Triggers and How They Affect Recovery

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Triggers and Recovery from mental illness

Knowing is half the battle. I found this to ring true in my experience with managing my mental illness during my pregnancies and postpartum.

I was diagnosed with Bipolar Type 1 in 2006. It took over a year for me to find the right psychiatrist, the right combination of medications, and the right techniques through therapy to allow me to begin to manage an illness which had taken me and my family completely by surprise. After months of anguish over what was working and what wasn’t, we finally found a medication that stabilized me and I started to feel pieces of my old self emerging from the darkness.

Once I had been stable for about a year, my husband and I decided we were ready to start a family. I was scared of a recurrence of my illness, but wanted to be a mom more than anything, so we started trying and I was able to get pregnant rather quickly. Unfortunately, our joy was fleeting as I experienced an early miscarriage and had to have a D&C. I was afraid that the medication I had been taking for my bipolar disorder caused the miscarriage, so I convinced my psychiatrist to allow me to taper off the med so that we could try again after I healed from the surgery.

We became pregnant again fairly soon after, and since I was doing so well off the medication and had no recurrance of symptoms, my doctor continued to see me as a patient but allowed me to stay off my medication for the duration of the pregnancy.

This was a terrible decision on both our parts, but I didn’t realize this at the time. Four weeks after delivering my son I experienced a severe episode of postpartum psychosis and had to be hospitalized for a week. It was arguably the worst week of my life, having been ripped from my child, having to abruptly stop nursing, and it took an incredible toll on me both physically and emotionally.

I was stabilized quickly by the team of doctors at the hospital by resuming my course of medication I had been on before my pregnancy. The recovery from the trauma of being taken away from my newborn for a week would take much longer.

I learned through my postpartum psychosis episode that my triggers are: lack of sleep and lack of medication in my bloodstream. These two facts would prove essential to me creating a much more positive postpartum experience with my second child. But not without another lesson first.

Once stable again after my PPP hospitalization, my husband and I began to talk about completing our family with one more baby. Even with my three hospitalizations (two before our first child and the PPP episode), I still didn’t know enough about my illness to know that the benefits of me staying on my medication during the pregnancy and exposing the fetus to the medication, although not the most ideal situation, far outweighed the risks of not being on medication at all given this was one of my top two triggers.

Doctors can advise patients, but it’s up to the patient to follow through with the prescribed recommendations. My doctor had agreed to let me stay off medication during the first trimester due to a heart defect risk, but after week 12 we decided I would go back on my medication for the duration of the pregnancy.

Tapering off my medication in just week 5 of the pregnancy, combined with my excitement and mounting loss of sleep over how excited I was to see those two pink lines on the pregnancy test, landed me in the psych ward again. My baby was barely the size of an orange seed and I had to be hospitalized for almost a week and put on antipsychotic medication to bring me down from the mania I had been struck with.

Because of lack of sleep and lack of medication. Two things I learned I could control.

Recovery from that episode took months; experts say that each subsequent episode is more difficult and takes longer to recover from, and I’ve found this to be true. But I emerged from that setback a much more informed and capable mother, ready to truly manage my illness so that it did not cause me and my family any further pain.

My husband and I talked about how we could handle my postpartum period differently with our second child, and we made plans to take charge over my triggers so that I could stay in recovery long-term. I stayed on my medication for the entire rest of the pregnancy and beyond because my medication kept me stable. We made plans that I would bottle-feed and my husband would take over the middle-of-the-night feedings between 2am – 5am so that I could get a long stretch of sleep at night, keeping my nocturnal clock in check.

I’m not saying it was easy. But my postpartum period with my second child was so much more enjoyable and relaxed compared to my first because I took the upper hand over my triggers. With my family’s support, I made it through. And I continue to keep a firm grip on my dedication to the medication that keeps me stable and getting the appropriate amount of quality sleep each night so that I can stay steady on my recovery path.

Bipolar disorder is a condition I’ll live with for the rest of my life. Learning my triggers and techniques which allow me to stay on top of them so they don’t throw me into a manic episode has been a learning process, but it is one which has empowered me to live well even with a mental health disorder.

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6 Ways You Can Be an Empowered Patient During Pregnancy When You Have Bipolar Disorder

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The best person on my care team? My OB. Hands down. When we found out I was pregnant (far sooner than we had planned), my husband and I decided right away that no matter what course of treatment  we decided upon after speaking with my doctors, our number 1 priority was my mental health. Still absorbing the shock, I remember my husband standing in our bedroom with his fingers lacing their way through mine, saying, “Health and wellness, Addye. That’s our focus, ok? Your health and wellness. No guilt, no shame, no matter what happens. YOU and your health are what’s most important. We’ll do whatever it takes. We’ll get through this together. I promise. Let’s do this.”  I’m pretty sure I was fighting back tears and a whopping dose of fear in that moment as I high fived him and agreed: We could do this. I could do this.

And I did. I have. I’ll be a year postpartum next month, and as I watch my youngest son crawl into the room he shares with his two older brothers, I think back to that moment in my bedroom and feel proud of that promise we made, and the treatment option I chose.

Given my previous history with PPD, the nature of my illness, and the increased risk of relapse I faced because I have bipolar disorder, we decided staying on two out my three medications was what health and wellness would look like for me…as well as for the baby and the rest of my family.

That was my choice, but I know many other mothers with bipolar disorder who opted to go without their medications during their pregnancies and remained healthy throughout. No matter what course of treatment you and your care team decide upon, the important thing to remember is that you DO have options. There’s nothing I hate more (aside from stigma) than coming across an article on the internet that gives women with bipolar disorder incomplete information regarding their treatment options during pregnancy and breastfeeding, doesn’t point to what resources they can utilize to make informed decisions, and doesn’t tell them how they can navigate the unique challenges they’re faced with.

So let’s talk about how to do that, shall we? (This post is going to a bit long, but bear with me, I believe what I’m sharing with you is important)

1. Build Your Care Team, Create a Treatment Plan

I cannot stress the importance of this enough: You MUST have people on your medical team who have experience in treating pregnant women with mood disorders. Think of this as your Dream Team. People you want on this team are your OB, your psychiatrist, therapist (if you have one), and a pediatrician. It’s possible your obsectrician will also want a reproductive psychiatrist and maternal fetal medicine doctor on your team as well, especially if their experience on this front is minimal. Thankfully, my OB had extensive experience with caring for women with bipolar disorder during their pregnancies and knew pretty much everything that’s out there regarding medication use during pregnancy and breastfeeding. He was up to date on the latest research available and proved to be my most invaluable resource on my care team. Seriously, he’s the one who gave me the confidence that all would be well, and that choosing to stay on at least two of my medications was a safe and healthy choice. Both he and my psychiatrist spent a lot of time going back and forth, weighing the risk vs. benefit of staying on meds or going without, and although they disagreed on a few minute points, they ultimately decided staying on medication would be healthiest for me, and ultimately, baby.

Also be sure to find a pediatrician to consult. You’ll need one anyway after the baby is born, so you might as well find one who knows about medications, postpartum mood disorders, AND does depression screenings at well visits. (Our pediatrician does and it has been incredibly helpful to me this past year.)

Finally, ensure that the team you build has your mental health as their top priority. As soon as a woman becomes pregnant, the focus tends to immediately shift toward the health of the baby and stay there. In the past, I’ve dealt with OB’s who only cared about how I was doing physically and what impact any physical conditions I had would have on my baby in utero. Not once did they focus on my mental well-being, let alone have it guide my prenatal care. Listen: I completely agree that baby’s health is a priority. I do. But I’m going to just come right out with it and say that a mother’s mental health is what’s most important and should be the foundation of her prenatal care, and if no one on your team shares in that philosophy? They shouldn’t be on your team or in charge of you and your baby’s care. Period. Same goes for the person treating your mental health condition. My first psychiatrist through the VA was woefully uninformed and unhelpful when I told her I was pregnant. It took a lot of pushing, but I was finally able to have my care transferred to a psychiatrist with a background in pharmacology and reproductive psychiatry, and it made a significant difference in my overall care.

2. Communicate and Advocate

Everyone on your care team should be in constant communication with you and each other through every phase of your pregnancy and delivery. They should also be able to come to an informed consensus (with you) about your treatment. There is nothing worse than having two of your doctors at an impasse over a part of your treatment plan because they just disagree. It’s incredibly frustrating and the last thing you need to be worried about. If this happens, don’t be afraid to speak up and advocate for yourself, reminding them that they are there to help care for you and your baby, and you need them to work together.

Always be open and honest with your care team about what you’re feeling and experiencing throughout your pregnancy, so they know how to help you as soon as possible. Part of my treatment plan involved staying off of my mood stabilizer during my first trimester, but remaining on my anti-depressant. At 11 weeks, I called my OB and told him my mood was starting to take a nosedive and I was worried about a depressive episode. He moved my NT ultrasound scan up to the start of week 12, and as soon as he reviewed the results, gave me the all clear to start back on my mood stabilizer.

3. Do Your Own Research, Knowledge is Power

There are books out there on  medication use during pregnancy and breastfeeding and the variety of treatment options available for women in our situation-get your hands on them and read as much as you can, being sure to talk with your care team about what you learn as you do. When researching my treatment options and discussing them with my team, books I read included Pregnant on Prozac by Dr. Shoshanna Bennet, Medications and Mother’s Milk 2012: A Manual of Lactational Pharmacology by Dr. Thomas Hale, and The Complete Guide To Medications During Pregnancy and Breastfeeding: Everything You Need to Know To Make the Best Choices for You and Your Baby by Carl P. Weiner MD and Kate Rope.  I also read everything I could on the MGH Center for Women’s Mental Health blog, which has a wealth of information on research studies and how to use their findings to make informed treatment decisions with your clinician.

4. Create a Birthplan That Takes Your Mental Health Into Account

Initially, I considered going without pain meds for my delivery. I read all I could about natural child birthing methods, and had it in my mind that I’d hypnobirth my way through labor and delivery, even if  I wound up crying uncle and utilizing some form of pain medication. But at 28 weeks, I landed in L&D with contractions that wouldn’t stop without magnesium. In fact, they didn’t really stop the rest of my pregnancy. I contracted every day of my third trimester without ever dilating more than 2 centimeters. Previous experience reminded me that neither of my labors with my older two progressed without intervention, despite having intense, painful contractions that were off the charts for a week. Looking back, I’m positive this contributed to the panic and anxiety I had during both deliveries and afterward. With this third go around, I was miserable, exhausted, starting to have anxiety attacks, and was starting to cycle between nesting induced hypomania and depression.

At week 38 I told my OB I was done and worried that continuing would put me over the edge and trigger a depressive episode-and I hadn’t done all of this preventative health and wellness work to be in a dark place when my baby boy was placed on my chest. I knew my limits, and wanted a bit more control. I wanted an induction. He agreed, and a week later I was in the delivery room smiling and laughing as I stared lovingly at my newborn-100% anxiety free. It was a calm and beautiful experience and in my opinion, gave me the strong start postpartum I needed.

Whatever your birth plan is, make sure it’s flexible, realistic, and compliments your treatment plan.

5. Have a Support Network

Having the love and support of friends, family, and your partner is so important. Lean on them when you need to, and don’t be afraid to ask them for help. Inform them of ways they can be a support to you. My friends (fellow Warrior Moms) and my husband did an amazing job of supporting me during my pregnancy and this past year. I couldn’t have made it without them to call, text, and share this experience with. A therapist can also be an invaluable resource to you during this time; they can help you process all you’re experiencing and develop coping strategies for managing your postpartum period. Consider finding support online in a private forum for pregnant and new moms with mood disorders (like Postpartum Progress’ Smart Patients Forum or the #PPDChat private group on Facebook), or find what’s available to you locally through organizations like NAMI or DBSA.

6. Self Care

Try to find ways to incorporate rest into your day as much as possible, even if you already have other children. Do not go without sleep. Create manageable to-do lists, and reconstruct your expectations about how much you can get done each day-especially if you’re working. Practice deep breathing exercises, and engage in physical activity that is both safe for you and baby and feels good. Engage in activities that are calming and nourish your soul-even if it’s binge watching your favorite show on Netflix. Keep track of your mood either in a journal, or with a mood tracking app on your phone; this will help you be able to communicate to your care team and support network how you’re doing. (I use iMood Journal) Prenatal massage, mani/pedis…whatever self-care looks like and is for you, be sure you do it and do it as much as possible.

 

I hope this is helpful and gives you a good starting point for creating a plan that works for you. Remember-You have options when it comes to treatment. You can do this. I promise. You got this, mama.

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Let’s Rewind: The Isolation of Motherhood pt. 2

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My family and I headed to a castle. No big deal.

My family and I headed to a castle. No big deal.

Parenthood is, in a lot of ways, just a bunch of sleepless nights bleeding into long days. That sounds kind of bleak, but I’m not sure there’s a more complex state of being than that of being a parent. You’re always being pulled in multiple directions and overcome with conflicting emotions. And, honestly, I’m not sure that it’s ever as hard as it is in the first gritty-eyed months of having a freshly baked baby.

Throughout Archer’s first year, inertia carried me. Once I went back to work, the force of my footsteps was the only thing that propelled me forward. Daycare. Work. Pump. Coffee. Pump. Lunch. Pump. Daycare. Home.

And through it all, I felt alone.

Physically, distance crushed me. I was half a continent away from my family. Emotionally, disconnect destroyed me. Most of my friends did not have children of their own. If I could have articulated how abandoned I felt, my words would have been scarcely a whisper.

But, again, let’s rewind.

Breastfeeding came easily to Archer and me. Despite his time in the NICU, he latched quickly and nursed like a champion. The emotional trauma of his tumultuous birth experience was healed by our outstanding nursing relationship.

Nursing sustained us. It bonded us. It provided just the right dose of feel-good hormones to shield me from the undercurrent of isolation that tried so insidiously to steal my joy. When we weaned, the loneliness reached up from the deep below and quietly pulled me down.

Without realizing it, my body and mind were being realigned as Archer nursed less. The chemicals in my brain like tectonic plates, slowly and imperceptibly shifting to create entirely new and unrecognizable continents within my psyche.

I left my job to pursue a freelance writing and marketing career and I spent each day deafeningly alone. Just me and my deadlines and – I know now – my depression.

Despite having solid support systems and amazing friends, I was borderline non-functional by the time I admitted that I needed help. Depression is a liar and she told me that no one knew my plight – that such loneliness was the result of being undesirable by friends and family alike.

In my first postpartum counseling session, I sat across from my psychiatrist and psychologist – both specially trained to work with mothers with mood disorders – and told them how impossibly isolating motherhood was. My doctor pushed up his glasses, looked me in the eye, and said, “Liz, I am not here to belittle your experience, but I want you to know that every mother who has ever sat in that chair has said those same words.”

Now, let’s fast forward.

With a diagnosis of “post-weaning depression,” I restarted on my Lamictal and recovered, once again, quickly. And, again, we reveled in my stability.

Archer became our co-pilot on a new adventure and we moved from Baltimore to Germany for a three year assignment with my husband’s job. In our time here, the isolation of motherhood combined with the isolation of ex-pat life to create a sort of mecha-loneliness that has tried to cut me down many times. If I’m being honest, sometimes, it has succeeded.

Enduring a rough pregnancy an ocean away from family and friends did little to quell the rising tide of lonesomeness. Late night nursing and long days working ignite sparks of heartache that occasionally rekindle the flames of alienation.

But, in my worst days, I rewind to my psychiatrist’s office and remember that my isolation is not a unique condition of my experience with motherhood.

You see, motherhood is a weird thing in that many mothers experience the same things, but in different ways. There are times when all of us feel alone. Motherhood, on some level, breeds some amount of isolation. But, in that isolation, we are – in a twisted way – brought together.

 

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Let’s Rewind: The Isolation of Motherhood

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Liz Bauman is an American wife, mom, and writer living in Weisbaden, Germany. When she’s not camped out behind her computer screen, she quests for castles, plays Dungeons and Dragons, and drinks a lot of tea. Earl Grey. Hot. She’s also one of my favorite people, and a woman who’s personhood and journey through motherhood while living with mental illness always leaves me inspired and hopeful. If you’re so inclined, you can learn about her, tweet at her, or hire her. I’m thrilled she’s sharing her experience with us here on Postpartum Progress this week. Here is part One of her story. 

 

Archer at 16 days old

Archer at 16 days old

If asked to describe my experience as a mother in a single word, I’d love to say something like “joyful” or “empowering.” There are certainly days where I feel like motherhood has made me a strong advocate, a better feminist, and a compassionate member of the cult of womanhood. Sometimes, I go weeks at a time feeling like my two children have made me a better, more resilient woman. Like all that breastfeeding and babywearing have somehow infused my very essence with radioactive awesomeness, transforming me into some kind of Hulked-up mama hero.

But, the truth is, my motherhood has been isolating.

Let’s rewind.

Back when my husband and I were young and wild college kids in the expansive plains of South Dakota, we decided we would get out. Get far, far away from small town life and farms and go have big experiences in big cities. Shortly after we got engaged, the husband got accepted to George Washington University and I – on uneasy terms with my family – agreed that we should set forth on our grand adventure.

After 7 years in DC/Baltimore sprawl, we welcomed our son, Archer, and my world got simultaneously brighter and darker.

Let’s rewind again.

I struggled with mental illness since my teens. My diagnosis was a fast-cycling flavor of bipolar disorder characterized by frequent, but largely harmless ups and downs that rarely affected my life profoundly. But, a miscarriage at 23 triggered some major shifts in my brain chemistry that twisted my “frequent, but largely harmless ups and downs” into a screaming spiral into the gnarly pit of mix-state madness that nearly shattered the foundations of the life my husband and I worked so hard to build.

It was my first dose of the vicious isolation of motherhood and I didn’t even get a baby out of the deal. We had told no one that we were expecting, so I grieved our lost child alone. I internalized it and the sadness wrapped sticky, black anger around my bones that eventually permeated my heart and mind.

Broken and desperate, I hit rock bottom and my husband made me promise that I’d seek help.

A new shrink and an RX for Lamictal later, I was better. That seems like an over-simplification, but it was a pretty uneventful period of recovery and we spent a couple years soaking in our baby-free life, just being young and married and loving life on the East Coast. We both had our dream jobs and, with time, overcame the anxieties of miscarriages and mental breakdowns and I weaned off my meds so we could try, once again, to bake ourselves the proverbial bun.

It took a while, but – after 8 months of trying – we discovered we were expecting Archer. And things were good. Pregnancy was wonderful to me. It was my renaissance. I was stable, productive, and happy-all while being unmedicated.

When Archer was born, via emergency c-section, his resultant NICU stay tested my mental fortitude in a way I couldn’t have expected. Without going into all the triggery details, he spent his first couple of days drifting down the “will he/won’t he” line and I wouldn’t wish that sort of terror on anyone.

As he and I recovered, I found myself alone in the hospital. I was discharged and my husband – an important dude with a high-pressure job – went back to work. The nurses, taking pity on me, let me camp out in their on-call room so I could nurse Archer through the night because they didn’t have on-site rooms available for discharged moms.

I cried a lot. I’d never felt so alone. “Is this what motherhood is supposed to look like?” I asked myself as I cradled him his next to his incubator, lights blinking and monitors blooping.

Now, as I sit on the cusp of my second child’s first birthday, I can say pretty definitively, that it may not be what motherhood is supposed to look like, but reality is Kryptonite to supposition.

 

to be continued…

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