What I have to offer on this topic is my own experience with some research I have done recently. I was not diagnosed with bipolar disorder until well after the birth of my last child, after which I had my tubes tied. So I cannot address what happens to women with full-blown mental illness when they become pregnant. But I did experience postpartum depressions and was on psychotropic medication on and off throughout my child bearing years. So I can address issues related to that kind of experience.
Each of my children were planned. When I prepared to get pregnant with Terrie twenty years ago, I was on Elavil for premenstrual syndrome symptoms. The conventional wisdom at the time was that no psychotropic medications were safe during pregnancy. The practicalities of the situation also led me to go off the medication well before I got pregnant—if I were pregnant, I would not have premenstrual symptoms anymore and would simply resume it after she was born.
My postpartum course was complicated with depression, however. I remember telling a nurse that came to see me at home to follow up on my recovery that I was eating well but that everything tasted like sand in my mouth—I was eating strictly for the breast-feeding baby’s sake. I was also plagued with guilt at leaving her at six weeks to return to work. I trusted my daycare provider but still struggled a great deal with leaving my baby to return to a job I hated. My depressive symptoms included excessive sleepiness and blue moods. After I weaned my baby, I still suffered what were supposed simple depressive symptoms with a soupcon of obsessive-compulsive symptoms thrown in, and I began counseling when she was six months old and was put on Zoloft for the depression by my ob-gyn. After another six-months, the depression lifted and I discontinued counseling although I stayed on the Zoloft.
When I planned to have my second child three years later, I again went off my medication well before I become pregnant but did not suffer the postpartum symptoms I had before. I felt like I had dodged a bullet. I was off medications for six years with no problems while I changed careers and was able to work from home and only have Amber in part-time daycare.
I gave no thought to mental illness when we decided to become pregnant a third time when I was thirty-four. I had no complications with this pregnancy, either and went on with my life as a freelance writer while keeping Rachel at home full-time. After a series of traumatic events, including a car wreck and Hurricane Katrina, I became depressed and six months later, fully psychotic. I had already weaned Rachel, so I was placed on a full battery of psychotropic medications, including lithium.
At that time ten years ago I started reading up on bipolar disorder, and the consensus was that the safest treatment during pregnancy for a bipolar woman was electroshock treatment if the symptoms were life-threatening. Ten years’ passage, however, has seen changes in thinking about treatment of mental illness during pregnancy. Some of the newer psychotropic drugs have been found to be safe for pregnant women to take during pregnancy—a relief to many women of childbearing age with mental illness.
The most important way you can protect your mental health in pregnancy is to make sure your ob-gyn and your psychiatrist can have a good working relationship in treatment for both the pregnancy and the mental illness, from the moment you go off birth control throughout the pregnancy and through the postpartum period, which can be the most dangerous time in a woman suffering from symptomatic mental illness. Be absolutely open with your doctors about any change in your condition, and know that they will do what is best for both you and your baby. If you don’t have that kind of relationship with your doctors, find ones that you can trust before you initiate a pregnancy.
Julie Whitehead currently writes and blogs from Mississippi at her personal blog. She has been a university lecturer, a disability examiner, and a freelance writer. She carries a diagnosis of bipolar disorder and blogs to create awareness and help others understand the disease and its effects.