So, I’ve hinted/skimmed over this before but I have a diagnosis of Bipolar Disorder. Specifically Bipolar II which is characterised by mainly experiencing periods of depression, and a “milder” form of elevated mood called hypomania – not the full on mania people usually associated with Bipolar.
I’ve been stable for quite a few years now, but Bipolar is a “serious mental illness” (and comes under the psychosis category although I don’t consider myself “psychotic”!!), so it’s something that needs to be considered and managed through out the pre-conception period, pregnancy, and post-partum…
I started taking mood stabilisers after a pretty rough patch around 3 years ago and I’ve found them really helpful in warding off depression. I still have good days and bad days, but I’ve had no major depressive episodes and when I have been low it’s been in relation to something that happened, which is what would happen to anyone (e.g. when my dad went into intensive care and I thought he might die), and the low mood hasn’t lasted long.
Now that I’m preparing to have a baby I need to decide whether to stay on my meds, and find out what the “care plan” would be for pregnancy. So today I had an appointment with the local Perinatal Mental Health team – specific mental health services related to pregnancy.
I’ve been umming and ahing about what to do with the meds as it’s difficult to weigh the pros and cons of staying on or coming off because there’s no way to predict what impact coming off would have on my health. I was hoping that the appointment would make it obvious what the best course of action would be, but it really hasn’t!
The psychiatrist advised that there are no known specific risks to the developing baby from my particular medication. I take Lamotrigene which was actually developed as an anticoagulant and is mainly used in the treatment of epilepsy. As such, women taking it for epilepsy often stay on since the risk of having a seisure is most likely more dangerous to mum and baby than the “risks” of staying on. In my case I can’t know if I’d get depressed if I came off, and whether the risk of me getting depressed (and any consequences of that) is greater than any potential risks to the baby if I stay on. I suppose there being no specific known risks at the moment is a good thing, but Lamotrigene is relatively new as far as meds go. The only difference to my pregnancy, if I stay on the meds, is that I’ll have to have monthly blood tests to make sure I have the right levels in my blood for the medication to remain effective.
As far as coming off… I’ll have to wean off the meds by gradually lowering the dose (probably over 6-8 weeks) and see how I get on. The doc suggested that if I wanted to try now, while I’m trying to lose the required weight, would be a good time. Since the weightloss will probably take 4-6 months it would give me a chance to come off and see how I get on before I starting to TTC. If coming off doesn’t go well then I would have time to go back on before TTC. Likewise, if I come off and need to go back on at any point during pregnancy that shouldn’t pose any problem. My only fear is that trying to lose weight, and trying to conceive could both be stressful and I have no idea how I’ll react to coming off. I’m afraid of relapse into depression under those circumstances, and what the knock on effects would be (i.e. in relation to my job if I get unwell and can’t go to work). However, apparently I can be fast-tracked to local therapy services if required either due to my history (during the preconception phase) or due to pregnancy (pregnant women get priority).
I will just mention hypomania for a sec. I’m really not concerned about the risk of a hypomanic episode. What generally happens to me in these phases isn’t really “dangerous”. Unlike a major depression it wouldn’t make me withdraw from society, stop eating/binge, and want to sleep all the time and not look after myself. It actually just makes me really productive at work, or find some “project” to research and work on ; like when I decided I would take on a PhD on top of my job and wrote a PhD proposal in a couple of weeks – and then the hypomania wore off and I realised I can’t do a PhD right now because that would be majorly overloading myself. When I’m hypomanic I believe that I can do everything because I’m super-capable, more-so than other people. It’s like I run on adrenaline and feel really energetic and need little sleep. I have also been known to overspend when I’m feeling “up.” However the episodes don’t last long and it doesn’t majorly impact my life negatively (although I do need a fair amount of sleep once the episode is over) – especially now that I live with family who keep an eye on me, bring it to my attentions if I’m starting to “obsess” over something, and make sure I sleep and don’t overdo things or go out on expensive spending sprees.
I have an appointment with my GP next week to go over everything from the 2 fertility clinic visits and today’s Perinatal Mental Health appointment, so I have 7 days to think over what I’m going to do. I think I’d like to try and come off meds because I now have more time to see how it goes and to go back on if need be. I’d be keen to hear from others though, so I may do some internet forum trawling to see what other people have done and what their experience was like.