Do you have bipolar disorder and wonder if you can have children?
We will explore pregnancy and bipolar disorder below.
What is bipolar?
The term is used a lot. Unfortunately, some people diagnosed with it do not actually have it. Conversely, some women suffer with bipolar disorder for years without proper diagnosis or treatment. Bipolar is a mood disorder with periods of mania or hypo-mania. Usually, these periods are followed by depression. Historically, this was called manic-depression.
What does manic mean?
Mania is characterized by periods of heightened energy and decreased need for sleep. This is a lot different than pushing yourself to do an “all nighter” while studying for exams. It means you can get as little as 2 or three hours of sleep and feel well rested. Other symptoms include:
- Grandiosity—inflated sense of self-worth or ability
- Talking excessively and quickly- friends may comment on this
- Lots of thoughts at once
- Increase in goal directed activity
- Often engage in risky behavior that are later regrettable (multiple sexual partners, gambling, spending sprees)
- Easily distracted
These symptoms must last a week and be present for most of the day. People with Bipolar 2 may have similar symptoms but they do not interfere with life as much as manic level symptoms. Irritability is also a symptom but not officially included in the diagnosis.
Bipolar is not mood swings.
A common misconception is that women who are “moody” have bipolar. Symptoms must be sustained over a period of time. They do not wax and wane in one day. We will talk in a separate blog post about moodiness. Recreational drug use and some medical conditions can look like bipolar. Getting a proper diagnosis by a qualified mental health professional is key.
Treatment of Bipolar during pregnancy.
Bipolar disorder is always treated with a mood stabilizer. Common mood stabilizers include Lithium, Lamictal, and Depakote. Sometimes, a second-generation antipsychotic (SGA) is used to treat bipolar. We will discuss the first three below and the SGAs in a separate blog post. These medication sound scary but some are safer than others.
Lamictal in Pregnancy
Does Lamictal cause a cleft palate?
The good news is that we now know Lamictal (lamotrigine) is much safer than previously thought. It was associated with cleft palates in the past. However more recent studies show that babies exposed have no greater risk of having a cleft palate than babies not exposed. Overall, the rate of birth defects amongst all babies in the United States is around 3%. This means, that without any kind of risk factors, we would expect about 3% of babies to have some type of birth defect. A registry created by Massachusetts General Hospital, which is a major center of research in reproductive psychiatry, found that the rate of cleft palates in babies exposed to Lamictal alone was 1.9%. This rate is below the general population. A UK registry found that the rate of cleft palate in babies exposed to Lamictal was 0.2%, the overall birth defect rate was around 3.2%. This further supports that you can take Lamictal while pregnant without increasing your baby’s chance of having a birth defect.
Does Lamictal cause miscarriage or still birth?
No! Miscarriage and stillbirth did not increase in a study of 2000 women where mom took Lamictal. Furthermore , Lamictal did not increase the risk of eclampsia, having a low birth weight baby, or babies who are small for gestational age.
Lithium in Pregnancy
This is a little more complicated. Numerous studies link Lithium with heart defects. However, there are some studies that don’t show as strong a link. Researchers have been studying the effects of Lithium on pregnancy since 1968. One major problem is that, in general, women with bipolar are more likely to smoke, engage in other risky behaviors, and be overweight which are independent risk factors for birth complications. Furthermore, many of the women studies were taking multiple medications. Regardless, most researchers agree that Lithium does increase the risk of heart malfunctions. However, the percentage of risk is debatable.
Should I stop my lithium once I get pregnant?
Please don’t do that! You should seek the help of a psychiatrist or a psychiatric mental health nurse practitioner (PMHNP) that specializes in maternal mental health. You also will need an evaluation by a maternal fetal medicine doctor. This is an OBGYN who specializes in high-risk pregnancy. You can still see your regular OB or midwife for your prenatal care and delivery but should have an evaluation by theses other professionals.
Depakote in Pregnancy
Depakote is associated with a higher rate of birth defects than other medications. In general, it is not recommended in pregnancy. However, you should never stop a medication abruptly. This could bring back your bipolar symptoms which could cause more issues with your pregnancy. Consult with a PMHNP, psychiatrist, or maternal fetal medicine specialist who is well versed on maternal mental health. Likewise, if you take Depakote and would like to become pregnant, consult with a specialist. Often times we can create a plan to get you on a safer medication.
Never stop your bipolar medication once you become pregnant.
70% of women with bipolar who stop their medication during pregnancy will have either a manic or depressive episode.
This can be far more dangerous for your baby than the medication. When possible, have a preconception consult with a PMHNP or psychiatrist that specializes in maternal mental health. You can find a qualified one on PSI directory. You can also ask your OB or midwife for a referral. Maternal Fetal Medicine Doctors can also do a thorough evaluation.
Non- Medication Treatments of Bipolar
Sleep is paramount to good mental health. In fact, sleep deprivation can trigger a bipolar mood event. Psychotherapy and coping skills are also important tools. Lastly, find good social support.
You can have bipolar and be a great mom! Find the right help to do it in the healthiest way possible for you and your baby.