46 First Person: Pregnancy and Bipolar Disorder

AUTHOR WITHHELD

The issue of bipolar disorder and pregnancy is close to my heart. To conceive or not conceive? What are the odds of me having a child with a mental illness? What are the medication risks? These issues are too daunting to write about in one article, so I have limited this essay to sharing the basic decision-making aspects of pregnancy, and have limited the detail of pharmaceutical aspects.

Pregnancy is such a wonderful experience and exciting time for parents to be. All parents want their children to be healthy. While the capability of testing for some genetic markers is possible, at this time, bipolar disorder is not one of those, despite the known genetic risk factors.

In 2007, when my husband and I were at the point in our lives of deciding whether to conceive, I decided to look for a book on this topic to help my decision. What I discovered—or rather didn’t discover—amazed me. Finding a book on the topic of pregnancy and bipolar disorder was difficult. In 2007, one book was in the process of release: Bipolar and Pregnant by Kristin K. Finn. One book! There were plenty of articles on this topic, but I was just flabbergasted there were not more published books. The books I did find only dealt with raising a child with bipolar or mental illness, or dealing with a spouse or significant other with a mental disorder.

What would happen to my child if they were diagnosed with bipolar?

Another factor I felt needed to be considered is that both my husband and I are bipolar, so that added more complexity to our decision. Bipolar disorder is known to have genetic causes.  I struggled with this tremendously. What would happen to my child if they were diagnosed with bipolar? Would they be angry knowing that I conceived them knowing that the odds were against them? If I was in their position knowing that I would be bipolar, would I be angry with my parents? These questions were just many of the numerous ones that went through my head.

While struggling with the above issues, I needed to look at the physical issues as well. Pregnancy can exacerbate symptoms. The additional hormones and the decision to manage symptoms with or without medication is an enormous issue to tackle.

Planning a pregnancy in itself consists of many factors: stopping smoking, alcohol and caffeine use, and prescription and over the counter medication use. It also involves taking care of one’s general health and eating a healthy diet. Dealing with pregnancy while having any mental illness comes with many trials and tribulations. For those specifically with bipolar disorder or a mental illness additional questions may arise:

• What psychotropic medications can I take?
• Will my child inherit a mental illness?
• Will pregnancy hormones work for or against me?
• Will there be an increased risk for the severity of postpartum depression?
• Should I breastfeed or not?
• Will medications that I am presently on be transferred through the breast milk?
• Will my disability destabilize me, and influence my ability to care for my newborn?
• Will lack of sleep be destabilizing? For me, lack of sleep throws me into either a manic or a depressive episode.

I wish I had a crystal ball that helped me to answer these questions. Bipolar disorder typically emerges during early adulthood and is present throughout the lifespan, usually coinciding with a woman’s childbearing years. I think many women, like me, grow up thinking “I want to be a mommy one day.” So trying to deal with this issue and this roadblock was very hard. There are still so many whys. Why me? What did I do to deserve this? All I wanted was to grow up and be a mommy!

What do you do when an infant is depending on you for their needs?

Unfortunately, there has not been a lot of comprehensive research on this topic. While some psychotropic medications have been shown not to have a significant impact on the fetus, what does “significant” really mean? There really is no definitive information that answers this question. The answer usually comes down to risk vs. harm: Do you manage the mother’s illness or simply consider the baby? Stopping medication is very risky and can contribute to a relapse, which jeopardizes the mother’s health and ability to care for the newborn.

What do you do when you are not able to stop taking prescription medications? The bottom line really comes down to a personal decision to make by the parents. Many people believe that conceiving a child is worth the risk for both themselves and the child. Careful planning before conception will help ease and aid in managing symptoms that may arise.

I am still struggling with these questions, as I have been for six years. I am still undecided, still trying to stabilize myself. It is a difficult decision, and I think taken for granted sometimes by those who do not have the same questions we with mental illnesses have. My husband and I still do not have an answer of yes or no. If only I had that crystal ball.