Biploar Medications

[Bluelady-sing]

Did anyone conceive with these on board what was the outcome for baby

[Lilybeth Volunteer]

Hello Pumpkins

Good to hear from you again.

I don't have any experience of Bipolar but there will be other mums here to advise you. In the meantime perhaps you can contact BipolarUK online which has an e-community with a forum, similar to this, where you might find helpful advice. The link being bipolaruk.org/

Take good care.

[JaneHW]

Dear pumpkins,

I suffered pp with my first baby and when my husband and I were considering a second I was on a whole raft of bipolar meds, including lithium and various anti-anxiety meds. The official Nhs advice we received at the time, perhaps 4yeats ago, was that I needed to come off the lithium completely because of a small risk of the baby developing a heart defect in utero. Unfortunately following this pre-conception advice meant that I became very ill, developing a bi-polar mixed episode, and I had no further access to Nhs help, forcing us to go privately. This new psychiatrist advised that perhaps some reduction over the first trimester was advisable, but that the balance of risk against the mother becoming seriously ill had to be taken into account, and that the specific heart defect (whose name I forget) was something that also effected the wider non-bipolar population.

We haven't so far ever tried again, and advice might have changed since then. I was very cross about how things were mishandled at the time, and the short comings of the so-called pre-conception advice available through the NHS. If I were to to do it again, I would want the security of knowing where my medical back up was while I was going through the process of reducing certain key meds and have contingencies in place.

I hope these ramblings are some help and that other mums might have experiences they can offer. Best of luck,

Jhw

[Bluelady-sing in reply to JaneHW]

So far I heave been told that I am a risk - I am actually making a complaint I was basically told I was doomed to failure, It seemed to me that the medical professionals would rather I did not have a family. please reply

[Ellie_at_APP Partner in reply to Bluelady-sing]

Hi Pumpkins

I'm not sure if you live in the UK or not so I don't know if some of the links for support I will give you will be helpful or not? First of all I wanted to make sure you have seen our guide for planning a pregnancy for anyone at risk of PP? It's free to download. This will give you all info about planning a pregnancy and perhaps you could also give it to the professionals supporting you, so they are informed too: app-network.org/what-is-pp/...

The most important thing is that you need to see a perinatal psychiatrist, not just a usual psychiatrist, even pre-conception. A perinatal psychiatrist specialises in supporting women during the perinatal period, and they will be able to advise you what medications etc are OK to take in pregnancy. From what I have heard about perinatal psychiatrists they are usually supportive and do try and give good advice, balancing the mental health of the mum and the also the health of the baby.

If you are in the UK I know that perinatal services can be patchy. If you don't have access to a perinatal psychiatrist you need to ask your GP or mental health team refer you to APP's second opinion psychiatry service. Dr Ian Jones specialises in bipolar and PP and will give you and the team supporting you advice about your pregnancy / meds etc. We have nothing but positive feedback from this service and most important you need to emphasise that it is a free service, so no cost to your funding authority or to you (as if they think there is a cost they may not want to refer you): app-network.org/what-is-pp/...

You also may find it helpful to look at this website where you can search for all mental health meds and their side effects, including whether they are safe to take during pregnancy: choiceandmedication.org/ncmh/

I do hope you can get the support you need, and I hope all this info is helpful.

[JaneHW in reply to Bluelady-sing]

Hi pumpkins,

I know it can certainly feel that way, especially when you're up against such a cash-strapped system.

I obviously had a very negative experience of the pre-conception advice, and there were lots of things I felt could have been done differently, which I subsequently fed-back into the system. I wasn't aware at the time of the service offered by Dr Ian Jones in Cardiff to bi-polar women. I think you'll find that lots of PP women on this forum are deeply grateful and have gone on to make an informed decision that is right for them. Ellie, in her reply below gives the details as to how to access that service.

I hope that it helps. I know how demoralising all of this can feel, but hope you'll know that there are lots of us behind you hoping you get the right advice.

Best, JHW

[Cicerenella]

Having a diagnosis of bipolar disorder doesn't mean that you're doomed to becoming unwell during pregnancy and the postpartum period. Really good pre-conception advice, and then good support during pregnancy and the year following the birth of your baby is really really important for having a good outcome. You may need medication during pregnancy, and depending on what has worked for you before (and the level of risk you and your psychiatrist are willing to take), the medication may or may not be unsafe for the baby. Antipsychotic monotherapy (or even in combination with antidepressants) is generally ok during pregnancy - although they can increase your risk of gestational diabetes. Lamotrigine has been linked to an increased rate of oral clefts. Lithium has been linked to Ebstein's anomaly (a cardiac malformation). The rates of those defects is still relatively low, and if you are on those medications during pregnancy you'll be very carefully monitored to see if the baby has been affected - in which case, surgery will correct the defect.

I unexpectedly fell pregnant while on sodium valproate (contraindicated in pregnancy) and while I had a mirena IUD in place, and our baby had a neural tube defect as a result of sodim valproate. NTDs are a known malformation related to the use of this drug. He had anencephaly, which is where there is an opening in the neural tube at the upper end where the brain should develop. He did not have any brain besides a rudimentary brain stem, and was also missing part of his skull above the opening. We chose to have a genetic termination of pregnancy, and induced labour very soon after finding out the diagnosis. I had a psychotic episode after giving birth, which I feel could have been prevented (or mitigated) if I'd had better support from the obstetric and midwifery teams immediately following the birth.

I've spent the last few months planning with my psychiatrist about what to do with any subsequent pregnancies and I feel really confident in the plan that we have. I've just found out that I am pregnant (Had my dating scan a few days ago, and I'm 7w4d!!!). I ceased sodium valproate well before trying to get pregnant this time, and stayed on 10mg of olanzapine. I also took 5mg of folic acid to try to reduce the risk of another NTD. I am going to have a meeting between the psychiatric team and the obstetric team at about 24 weeks regarding postnatal care - and the plan is that I stay in hospital for between 5-7 days (we're going to birth at a private hospital so that this can be accommodated). I'll probably increase the dose of my antipsychotic immediately following the birth too. I will have really frequent visits from mental health nurses after I'm discharged from hospital, so there'll be lots of people visiting me and making sure I'm coping. I'll also have a pretty low threshold for admission to the MBU. I have the option to start taking sodium valproate or lithium after the baby is born, but I am trying to avoid that because I really want to breastfeed this time and antipsychotic monotherapy is the safest option during breastfeeding.

[Hannah_at_APP Administrator in reply to Cicerenella]

Thanks for sharing your experiences Cicerenella, you have been through a lot and sound like such a strong lady!

Congratulations on your pregnancy too and all the best for the coming months, it sounds like you have good plans in place. Please feel free to come back and share more questions and update us all on how you are doing, take care, xx