I’m a female of child-bearing age… who has been diagnosed as Bipolar II. The message that the different doctors have given me so far has been “don’t get pregnant.” (In fact, one offended me so much with how she delivered this message that I cancelled my follow-up appointment and got a new psychiatrist!)
There’s a strong family history, so I’m well aware that there’s a risk of having a child with bipolar disorder.
But what I would particularly like to see discussed is how we can make sensible decisions about becoming pregnant – with respect to medications, psychological therapies, family support, etc.
Do I go off the meds, because there’s a risk to the child? Or do I stay on the meds, because I need them to be stable enough to care for it once I give birth? Is there research to guide this decision?
We really have two questions to address here:
I’ll address each of these in turn….
Answering this question involves a very complex and personal decision process that will include you, your partner, your psychiatrist, and your OB/GYN. There is a growing body of literature on the patterns of genetic risk related to bipolar disorder and we have previously discussed some of the most current statistics in Part I of a previous two-part series entitled “Bipolar Disorder & Heredity &ndash The Genetic Link.”
The data keeps expanding though and a recent study published out of the University of Pittsburgh indicates that children of parents with bipolar disorder have an elevated risk of developing early onset bipolar disorder, anxiety disorders, and mood disorders, not just standard bipolar disorder. See “Pitt Study Finds Children of Bipolar Parents Have Increased Risk of Psychiatric Disorders” for a summary of the article.
As you rightly point out, there are risks to exposing a developing fetus to the medications used to treat bipolar disorder, but there are also risks to a developing fetus from untreated depression or mania during pregnancy. This is in addition to the potential for reducing care-giving ability that you have thought about.
Some of the medications are more clearly teratogenic (prone to causing birth defects) than others, but for many medications, the data is unclear. Certainly, a big part of the work includes close psychiatric monitoring throughout pregnancy and the post partum period. Changing medications, stopping some meds, reducing others, using non medication interventions more aggressively – for example, psychotherapy, light box treatment, etc. – are all possibilities.
Dr. Lee S. Cohen, Director of the MGH Center for Women’s Mental Health, is one of the most published and sensible experts on the topic of using medications to treat mood disorders during pregnancy. The center’s website provides excellent information on many topics related to mental health issues during pregnancy and the postnatal period. The website also contains a link the center’s blog.
Dr. Cohen has a book out that was published in 2005 entitled Mood and Anxiety Disorders During Pregnancy and Postpartum (Review of Psychiatry)
. His writings and the website are good starting points for obtaining more information and updated discussions about the research regarding specific medications and the general approach to psychiatric medications during pregnancy.
If you have any insights, experiences, or tips to share about managing pregnancy or raising children as a parent with bipolar disorder, please post a comment.
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MGH Center - What a great resource! Thank you for posting this.
I got through one pregnancy with no medication at all until the 8th or 9th month, and then as a preventive measure. I was working closely with my psychiatrist, my OB/GYN and her superiors and my spouse throught the whole pregnancy. I received my prenatal care and delivered my baby at hospital that is well known for it’s research on how drugs affect babies. My psychiatrist who had been opposed to the pregnancy in the first place, moved in my 5th or 6th month and I had to start seeing someone new. This was possible the most difficult part for me, emotionally, but she was very supportive and had seen other patients through pregnancy before. She started me back on my meds about 6 weeks before I delivered with the agreement of my OB/GYN in order to prevent mood swings post-partum. I made it through the entire process with not mood swings at all. I had been stable for about 5 1/2 years which made a huge difference, I think. I would not recommend stopping all medications for everyone, but I was determined to do it and it worked for me.
As for whether it was a good idea to pass on my genes, I don’t know. Is it any worse than the genes I may carry for heart disease or cancer? My child’s pediatrician is aware of my bipolar status and asks me about my mental health everytime we see her and I’m certain she will be watching for any signs of mental illness in my child. The one thing my kid will have that I didn’t is parents who are aware of the potential for this illness and know how to handle it.
I have a wonderful child who might be considered bipolar in later years, however I have found that having a mental disorder does not mean a child will develop the disorder. Society in what causes mental disorders in our children because there are many people out there who are mentally ill and they do not accept it. Bad life situations does not mean that one cannot have rear children. Just take a look a the people who do not have any mental illness, thier kids end up in jail and make horrible decisions. But of course, if a women cannot take care of her personal needs then, no she should not have a child and niether should a man for that matter.
I am 26 years old. I was diagnosed with bipolar when I was 22, when I was admitted to a hospital in the middle of my failing college career. I took meds for two months, then quit, thinking, “This illness will not define me…it’s temporary…it’ll go away.” Four months ago, I realized I was 1 1/2 mo. pregnant to a man I had known (and had been sleeping with) for a month and a half. I was, at that time, by no stretch of the imagination managing my illness. In fact, I was drinking heavily, staying up late, and sleeping with a man I barely knew, prescription-free (including birth control).
When my hormones began to rage, and triggered my bipolar about two months ago, the dad decided he wanted out of the relationship. Still wanting to “be a part of the baby’s life” (whatever that means..) he left me alone, five months pregnant with his child, to struggle and deal with a whole new life awaiting me, and face-to-face with my illness, again.
I was readmitted into the hospital a month later. My psychiatrist now has me on a low dose (very low - 5 mg/day) of Lexapro. I am not sure if it is helping, or if I am just cycling through alternating mood swings and regular un-symptomatic periods of time, but I am getting more used to the idea of being alone right now - it’s better than being with someone who cannot forgive, or love me in spite of my illness.
And chances are my daughter will have the illness, as well (my mom has always had it). If I want to be the best mother I can be, I need to learn as much as I can now about the illness and how to treat it, and I need to find a partner who loves me enough that he is willing to do the same.
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