Navigating Bipolar Disorder During Pregnancy and Beyond, Part 1

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addyepreg1When the pregnancy test flashed a positive sign nearly a year ago, I was elated, shocked, and terrified. It was completely unexpected; we weren’t planning on trying to add to our family for at least another year. Nevertheless, my heart soared with the thought of newborn snuggles and ample baby chub to nibble on and kiss. Then fear settled in my stomach like hardening cement as my head began to spin with the reality that lay ahead of me.

I have rapid cycling bipolar disorder II with OCD and anxiety.

At the time, my treatment plan included three medications: Lamotrigine (Lamictal-mood stabilizer), Fluoxetine (Prozac-antidepressant), and Clonazepam (Klonopin-for anxiety).

I had suffered from antenatal and postpartum depression during and after my previous pregnancy 4 1/2 years ago.

Having bipolar disorder increases the risk of a recurring onset of PPD and postpartum psychosis significantly.

That fear birthed questions…

Would I be able to stay medicated? What if I couldn’t? What would I be able to take? Would taking medication to manage my illness harm my baby? Was I being irresponsible or a bad mother for wanting to continue medications, knowing the risks associated with certain medications like Lamictal?

Could I handle being a mom of three?

Would the rage and despair I had experienced during the darkest moments of PPD return?

I had just been hospitalized five months prior for suicidal ideations after a significant depressive episode. Even if I made it through the pregnancy, would I fall prey to psychosis in the days or months after bringing my baby home?

My closest friends, the very ones I had found within the Warrior Mom community responded to my fears with hope: “You can do this. It doesn’t have to be like last time.”

Despite his fears (which were pretty much the same as mine), my husband responded to it with an assertive declaration while looking me straight in the eye and saying, “Hey, we’re in this together. Health and wellness, Addye-that’s our mission this pregnancy. Whatever you need to achieve it, we’ll seek it out, I promise. You’re not alone.”

Their support was the push I needed to move past my fear and set about finding the answers to my questions — most importantly, what to do about my medications. As a disabled veteran, my mental health care was handled through the VA healthcare system. Upon telling my psychiatrist I was expecting, she responded by telling me that considering my “condition,”  getting pregnant was “irresponsible and selfish,” and taking any medications to treat my illness during pregnancy would harm my baby.  I walked out of her office and began seeking a more knowledgeable opinion.

I found hope in my obstetrician, whose 20+ years of experience included successfully treating pregnant women with mood disorders like bipolar. When I called to schedule my first appointment, I informed the nurse of my illness and concerns about my medications. She took down my mental health history, and placed me on hold while she queried my OB for guidance. She came back to the phone with an initial treatment plan and instructions to call immediately if I began to struggle and needed an adjustment of any kind before my appointment. At that initial appointment, my OB walked in, introduced himself while giving me a bear hug, sat me down, and spent the next 20 minutes going over my treatment plan, the latest research regarding risks, and his recommendations based on it and his experience. With his help, I was  finally transferred to a more knowledgeable psychiatrist at the VA mental health clinic here in Austin.

I also found hope in researching treatment options and medications, and talking to other moms with bipolar disorder who had navigated the same journey successfully, both with and without medication. I went to the library and checked out books from  experts such as Thomas Hale, (the latest edition of Medications and Mother’s Milk) Carl P. Weiner and Kate Rope (The Complete Guide to Medications During Pregnancy and Breastfeeding: Everything You Need to Know to Make the Best Choices for You and Your Baby), and Dr. Shoshana Bennett (Pregnant on Prozac: The Essential Guide to Making the Best Decision for You and Your Baby).

Once I was placed under the care of a new psychiatrist (one with expertise in pharmacology), I walked into her office with those books in hand and we went over the pros and cons of what I was taking and discussed my options around breastfeeding. We also agreed talk therapy with an emphasis in Cognitive Behavioral Therapy (CBT) would help me manage my OCD symptoms, and assist me in developing a self-care plan and coping strategies to manage my moods. I saw her twice a month, and if at any time it was determined that my medications needed to be adjusted, we made calls to both my OB and pediatrician to discuss dosing.

The pregnancy itself was physically difficult, and there were days I found the discomfort and pain I was in triggering — especially during my third trimester where I experienced painful contractions daily. On those days I often had to force myself to reach out to my support system, ramp up on self-care, and make peace with where I was at, reminding myself it would pass.

Upon reaching 39 weeks I was exhausted but hopeful, wanting it to be over but nervous about what would be coming next: a new baby and a new life as a mom of three.

Stay tuned tomorrow to find out how my delivery went, how I’ve been adjusting to the postpartum period, and how it’s different from my last. 

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About ADriane Nieves

A'Driane Nieves is a writer and artist best known for her love of Prince. She writes about navigating the nuances of motherhood and bipolar disorder type 2 along with her thoughts on various social justice issues on her blog Butterfly-Confessions.com. She lives in Austin, Texas with her husband and three boys.

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  1. I also have bipolar disorder type 2, and I did choose to be medicated through my last pregnancy (my second – I hadn’t been diagnosed at the time of my first). It took a lot of planning before we got the ‘ok’ to get pregnant, but it was worth it. I stayed on a selective few medications and I chose not to breastfeed, which was also a good choice for me – I was able to get a tonne of help from my husband and from other family so that I could continue getting a decent amount of sleep – lack of sleep is a major trigger for my bp episodes – without the stress of feeding and pumping, something I hated the first time around. I was able to avoid antenatal/PPD and anxiety, which was awesome. The years since then haven’t been the most awesome, but none of that relates to the pregnancy or post-partum things. Anyway, that’s my experience.

  2. Sarah F says:

    Hello, I just wanted to say again thank you to everyone. I am trying to stay hopeful and trying really hard to get rid of these thoughts and make myself think differently. I notice the only time it happens is when I get very nervous or anxious. But I despise this am I am going to not think like this I believe that to be true. Most of the thoughts are not directed towards my baby but revolve around. I don’t know if that makes sense. Like I said my mind goes to gutter gutter on things that either people say or I say. I was constantly anxious and started to be nervous around my baby. I’m trying my hardest not to be like that. But I think I am getting hope back.

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  1. […] ADriane Nieves February 18, 2014 Leave a Comment var hupso_services_c=new Array("twitter","facebook_like","google","pinterest","email");var […]

  2. […] To read some more about my experience with PPD & Bipolar Disorder during pregnancy, you can type “ppd” in the search box here to find some older posts, and you can read guest posts I’ve written here and here.  […]