Hi guys, I'm new here and just looking for some advice. Hopefully I get it right!
And heads up/content warning for pregnancy loss too.
I've got bipolar type 1 which was diagnosed in my late teens. I have become psychotic during both depressed and manic episodes, although never when I'm well. I have had two pregnancies. The first as a teenager which ended in miscarriage at 8 weeks, and had no effect on my mood. The second was about two years ago, and it was deeply traumatic. I fell pregnant with a mirena IUD in place and while I was on 2000mg of valproate, which was stopped after I found out about the pregnancy - we found out at twenty weeks that the baby had anencephaly and we had a termination about a week later. In the next couple of days I became increasingly depressed and then delusional, which was missed by my health care providers because they assumed it was normal grief. I got really unwell really rapidly after I left hospital, and after a week my partner called a crisis team and I spent four months in hospital and ended up having ect. I've been on valproate (2000mg) for the last eighteen months, during which I have had one episode of hypomania lasting two or three weeks about a year ago, and 10mg of olanzapine was added. I've been back in fulltime work for a year, and I'm doing pretty well.
So, I guess my question is - how do I bring up planning for pregnancy with my psychiatrist? I absolutely do not want to go through a pregnancy on valproate again, so I know I will have to get off of it, but I don't know if the olanzapine by itself will be enough? I don't want to be unwell again, and even if I stay fine during the pregnancy, what about postnatally??. Plus I get the feeling that my psychiatrist will judge me for wanting to risk my mental health by getting pregnant.