/ geneticists and lots of tests, we learned little "Luigi" was fine. I stopped taking the drug the second I finished peeing on my third stick in a 15 min. period. Was about 3-4 weeks along.
Pregnancy was great except for puking every day. I had lots of energy and was very excited. However, the Trauma caused by Luigi's birth and emergency C-section and my subsequent inability to lactate at all to feed my child was my hook into PPD – the bone I constantly gnawed on and would not let out of my sight. I firmly believed that both of my womanly failures to give birth and feed my own kid – 2 of the most basic components of being a mammalian mother – made me a less than zero. I called myself "the Babysitter" b/c I was only doing that which any other person could do. I wasn't a mom. I was an abject failure. The day I realized I had to feed my newborn Luigi "sub-standard" formula and forgo the "breast is best" philosophy is the day I slashed my useless breasts with kitchen knives and gave up my sanity. I was Super-Mom on the outside meeting every developmental need for him w/ almost OCD-like fixations, lavishing him with love and attention and opportunities; but inside, I died a little every day and felt even more horrible that I was suicidal when I had this gorgeous sweet-natured gem of a boy. PPD cyclical thinking is so short-sighted and unrelenting. And I think many of us have a hook that our depressed brains recycle and recycle until the hook is the only thought we are capable of having – Bipolar or not, PPD is an ongoing loop of destructive thinking.
After a thorough 2 yr. therapeutic treatment plan to treat the BP following the aforementioned suicide attempt – well you know that story – my husband, "Bowser" and I met with geneticists again, two pediatricians, our family physician, and my beloved Dr. Mean Old Lady (therapist who Dx-ed me and made me work my butt off to rid my brain of old thinking patterns), we decided to try for a second child. Part of me wanted to prove to myself that I could do it right this time, bipolar or not, but mostly we wanted "Luigi" to have a sibling with whom to share holidays and rivalry for parental attention. They are very good at the latter. 🙂
We had a full team on board, a pregnancy treatment plan, a medication plan, and all sorts of written agreements on what to do should I get PPD (best case scenario) or PPPsychosis (worst case scenario) again up to and including my consent to ECT or inpatient facilities. I wrote a letter from my well & typical thinking self to my postpartum and possibly psychotic self and had my BFF mail it to me a week after "Mario's" birth to remind me of who I was when I was most myself and repeated my self-soothing mantra "It's okay, Sweetie" many times in the letter.
For weeks before Mario's birth, I did what I called Psychological Calisthenics. Gratefully, Mario was a planned C-section (I have a small pelvis and grow huge-headed kids) plus Mario & I got super hypertension and the OB hospitalized me and whipped the little bugger out the moment I hit 37 weeks. As part of my mental exercises, I read all my journal entries from when I had PPD and from when I was getting well. I wrote down flashcards to come up with a battle plan to deal with Thought Monkeys and read them every day. I read and re-read and practiced and memorized. I was aware Luigi would know something was wrong w/ Mommy if I got a bad case of PPD and was determined to do everything in my power to stay on top of things. I could not prevent it and he already knew Mommy's feelings got sick sometimes, but I hoped for the best and really hoped he wouldn't blame my sick feelings on the new squalling thing that moved in.
All doctors involved agreed that I could take my daily dose of Seroquel throughout the pregnancy (and I seriously researched every medical journal on mood-stabilizers during pregnancy) and they decided that I would start a small dose of Lithium when I hit 35 weeks (way after the point at which any damage could be done to the baby) to stave off PPD. 'Cuz we all assumed I wouldn't be able to lactate anyway. Surprisingly I did, and not being able to nurse my kid b/c the lithium would be poisonous to him was so dang hard, but absolutely necessary. But, man, after trying so hard to breastfeed Luigi w/out milk and then making milk that I couldn't use. Mama, wasn't happy, but I did the right thing. Formula.
***Please note: these were personal decisions made with 4 doctors based on my medical history – I don't want to be preaching the "right way" for anyone. however, there are options for most that can be evaluated on a case by case basis. Healthy Mom, Healthy Baby. This includes mental health.
And, you know what. It all turned out okay. About 3 weeks after Mario's birth i had a VERY bad 3-4 days of depression and then it was over. Of course, I'm still bipolar and I still cycle, but being prepared as could be for that pregnancy was incredibly empowering. I think even if I did end up with a few months of PPD, it still would have been okay. I would have been able to forgive myself, unlike before.
Katherine, I'm sorry for this long story and appreciate you allowing me to say all of this. I don't know how many Bipolar moms are going to read this and I want them to KNOW it really can be okay, even more than okay. I'd like to also point out that severe PPD is often the exact thing doctors need to see (after pulling their heads out of their butts and realizing it's not Baby Blues) to finally give a woman a diagnosis and treatment that can set her free to live life and not feel like a freak. Unsolicited advice: if you haven't been diagnosed as bipolar or as having any other mental illness and find yourself battling a war with PPD that refuses to budge no matter what anti-depressant your GP prescribes, please go to a mental health professional and talk w/ them. GPs are really only equipped to deal with standard depressive cycles. I'm not belittling them, I love my GP, but he should have moved me on to someone more qualified a long time before I hit Psychosis.
Now we're all good and healthy and happy. My house is loud w/ 2 boys rough-housing all the time and driving me insane (in a good NORMAL way) and our long-term family prognosis is excellent. This is my prayer, wish, and blessing for all of you, too. Lots of hope out there. Lots of options. And keep reading Katherine. She's a virtual encyclopedia of compassion and wisdom in all things postpartum.
Namaste.
-Sophie
P.S. BTW, Mario, Luigi, and Bowser are all names my now 9 year old Luigi came up with as our family pseudonyms. Thank goodness I had already decided on my own name otherwise I'd probably be Princess Peach. Blech.
Katherine, Thanks for sharing this article. This sentence, "It seems to me the best thing a bipolar woman can do is work closely with an experienced reproductive psychiatrist to create a plan that works best for her individual situation and to be carefully cared for during the pregnancy and postpartum" gives me optimism because that's exactly what I'm doing right now. We're trying for a second child. I was diagnosed with bipolar disorder after my first child was born.
Dear Sophie,
As another mother with bipolar disorder, I want to say, thank you for sharing. I'm so glad to hear that your family is healthy and happy. I'm so proud of you and how you handled your second son's birth. I like your idea of writing yourself a letter to read postpartum. All the best,
Holly
Holly,
I'm so glad for your optimism. I really think having a baby doesn't have to be a "disaster" for moms with bipolar disorder. There are some great healthcare providers who are standing at the ready, and want to provide real support and monitoring and care for moms in your situation. Many blessings to you.
I am a mom with bipolar disorder that was triggered by childbirth. I’m honored my story is shared here on Postpartum Progress and I provide the link to that experience at the end of my comment. I’ve been advising all women and health professionals to educate themselves about ALL the perinatal mood and anxiety disorders (PMADS). There are eight PMADS listed on the excellent Postpartum Progress FAQ page – thank you Katherine Stone for your support!
http://postpartumprogress.com/frequently-asked-questions-on-postpartum-depression-related-illnesses
I was diagnosed with the PMAD of bipolar, peripartum onset (postpartum bipolar/PPBD), a.k.a. childbirth-triggered bipolar.
For more information I suggest checking out the outstanding website Postpartum Support International:
http://www.postpartum.net/learn-more/bipolar-mood-disorders/
and the APP (Action on Postpartum Psychosis) website:
http://www.app-network.org
which addresses antenatal and postpartum bipolar disorder.
My postpartum bipolar disorder, or bipolar, peripartum onset is rare but it definitely happens. Postpartum psychosis can be accompanied by bipolar, peripartum onset, but that’s not always the case. At age thirty-seven I had my second baby. I walked into the maternity ward in labor with no previous diagnosis of bipolar disorder. Within 24 hours of my daughter’s birth I was hypomanic and hypergraphic (compulsive writing); no one recognized I was in trouble until six weeks later when I was acutely manic.
It was then when I voluntarily admitted myself for hospitalization and received an official diagnosis of bipolar, peripartum onset with no psychotic features. That was in 2007, and I’ve finally achieved mood stability and a full, wonderful life. I want to help other moms living with this postpartum mood disorder so they don’t suffer the way I did, and one way to do this is to educate about the existence of this PMAD and its symptoms.
I was thrilled to have my story published on Postpartum Progress website: http://postpartumprogress.com/story-postpartum-bipolar-disorder and thank Cristi Comes and Katherine Stone for their assistance and encouragement.
Thanks for reading,
Dyane Leshin-Harwood
Founder, Depression and Bipolar Support Alliance (DBSA),
Santa Cruz County, CA
Member, International Society of Bipolar Disorders and
The Marce Society for Perinatal Mental Health, Postpartum Support International
Author of “Birth of a New Brain – Healing from Postpartum Bipolar Disorder” with a foreword by Dr. Walker Karraa (author of “Transformed by Postpartum Depression: Women’s Stories ofTrauma and Growth”) to be published by Post Hill Press, Fall, 2017
@birthofnewbrain #EveryPMADCounts #NotJustPPD