Psychiatric Medication during Pregnancy

QUESTION

Dear Experts,
I was diagnosed with bi-polar disorder 7 years ago. It usually manifests itself as extreme irritability and depression (only 4 severe manic episodes ever). I have been on a class C medication ever since my diagnosis, which eliminates all of my symptoms unless I am under high levels of stress or sleep deprivation, at which time the medication seems to have no effect.My husband and I have been actively trying to get pregnant for only 2 months, but as you can probably guess, I am very concerned about the consequences of staying on the medication, as well as the consequences of going off of the medication. My husband is against staying on the medication, but is afraid that I will be unbearable if I stop.

Is it worth the risk? I've heard that irritability and depression are common during pregnancy even in normal people. Is this true? Will the stress and irritability of being pregnant be great enough to make the medication ineffective? If I stop the medication, will the stress and irritability of being pregnant be great enough to send me into a severe depression and put me on disability leave from work? What have been the results of other anti-seizure/anti-depressant medications during pregnancy?

Please help me!

Nikki

ANSWER

Dear Nikki,
The first step that we would suggest is to find a woman's health psychiatrist in your area and set up a consultation. When you have someone who is an expert in medication management during pregnancy, you will be able to more fully discuss your options, ask any questions that you may have, and devise a plan for moving forward.While some women do become irritable and depressed during pregnancy, these are not typical pregnancy symptoms, and may be signs of an antepartum (during pregnancy) depression. Management of bipolar disorder is nothing to be taken lightly. Discontinuing medication while trying to get pregnant may set you up for a relapse, in which case, you will likely need to delay attempts to get pregnant while you get your symptoms under control again.

Antidepressant medication is commonly used during pregnancy, but sometimes triggers manic episodes in someone with bipolar disorder. There are other mood stabilizers however, that are frequently used for manic depression and that have minimal risks during pregnancy. There are options available to you and consultation with a woman's health psychiatrist can give you this information, and help you maximize the health of both you and your future baby.

We wish you the best,
-- Debbie and Mara
The Childbirth Complication Expert Team

Davis and Stein

Deborah L. Davis, Ph.D. and Mara Tesler Stein, Psy.D. are the authors of Parenting Your Premature Baby and Child: The Emotional Journey, a 2004 National Parenting Publications Awards "Gold Award" winner. They also collaborated on Parent: You and Your Baby in the NICU (2002), as part of the nationwide March of Dimes NICU Project. They.ve been invited to regularly contribute to Advances in Neonatal Care, a neonatal nursing journal; their first article appears in Spring 2005. They are the founding members of Partners in Perinatal and Pediatric Consulting, which promotes developmentally supportive care for babies and parents, as well as collaboration between families and health care professionals.

Dr. Stein is a clinical psychologist in private practice, specializing in the emotional aspects of coping with crisis and adjustment around pregnancy and parenting. She is regularly invited to lecture and give workshops on these issues throughout the country to conferences of physician and nursing groups, doulas, and lactation consultants. Since 1997, she has been consulting with organizations and providing training to health care providers, guiding their efforts to improve the level of psychological support and developmentally supportive care to families during and subsequent to perinatal crisis.

Dr. Davis is a developmental psychologist, researcher, and writer who specializes in perinatal and neonatal crisis, medical ethics, parental bereavement, parent education, and child development. Dr. Davis is the author of four books for bereaved parents, Empty Cradle, Broken Heart (Fulcrum, 1991; 1996), Loving and Letting Go (Centering, 1993; 2002), Fly Away Home (Centering, 2000) and Stillbirth, Yet Still Born (PILC, 2000). She is also on the Board of the Pregnancy Loss and Infant Death Alliance (PLIDA.org) and is regularly invited to write articles for professional periodicals and parent support materials.