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Old 08-18-2006, 11:47 PM   #1
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Treatment for bi-polar disorder and pregnancy

Hi all,

I just went to the doctor today, who suspected that I may be bi-polar. This was a relief because I have been dealing with emotional problems my entire life and no anti-depressant has ever worked--and I've tried just about everything. One concern, however, was that my new husband and I are considering starting a family soon (within the next year), and she told me that most treatment (Litium, Depacote, etc.) are known to cause birth defects. Well then, the treatment is simply not an option for me then, at least, not until after we've had a baby. But I am desperate. Does anyone have any information they can share about other treatment options in the interim that are not harmful prior to and during pregnancy? To finally have a diagnosis but in the same breath be denied treatment was a very bittersweet experience to put it mildly.

Any advice would be greatly appreciated.

 
Old 08-19-2006, 09:35 AM   #2
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Re: Treatment for bi-polar disorder and pregnancy

As far as I am aware there are no medications that any reputable doctor would recommend during pregnancy. In particular the leading up to pregancy & especially the first 3 months.

Have you been told what type of Bipolar you are? Type I, Type II, rapid cycling, etc?

Please don't feel that you are being denied treatment... You are facing difficult choices, true.

Last edited by Ruth6:11; 08-19-2006 at 09:39 AM.

 
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Old 08-19-2006, 07:54 PM   #3
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Re: Treatment for bi-polar disorder and pregnancy

Hi Ruth,

I have been told that I am probably Type II, although we are still in the process of my evaluation. I have a follow-up appt. next Friday, at which time we are going to continue going over my history, my concerns and plans for the future. She gave me several websites to read about mood disorders and preganancy. From what I've read, Lithium seems to pose the least danger--only a 1 in 1000 or 2000 chance for cardiovascular problems in infants whose mothers took the drug prior and during pregnancy. I do not want to do anything to put my future children at risk, but without knowing when we are going to start trying to conceive (within the next few months or the next year), I feel desperate. I have also read that women experiencing major depression during preganacy also pose a risk to their unborn child, causing stress which could lead to premature labor (I have a 13 year-old daughter who was born premature. I never connected her premature birth to my depression).

I am compiling a list of questions to ask during my appt. next week. Of course, my husband is against taking anything before we have a child, but he isn't the one dealing with this either (well, I guess he is in his own way). I have been dealing with this all my life, and finally have a diagnosis that can significantly increase my quality of life.

That's all I know right now.

 
Old 08-20-2006, 02:58 AM   #4
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Re: Treatment for bi-polar disorder and pregnancy

hi,
im in a similar situation to you, i was diagnosed bipolar II in may this year and now want to start a family, ive actually been agonizing over this over the past few weeks. Im currently taking lithium which is doing a fantastic job but i wouldnt want to take anything that could potentially harm my baby. ive already decided that i will stop my meds throughout the entire pregnancy, no arguments. But my worry is the amount of time it could actually take me to get pregnant, you are ideally meant to stop when you are actively trying, but i dont know how long it will take me to fall and i dont think i could go unmedicated all that time. If i wait til i get pregnant, i will have to cut down the meds before coming off them, which could take a while. so therefore i will still be having to take meds throughout the first trimester of my pregnancy, which i really dont want to do. i guess i could start cutting down the meds now, but im already on the lowest possible therapeutic dosage, and again, it could take me a while to conceive. i feel trapped in a real vicious circle with all of this.
my pdoc hasnt been particularly helpful, i think they feel i should wait before starting a family, but i will always have to face this situation whenever i decide to do it.
i cant really offer you any advice, i just wanted you to know you are not alone in this very difficult situation. please keep me updated and i will do the same,
Angel
p.s ive been told that (hypo)mania is mainly controlled in pregnancy and that depression is the greater risk. but the largest risk of all comes immediately after birth

 
Old 08-20-2006, 05:01 AM   #5
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Re: Treatment for bi-polar disorder and pregnancy

The book Women's Moods has a chapter in it about pregnancy and BP I & II. I think Mass. General Hospital has a good Women's Health section online and talks about pregnancy, postpartum and various mood disorders and how to treat them during this whole timeframe.

One book I have says that Lithium in pregnancy is okay; Depakote and Tegretol are not.

Anyway, find a psychiatrist, maybe one who specializes in women's health if you can.

I have a friend who made it through her second pregnancy (she has BP II) without meds, just seeing a therapist weekly. After the baby was born she started meds again. Both are doing just fine.

 
Old 08-20-2006, 09:58 AM   #6
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Re: Treatment for bi-polar disorder and pregnancy

And while I know most women can't make the decision I did, in case you DO decide to stay on meds and not have children let me know, as this is the decision I made for myself when I was diagnosed.

 
Old 08-20-2006, 10:38 AM   #7
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Re: Treatment for bi-polar disorder and pregnancy

Thank you all so much for sharing your thoughts and experiences on this issue. I will definitely keep you posted on what we decide. Like Ruth, I would probably be OK without having anymore children, but my husband has no children and has always looked forward to having a child. It's something we agreed upon before we got married, and it is really a non-negotiable. We only plan to have one, as I am getting older (33). I just wouldn't feel right about taking the choice of having a child away from my husband, it is all he talks about and has wanted for as long as he can remember. He is very supportive and kind and patient, but this would devastate him and our marriage very much. Plus, I really think we would be great parents. One reason I've spent the last 8 years in college is so that I am able to take care of my family. To decide not to have a family now would not be good for either one of us. But I certainly can understand why someone would decide to go the other route. It is something we've talked about and considered, but I don't view as wholly my choice to make.

On the other hand, I am in the same situation as the kind lady who posted to my message, the bipolar II on the mild dose of lithium. I have researched some on treatment options and did read as the other poster stated that lithium is the least dangerous, with the anti-convulsant medications posing the greatest risk. Also, like the other girl, I don't know how long it will take to get pregnant. Like I said, I'm 33 and it might take longer for me than, let's say, for someone in their 20s.

With the information I've gathered from this board and from other websites, I feel confident that I will be able to ask the right questions, etc. I will definitely need to talk more about it with my husband, maybe even invite him to talk with the psychiatrist before starting any meds at all. Even if I become convinced that it's safe as long as I stop while pregnant, he needs to feel good about it too.

What's strange is that when I was pregnant with my daughter 14 years ago, I felt SOOOO much better while pregnant. It was like I finally had the perfect balance of hormones flowing through my body. But when I had her, suddenly, two months early, I went into a horrible depression and cried every single day for months. I now understand that it is common for postpartum depression to affect women with these types of illnesses, but I have gone my whole life with little to no support or understanding, and definitely no diagnosis. I feel optimistic, but afraid.

Also, can anyone tell me their about experience on lithium during the first couple of months. I am currently in the middle of graduate school with only two semesters left. If it screws me up, I'm in real trouble because I am on a tight schedule and want to graduate on time. Also, I am working altogether with school about 60 hours a week, starting next week, with a 600 mile commute every week. What can I expect to happen as far as side effects, and will it make me groggy. Also, does anyone know about lithium and weight gain? I've already gained about 30 lbs in a year from my depression, and I think it is making me even more depressed, as I feel like a cow.

Any advice would be appreciated.

Thanks, ladies

 
Old 08-20-2006, 11:06 AM   #8
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Re: Treatment for bi-polar disorder and pregnancy

Hi again,
it feels good to know there is someone in a similar situation to me with the whole pregnancy issue, it is such an awkward situation. But im confident there will be a way through it!
I just wanted to help answer some of your questions about lithium, as i myself was very nervous about taking it and had a lot of concerns. Firstly, i want to say what a fantastic med it has been for me, it really has worked wonders. As far as side effects go, everyone is different so its impossible to say how an individual will be affected, but speaking from my own experience the side effects have been minimal. Infact i have been shocked at how well i have felt since taking it. Ive been on ssri anti depressants for about the past 11 years after being wrongly treated for just depression all this time, and they made me feel terrible, lethargic and generally lacking in energy and concentration. I was expecting the same thing again, but since taking lithium i am brighter with much more energy, i sleep well when i need to, but dont feel the need to go to bed during the day anymore, like i used to on anti depressants. I had some headaches when i first started taking it, but they have now passed completely and i cant remember the last time i had one. The only other side effect i would say i experience is a metallic taste in the mouth and increased thirst, but i just make sure i drink plenty of water, which you are advised to do anyway when taking lithium. Other than this, i feel fine physically and am able to concentrate and get on with things even better than i did before. I was also concerned about possible weight gain (i think we all are as women!) but im pleased to say i have actually lost a little weight since being on it. My pdoc said it can cause water retention, and increased appetite which are what can lead to the weight gain, i think many people also drink sugary drinks if they experience increased thirst, so the best advice i can give is just to drink loads of water! But ive certainly not had any problems with my weight since ive been on it.
I started taking lithium in may this year and id say ive noticed big improvements in the past month, so for me it took around 2 months to start to help me. To begin with i was expecting miracles so i think its important to remember that it can take time, but once it started to work it has been great.
if you would like to know anything else please just ask

Last edited by fallen_angel; 08-20-2006 at 11:06 AM.

 
Old 08-20-2006, 11:26 AM   #9
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Re: Treatment for bi-polar disorder and pregnancy

Thank you so much, fallen angel. That really helps. I am glad to hear that your experience has been so good, and that you are really finding the help you need. Since we have the same diagnosis, I am more optimistic than ever. I was on anti-depressants for a long time too, and they didn't do anything at all. The feelings of not wanting to get out of bed, no energy, lack of concentration, etc. are all symptoms of my regular depressed self. I have spend years and years without a correct diagnosis too, and I am excited that I've finally found the correct one.

I guess I was scared about lithium because in my mind, I think I had made it out to be something it wasn't. One of my friend's mom's when I was younger was supposedly on lithium, and she seemed like she was drunk or on drugs all the time. Her speech was slurred, she'd drool on herself, it was a horrendous sight! Now, I realize there was probably much more going on there than just that. But, that was my impression of it my whole life, and I remember thinking, GOOD LORD, I would never take that, and always thanked the Lord that I didn't ahve her problems. Of course, I was a kid too, and probably made her into something she wasn't in my head.

Thank you so much for sharing. Please keep me posted on your pregnancy situation, and I will absolutely keep you posted on what my doc says and what we end up doing. My husband just graduated with his masters and is looking for work, and we don't want to start trying to have a baby until he's working and we have insurance, of course. So, we don't know how long it will be, and that's not counting the months it might take to actually get pregnant. Are you guys actively trying to get preg. now? Or are you waiting. If you are waiting, how long are you going to wait before you try to start weening yourself off the meds? THis is a tough situation for both of us, but we seem to have a lot in common--recent diagnosis, same diagnosis, and same treatment options. Have you also stared counseling? And one more thing (and if you don't feel comfortable saying, I certainly understand), but I was wondering if you're also dealing with a troubled past at the same time as dealing with the disorder? I have a troubled past, partly because of the bipolar disorder, and partly because of envirnomental factors.

Thanks for sharing! And congratulations on your successful treatment. Please keep me posted, as we share a lot in common.

 
Old 08-20-2006, 12:35 PM   #10
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Re: Treatment for bi-polar disorder and pregnancy

hi there,
it is interesting how our situations almost mirror each other! But comforting too.
I too was very apprehensive about taking lithium, all i knew was that it was a very dangerous drug and was terrified of "poisoning" myself so to speak. I think the most important thing to remember is that it is a potentially dangerous drug, but taken under the right medical supervision it can be totally safe and wonderfully therapuetic. Im sure you know this as it sounds like you have done a lot of research, but you need to have regular bloodwork done with lithium to check your levels, and also regular thyroid and kidney checks, but these become less often once you are stabilised on a certain dosage.
I am trying for a baby at the moment. Im only on a low dose of lithium at present due to the fact im bipolar II. I thought about coming off it completely, but ive only been on it 3 months and i must say im scared to cut down as i dont want to go back to the way i was before. If i found out i was pregnant, i would stop, no question of it. They dont recommend you stopping completely straightaway, so i know it would be a case of having to ween myself off it during the first trimester, which is risky. But i guess i would have to seek medical advice if and when it happened to see which would be the best option. I would certainly be cutting down now if i knew i would fall pregnant easily, but i was trying last year (before i was diagnosed) and i had problems conceiving. Tests showed i wasnt ovulating, so i dont know how long it will take me to get pregnant. Its certainly not something i take for granted which is why i cant risk going unmedicated for any length of time. I have done a lot of research and like you, discovered that the risk of abnormality is thankfully fairly small and a smaller risk with lithium than with anti convulsant medication.
In response to your question, i did also have a troubled past, my father is also bipolar and spent most of my childhood having affairs. I grew up with a lot of emotional problems, i was first diagnosed with depression when i was 12 but id say the bipolar was there from the age of about 13 or 14. I know there are a lot of different theories about whether or not bipolar can be "caused" by emotional traumas in childhood. I have had counselling in the past for these problems but even when i felt id dealt with them the bipolar was there, so i feel drug therapy is the best way to go for now, although i do think counselling/therapy can be extremely beneficial.
Good luck and please keep in touch

 
Old 08-21-2006, 04:43 PM   #11
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Re: Treatment for bi-polar disorder and pregnancy

Hi Fallen Angel,

I find that our experiences are so similar comforting as well. I am going back and forth about starting the meds, afraid that if I do, I'll have to get right off in a couple of months to get pregnant while also trying to finish the last semester of my master's degree and internship; on the other hand, afraid not to start for the same reasons. It's enough to make me go batty, as if I can handle any more of that! Right?

But also like you, I worry about doing the wrong thing for my future children. My husband says "You know there is a small chance that something might happen, and you know that if something did, we'd never be able to forgive ourselves knowing that we might have caused it by making the wrong decision." I have to agree. I already have to live with so much guilt from my past (both from my poor choices and bad decisions, my unpredictable and embarrassing behavior, and from the physical and emotional abuse of others). I harbor a lot of anger and resentment from those things, disappointment in myself as well as those I'm supposed to love and who are supposed to love me. It is enough to drive anyone crazy. But I also obsess about things, includng this. I just don't know what's right.

On the other hand, I worry very much about post-partum depression, and not getting the help I need while I can leading to even greater problems later. I read that the additional stress from not receiving treatment can also cause harm to the baby.

So, what's the right answer? It is probably just a very personal decision, and one that I need to make soon before I flunk out of school or get fired from my job.

 
Old 08-22-2006, 01:36 AM   #12
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Re: Treatment for bi-polar disorder and pregnancy

Hi there,
yes you're totally right in saying that its a personal choice, only you can make that decision.
Do you have a time scale in mind in which you might start trying for a baby? If its not for another few months or so to a year, i would consider starting the meds. If you were going to start trying within the next couple of months, it probably wouldnt be worth it, as they would barely have a chance to have begun working when you would have to either cut down or come off them. Also, if you are prescribed lithium, the dosage is increased gradually to begin with, until it reaches a therapeutic level.
I guess it also depends how much you feel you need the meds at this point in time. Bipolar II is the less severe form of the illness, but any degree of untreated bipolar can be devastating, especially as we, as no II's, are more prone to rapid cycling.I had become totally destructive, swinging from spending ridiculous amounts of money and drinking excessively when i was hypomanic, to plunging into being suicidal. I desperately needed help and was so relieved when i got it. But everyone is different and some cope better than others. Im sure you will feel the benefit of the meds when they have started working, but the question is can you wait to start taking them?
I know how worrying this whole situation is, but its important to remember that lithium only poses a small risk when taken in pregnancy. Some women do take it throughout. i wouldnt personally want to do this, but it does happen.
It is so true when you said this has to be our personal decision, and I dont believe there is any such thing as a right or wrong decision in this situation. It has to be the one that you personally consider to be best for both you, and your future child.
Take care and keep in touch

 
Old 08-22-2006, 12:44 PM   #13
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Re: Treatment for bi-polar disorder and pregnancy

Hi again, Fallen,

I totally agree. And I have also read that it is the least risky of the bipolar medicinal treatments (lithium). Like you, I have dealt with high highs and low lows, but mine last for a LOOOOONNNNNGGGGGG time. Like the depression, this time, has lasted for about 6 months. I also lose my mind with spending and partying and drinking when I'm not depressed, and my drinking has always gotten me in BIG trouble, with my jobs, leading to other bad decisions and using, and with my relationships. After so long, I just assumed all my problems were because of the alcohol, but I knew in my heart that alcohol was not the root cause of my problems, the depression and strange behavior and feelings of insecurity were. I have absolutely no coping skills, and always feel that I'm nearing a nervous breakdown when I'm depressed and working hard, because now I understand that I build myself to be superwoman during my mania and then I'm expected to keep up the pace when I'm depressed. I wonder if that happens to most and that is why I've been seeing a pattern of bipolars confronting trouble in their professional lives around that one-year mark. That has been the same pattern as I've had all my life (read the posts under the heading "Is bipolar holding you back, or is it only me?" or something like that). We've been talking about that.

I feel like I need the meds right away. The problem is, we are not sure when we are going to start trying. Another concern is how long it will take me to get pregnant (I'm 33, turning 34 next April). I graduate in May and then we are moving back down South. My husband has come into some unexpected problems recently with finding a job, so our original plans to get pregnant in December might be put on hold indefinitely for insurance and financial reasons, in which case we would have to wait until next summer before we started trying. It's good if we wait in the sense that I wouldn't be so stressed out while pregnant trying to finish school; on the other hand, I ain't getting any younger, you know? Plus, it would mean I would be out of work for almost a year while pregnant, because I don't want to interview for a job knowing that I am deceiving them about being pregnant. That's not a good way to start off a working relationship in my opinion. It's a damned if I do, damned if I don't situation, and at the moment, I don't have any answers.

But, I have talked to my husband more in depth about wanting to be on the meds, and he was very supportive. I think he realizes more than ever how desperate I feel inside for help. It's something I've needed for as long as I can remember. I have been going through life sick and in need of help and have paid heavy prices for it throughout. I'm ready to be the person that I was meant to be, and that includes being a good mom. You've got to be able to relate to that.

You keep in touch, too. I feel like we could both give a lot of support to each other because of our similar situations. Maybe you or I could start a new thread for that purpose.

 
Old 08-22-2006, 02:30 PM   #14
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Re: Treatment for bi-polar disorder and pregnancy

Hi again!
yes i will definitely keep in touch. its nice to find someone in a similar situation as id started quite a few threads regarding this, (it was one of my first concerns when i was diagnosed) and no one could really relate. Most people had either been diagnosed after having kids, or decided not to have them. i totally respect anyone who has made that decision, but i knew i still wanted children as it has been my absolute dream since i was very young. Ive spoken to my pdoc about this and she advised me to wait a year before trying, but i was trying last year and had problems conceiving (think i mentioned this in an earlier post) so it could take me up to a year or more to get pregnant. I wish we could decide on a month and plan it round that, knowing we would definitely get pregnant at that time! But unfortunately nature doesnt work like that.
maybe the best thing would be for you to start your meds for now and then decide on a time to cut down/stop them, when you want to start trying. at least then you would have a stable few months.I would do this if i knew i would fall pregnant easily but as ive had problems i have to carry on until i know im definitely pregnant.
its so hard, nothing is exact or guaranteed! I bet you, like me, are so happy to have a diagnosis and potential treatment, but at the same time that treatment interferes with your plans and dreams. I guess life wasnt meant to be easy!
speak soon

 
Old 08-22-2006, 02:42 PM   #15
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Re: Treatment for bi-polar disorder and pregnancy

Hey there. Well, my husband and I just had another heart to heart, and I think we've decided to do this: get me on the meds and postpone the pregnancy until after I've graduated with my master's degree in May. After that, starting weaning me off the meds and set a conception date for September. OF course, we might have some problems too, so it might take longer like it has been for you (who knows, right?), but he thought that I should get the benefits from the meds when I need it most, which is now. Like I said, he's very supportive, but this is a new diagnosis with new issues that we weren't prepared for. I think this is a good solution, and I am happy about telling the doc on Friday that I'm ready to start treatment ASAP.

I think this is the answer for us. We can keep in touch and support each other throughout the experience. I would be glad for it, and I will be happy to be there for you too. In fact, I met someone on here in another group (I think it was the cervical cancer board, since I had that scare a couple of months ago and have to go for my re-pap next month). We still write to each other every single day and have become very good friends.

That's what it's all about, I guess, eh?

 
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