Planning Pregnancy with mental disorder

[Amimac22]

HI. I'm new here. I have been on a year journey of reducing medication so I can safely plan on my first pregnancy. I have bipolar disorder and I am trying to learn as much as I can about postpartum psychosis. Also, honestly it has just been very hard to fund any good reading material on GOOGLE about biploar disorder and planning my pregnancy.

[Ellie_at_APP Partner]

Hi Aimimac22

Welcome to the forum. It's so good you have found us.

I had postpartum psychosis in 2011 after the birth of my son. I haven't had another child, and didn't have bipolar at the time, so I'm afraid I don't have any personal experience to share about planning a pregnancy, but I'm sure you will get a lot of replies on here from others who have 'been there'.

I just wanted to make sure that you had found our information on our website about bipolar disorder and pregnancy, which has a wealth of information. All our information, leaflets etc are free, and were written by families with experience of bipolar / pp, and leading perinatal mental health clinicians: app-network.org/what-is-pp/...

I am not sure if you are in the UK or not, and whether you have been working with a specialist perinatal psychiatrist (who supports women who are unwell or possibly unwell in the perinatal period), around coming off your medication? I know in some countries there aren't specialist perinatal services, like here in the UK. Specialist perinatal psychiatrists know the particular risks of each medication in pregnancy etc, and can advise whether it is best you come off them or not, looking at your particular risk etc.

I really hope you find the information on our website helpful. Do write here to ask any questions, or just offload your worries, we're here for you.

Ellie

[Amimac22 in reply to Ellie_at_APP]

Hi. I live in NJ (US). I am seeing a prenatal psychiatrist. I researched and realized I needed specialist care for planing my pregnancy. I was able to find the packet about Bipolar disorder and postpartum depression very insightful. It seems to me that mental health is treated a bit differently in the US. Or it’s just very hard for me to find helpful information about bipolar pregnancy. I have been googling it and mainly get articles explaining bipolar disorder but not discussing pregnancy in particular. I changed my psychiatrist to a prenatal one last August and I am at my final stretch getting off Lithium. I am thankful that I live near NYC to have access to a lot of specialists. I feel like there is so much I want to learn to be as prepared as I could be especially regarding prenatal psychosis. Thank you for your insight and information.

[Pikorua Volunteer]

Good morning Amimac22,

I am in the UK, but originally from mainland Europe. A warm welcome!

You already have had some good information and links, which may help you further with your journey of planning for a baby. I believe every country is very different in offering help and advise for family planning, especially when mental health support is required.

Since I became so very poorly with PPP and being sectioned in 2010 a lot has changed for mums in the UK, who suffer with this traumatising illness.

In your case as Ellie mentioned already, a Peri Natal Mental Health Team could be very useful, available here in the UK. There is a risk of contracting PPP, if you have Bipolar, but there is a research gap and more studies need to be carried out in this field, especially for more mature mums with Bipolar.

My baby was planned-only at the time of my illness and throughout recovery of PPP I did not know that I always had Bipolar.

In my opinion weaning of medication has to be a gradual process. I would not have survived PPP without my traditional medication and it took 3 health professionals including my partner to support my weaning-off process from Lorazepam, Risperidone and Haloperidol.

I wonder, if I had known about my BP before pregnancy, I probably would have listen to the Peri Natal Mental Health Team. I am convinced, that the set off hormones and BP led to PPP. Medical intervention, probably could have reduced my long term suffering or even prevented me from being sectioned and/or even would not have led to PPP.

Who knows! I can not change the past, but know now that preparation and prevention is available, and even appropriate care via mother and baby units have been built covering most of the map in the UK.

It maybe interesting to look into other case studies of females who knew about their Bipolar and how they got prepared for family planning and particularly working out meds planner or other choices.

Wishing you well and good luck

x

[Amimac22 in reply to Pikorua]

Hi! Yes medicine changes are not fun and do take a lot of time. I had a deadline in my head on when I wanted to get pregnant but I have learned to just take it day by day. I have been juggling a full time job and dealing with all these medicine changes with unexpected side effects. I am just happy to hear that I am not alone. Sure feels like that sometimes. Each case of bipolar disorder is different. Also I don’t know anyone in my family or friends who have a mental disorder and can understand what I am going through. Glad I went down a rabbit hole staying up past midnight researching things. If I didn’t decide to do my own research I wouldn’t have know that I even needed a prenatal psychiatrist. I think here in the US, there isn’t prenatal mental health team. I was guided by my gynecologist that there is a way for me to safely plan on getting pregnant while medicated. Thank for you input!

[Pikorua Volunteer in reply to Amimac22]

Thank you for your quick responds Amimac22,

I am so pleased that you can talk to your gynaecologist about possible avenues for making sure you can keep safe for planning a pregnancy.

Yes, I have had a feeling that you might be from a different country, and health systems, especially on peri and post natal topics do vary a lot. You are absolutely spot on in saying that we are all so very unique with our BP. Too much stereo typing and stigma!

I hope there are peer support groups for you or online orgs to connect with like minded people, who are on the BP spectrum and maybe interested in family planning.

Good night

x

[Maria_at_APP Moderator]

Hello Amimac22,

A warm welcome from the other side of the Atlantic.

I have no experience of bipolar disorder, but I had pp in 2018 and I am currently planning a second pregnancy. I am currently not on medication, I weaned off the antipsychotic last December and I am only on a small dose of antidepressant. My pp developed very soon after the birth of my daughter, but without a previous history of mental illness it caught us very flat footed. Having lived through it, we will be much more tuned into the early warning signs second time around.

I agree that there is sadly a difference between our countries on their approach to perinatal mental health, although I only know about the US system by anectdotes I've read. Here in the UK I attended a pre conception planning meeting with a perinatal psychiatrist. It was useful for me to have the opportunity to ask questions about what support would be in place for me if I were to get pregnant a second time, what are the risks and what assessments would take place to reduce them, choices of medication and treatment, etc. I am very pleased to hear that you are under a perinatal psychiatrist now, and that you are working on a plan around medication.

Ellie has already mentioned the information on the app site and the guides, I have found the one on planning a pregnancy at risk of pp especially useful.

I think knowing your triggers and avoiding them during pregnancy is a great start, not having too many changes or stressful situations is also helpful. I know that in the back of your mind there is a nagging what if scenario construction going on all the time, but take action on the things that you have some control over and try as much as possible to let go of the rest.

I almost forgot to add that I did CBT recently to refresh on some anxiety management techniques and I found those sessions very helpful. Is that something that you could look into? A lot of the tools are simply common sense but there is something to be said about the benefits of rationalizing your thoughts when expressing them out loud.

That's me for this evening, I hope you find useful information on the app site and write here whenever you feel like, we are all here to listen

[Kokoraki]

Hi Amimac22,

I'm in the same boat as you - Bipolar I, and going to start trying for my first baby in a couple of months time.

It's really great that you have a psychiatrist to work with now and that you're almost off of the lithium. I've been working to get off of sodium valproate for the last couple of months myself.

I found reading the NICE guideline, and the associated pathways really helpful

pathways.nice.org.uk/pathwa...

nice.org.uk/guidance/cg192/...

[AstroSue]

A really good website my GP directed me to when I was pregnant was called BUMPS - best use of medicines in pregnancy (you can google). You enter your medication in the search bar and it gives all the known information on your particular medication.

I've actually recently started lithium as a medication that can be taken in pregnancy. I'm not definitely planning a pregnancy but also haven't ruled one out if my circumstances change, and nobody wants me having another unmedicated pregnancy since the last one went so wrong!

There are medications that you can take with minimal risk to baby. Ultimately, babies do best with well mums!

Good luck with it xx

[Amimac22 in reply to AstroSue]

Thank you so much! BUMPS is a great source. I appreciate it! I agree babies do best with well stable moms. That is the one thing I have learned. Yes there are risks while taking meds when pregnant. But it’s more risky for me not to be stable. That is what I have been trying to find. The balance of how far I can push myself off certain medications but still be able to maintain my 9-5 Job.

[Lilybeth Volunteer]

Hello Amimac22

Welcome to the forum where you have already received some good support and links which I hope will be helpful in planing your pregnancy.

I’m sorry I don’t have any experience to share about bipolar but there are mothers of courage here, like yourself, who have lived experience. I had PP many years ago when mental health was in the shadows but thankfully I eventually fully recovered.

I hope you have been reducing your medication with supervision and are feeling ok with the unexpected side effects. It must be difficult coping with a full-time job, especially with the restrictions of Covid? It’s good that you have support from a gynaecologist to safely plan your pregnancy.

I’m not sure whether you found APP and the forum via Postpartum Support International? If not, perhaps you might find them a useful contact during your pregnancy at postpartum.net/ as there are local contacts in the US? I haven’t been able to access their website for some reason but they do have Facebook pages in different States.

You are not alone ... we are all here too. Stay safe and take care.

[Lilybeth Volunteer]

Hello Animac22

I hope you are well. I wonder if the guide found under the link to the PP Guides might be helpful as you research for your first pregnancy? The link is app-network.org/what-is-pp/... entitled “Bipolar disorder, pregnancy and childbirth”.

I’m sure Covid restrictions and working 9-5 is a challenge for you in the US. Stay safe.

[Amimac22]

Thank you for your kind words. It means a lot. I actually never saw this guide in particular. I will definitely check it out. Life now during these COVID times are definitely challenging but it is what it is. The one thing that was beneficial was that due to restrictions being in the office. I work less hours. 3x a week I go in for only a couple of hours. So It was actually less stressful. Now that everyone is back to full time. I had to slow down on the drastic medicine changes. Just have patience and not be too hard when I can’t reach my goal date of getting pregnant. Take care!

[Maria_at_APP Moderator in reply to Amimac22]

Hi Amimac22,

Absolutely, sometimes life throws some curveballs and you have to take it a bit easier and listen to your body, that's the right thing to do in my view. I hope I am not repeating myself but when planning a pregnancy is also good to not pick too many other projects at the same time. Sometimes that is not always possible, but for things that are under your control give it a try. Its something I tell all my friends who are pregnant or trying, regardless of their personal mental health history. Don't do works in the house at the same time, give it at least a couple of years; if you have to move to another place do it as stress free as possible and get as much help as you can; try and keep changes at work at the lowest possible disturbance level. Its true its not always possible, and I don't want to sound sanctimonous, I personally had a lot going on while pregnant in 2018 and externally seemed to be coping tremendously well with it all, I think I carried a bit of that invincible attitude into the first few days postnatally, which snowballed into not a very good place.

Take good care, wishing you all the best

[Lilybeth Volunteer]

Hello Amimac22

Thanks so much for your reply across the pond I hope the guide will be helpful when you have time to check it out. I’m glad you were able to work less hours for a while and I think were very wise to slow down on the medicine changes, although I don’t have any experience of bipolar. I hope your gynaecologist is still supporting you.

Perhaps you might try yoga or something similar to feel relaxed after a busy day? I like chair yoga myself and there are some sites on YouTube to follow.

Try not to be hard on yourself .... you are amazing coping with a challenging environment which is far from routine, full-time job and the effects of medication. So be kind to yourself and stay safe ... we are all here for each other.

[Amimac22 in reply to Lilybeth]

Thank you for your support. Have a nice day!