Some women approach the topic of pregnancy with thoughts of optimism and enthusiasm. Others, meet this topic after deep reflection and deliberation. And even fewer women, broach the topic of pregnancy with honest fear and apprehension.
“According to Psychology Today (2015), Research suggests that women are about 40% more likely than men to develop depression. They’re twice as likely to develop PTSD, with about 10% of women developing the condition after a traumatic event, compared to just 4% of men.” Depression occurs most often during a women’s childbearing years, ages 25 to 44 (MHA, 2015). Although women seek out treatment more often than men, women in treatment make up less than half of the depressed female population (MHA, 2015).
Although women are typically more comfortable seeking treatment and disclosing personal information, making the decision to become pregnant with a mental illness is a daunting one. According to Massachusetts General Hospital’s Center for Women’s Mental Health, “20% of women suffer from mood or anxiety disorders during pregnancy” (2015). “In a recent study, which prospectively followed a group of women with histories of major depression across pregnancy, of the 82 women who maintained antidepressant treatment throughout pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued the medication. This study estimated that women who discontinued medication were 5 times as likely to relapse as compared to women who maintained treatment” (MGH, 2015). Although data accumulated over the last 30 years suggests that some medications may be used safely during pregnancy, knowledge regarding the risks of prenatal exposure to psychotropic medications is insufficient. Thus, it is all too common for patients to discontinue or to avoid using the medication in pregnancy.
I didn’t want to put my baby or myself at risk. So many women with mental illness struggle with the idea to become pregnant because they feel pressure to prioritize the health of the baby or prioritize their personal health. High rates of relapse are noted in women with bipolar disorder. “For women who have been ill in the past, rates of relapse into bipolar mania and psychosis are estimated at 50% to 75% respectively” (Bipolarlives, 2015). For women with bipolar disorder, maintaining treatment with a mood stabilizer during pregnancy can significantly reduce the risk of relapse. However, several of the medications commonly used to treat bipolar disorder carry some developmental risk to the baby when used in pregnancy. My medication carries a congenital developmental risk.
It’s important to note in each pregnancy, “a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk” (MotherToBaby, 2014). Recent studies have suggested the rate of any heart defect while using lithium “is approximately 1-5%. This is only somewhat greater than the background rate for heart defects in the general population, 0.5%-1.0%” (MotherToBaby, 2014). All things considered there is an increased risk for a developmental defect to occur in my circumstance, however, there appears to be a risk for birth defects in pregnancy regardless.
When weighing side effects and relapse rate it’s important to consult with more than one psychiatrist. I was fortunate enough to have a well-respected psychiatrist, to begin with. She was able to counsel me on the issues surrounding lithium and pregnancy, as well as refer me to a women’s mental health specialist, who was able to answer questions about breastfeeding and postpartum depression amongst other things. Both psychiatrists recommended a brief discontinuation of my mood stabilizer for the initial 8 weeks of the pregnancy. My primary psychiatrist recommended switching to a different mood stabilizer with less developmental risk. I ended up switching medication, only to switch right back.
My submission was taken from my personal blog. This selection focuses on my first pregnancy and the decision to remain on medication.
My priority was to avoid relapse at all costs. I had been stable on the same medication/dose for five years. I had been hospitalized in the past and had no intention of repeating history. After consulting with my OBGYN we were reassured that the risk of heart defect was small, and if surgery post-delivery were necessary, it would more than likely be successful. With medical professionals, some current data points and faith, Ben and I choose to maintain treatment. I would remain on my same medication and dose for the entire pregnancy and beyond I was confident in our decision, however there was still much riding on faith. Would I experience a mood episode regardless? Would the baby develop normally? Should I breastfeed?
“Surrender to what is. Let go of what was. And have faith in what will be.” -Sonia Ricotti
I identify as a mother, speaker, writer and advocate. My experience with mental illness began mid-way through high school. I was initially diagnosed with major depression. I underwent several treatment changes and was diagnosed with bipolar disorder just before my 20th birthday. I have experienced success with treatment for a little over a decade. I have an academic background in communications and social work. I received my MSW with a mental health specialization in 2012. I married my high school sweetheart that same year. After much research and deliberation, we opted to begin a family early on. I am currently pregnant with my third child. Family, prayer, yoga and sleep keep me sane. Kirsten can be found on her blog and Facebook.