Sunday, February 28, 2010
Pregnancy and Medications
I get a lot of email asking if and how much medication I was taking during the pregnancy and if I felt it affected my daughter. So I wanted to post about this important topic.
First, I want to start out by saying I believe that every bipolar woman has to make the choice for themselves whether to take psychiatric medication during pregnancy. I primarily hear three things:
1. The mom-to-be doesn't want to take any medication
2. The OB/GYN or psychiatrist has told them to get off all medication during the pregnancy.
3. The mom-to-be doesn't think she could last the whole pregnancy without medication.
This is a very personal issue and decision that should be made with lots of planning.
Here's my story. I have bipolar I disorder with psychosis (which means I have been through psychosis in the past not that I am currently with it). I firmly believe that medication keeps me well (or at least helps me stay better). Given the severity of my past episodes I didn't think it was wise to stay off all medication during the pregnancy. I have been criticized by a few women for this choice, but my gut and instincts said for me it was the right decision. I did however not want to be on medication during my first trimester which is the riskist time for birth defects. I planned for about 8-12 months before getting pregnant to lower my medications so that I would not abruptly stop them when I became pregnant.
I was all psychiatric medications during my first trimester. The only drug I took was Zofran for my hyperemesis (excessive vomitting). When I reached my second trimester I went back on Lamictal and remained on it to this day. I did not think that I would stay well during my pregnancy without the medication -- I didn't want to risk a relapse.
I don't think that my daughter has had any problems from the medication I was on during the pregnancy or breastfeeding. In fact she is ahead of the curve on pretty much everything. She's amazing.
I'll write more soon ...
First, I want to start out by saying I believe that every bipolar woman has to make the choice for themselves whether to take psychiatric medication during pregnancy. I primarily hear three things:
1. The mom-to-be doesn't want to take any medication
2. The OB/GYN or psychiatrist has told them to get off all medication during the pregnancy.
3. The mom-to-be doesn't think she could last the whole pregnancy without medication.
This is a very personal issue and decision that should be made with lots of planning.
Here's my story. I have bipolar I disorder with psychosis (which means I have been through psychosis in the past not that I am currently with it). I firmly believe that medication keeps me well (or at least helps me stay better). Given the severity of my past episodes I didn't think it was wise to stay off all medication during the pregnancy. I have been criticized by a few women for this choice, but my gut and instincts said for me it was the right decision. I did however not want to be on medication during my first trimester which is the riskist time for birth defects. I planned for about 8-12 months before getting pregnant to lower my medications so that I would not abruptly stop them when I became pregnant.
I was all psychiatric medications during my first trimester. The only drug I took was Zofran for my hyperemesis (excessive vomitting). When I reached my second trimester I went back on Lamictal and remained on it to this day. I did not think that I would stay well during my pregnancy without the medication -- I didn't want to risk a relapse.
I don't think that my daughter has had any problems from the medication I was on during the pregnancy or breastfeeding. In fact she is ahead of the curve on pretty much everything. She's amazing.
I'll write more soon ...
Thursday, February 11, 2010
Safety of Polytherapy Anti-convulsants (mood stabilizers) During Pregnancy
The North American Antiepileptic Drug Pregnancy Registry is pleased to announce findings on the comparative safety of some combinations of anticonvulsant drugs. We have previously published our findings regarding phenobarbital, carbamazepine, valproate and lamotrigine taken alone as monotherapy. Since we have analyzed the rate of malformations in infants for each of these specific drugs when taken alone, we wanted to investigate the effect they might have on the prevalence of major malformations when taken in combination.
A common perception in prescribing anticonvulsant drugs during pregnancy is that the combination of two or more drugs harbors a greater risk of major malformations.
Read the full study on drug therapy during pregnancy
A common perception in prescribing anticonvulsant drugs during pregnancy is that the combination of two or more drugs harbors a greater risk of major malformations.
Read the full study on drug therapy during pregnancy
Wednesday, February 10, 2010
BlueLite Therapy, Dark Light Therapy?
I've spent a lot of time researching the different light therapies this past month. I have decided I really need to take a more natural approach to my treatment. Even though I've been on multiple mood stabilizers, antidepressants and even an anti-psychotic I still have not been able to get my cycles under control.
I haven't really talked about this much here, but I really do believe that to this day the effects of my pregnancy have not been corrected. Let me explain. Prior to becoming pregnant I was completely stable for 5 years and on only one medication daily (Lamictal) and as needed sleep meds (Ambien & Sonata). I had to wait till I was really stable before I felt confident that I could have a baby. I honestly felt a little like I was "cured" after having NO mood issues for 5 years.
Prior to my stability I had a severe manic episode where I went into psychosis. My official diagnosis has been Bipolar 1 with Psychosis. I remember my psychiatrist once telling me that statically with the severity of my illness I would most likely even on meds relapse at least every two years if not more. And that over my lifetime I should expect a worsening of the disease. He also told me that I should consider adoption and not biological pregnancy. It was a devastating diagnosis.
Fast forward 5-6 years and my doctor thought having a biological baby was no problem and he even weaned me off all meds for my first trimester. He told me he has never seen a patient that had recovered as well as I had. This was a huge triumph.
Fast forward to two years after having my daughter and I had postpartum depression and then began a rapid cycling. I am now classified as a ultra rapid cycler - it's not a good diagnosis to have.
And back to our scheduled programming -- Light Therapy
I've gotten the 'Philips goLITE BLU Light Therapy Device'. I've been using it everyday for about 2 weeks. And I notice a huge difference in my energy level and mood. I am a big believer in the blue light.
Here is some interesting reading about Light therapy.
I haven't really talked about this much here, but I really do believe that to this day the effects of my pregnancy have not been corrected. Let me explain. Prior to becoming pregnant I was completely stable for 5 years and on only one medication daily (Lamictal) and as needed sleep meds (Ambien & Sonata). I had to wait till I was really stable before I felt confident that I could have a baby. I honestly felt a little like I was "cured" after having NO mood issues for 5 years.
Prior to my stability I had a severe manic episode where I went into psychosis. My official diagnosis has been Bipolar 1 with Psychosis. I remember my psychiatrist once telling me that statically with the severity of my illness I would most likely even on meds relapse at least every two years if not more. And that over my lifetime I should expect a worsening of the disease. He also told me that I should consider adoption and not biological pregnancy. It was a devastating diagnosis.
Fast forward 5-6 years and my doctor thought having a biological baby was no problem and he even weaned me off all meds for my first trimester. He told me he has never seen a patient that had recovered as well as I had. This was a huge triumph.
Fast forward to two years after having my daughter and I had postpartum depression and then began a rapid cycling. I am now classified as a ultra rapid cycler - it's not a good diagnosis to have.
And back to our scheduled programming -- Light Therapy
I've gotten the 'Philips goLITE BLU Light Therapy Device'. I've been using it everyday for about 2 weeks. And I notice a huge difference in my energy level and mood. I am a big believer in the blue light.
Here is some interesting reading about Light therapy.
Tuesday, January 12, 2010
Are Antidepressants not any better than the placebo effect?
Interesting article in the New York Times about an antidepressant study which concluded that antidepressants aren't any better than the placebo effect for mild to moderate depression.
Before you Quit Antidepressants
My personal experience with antidepressants has not been that positive, granted I have bipolar disorder and not major depression.
As a teenager I was on Prozac, and looking back I'm not sure that it did any good. At the time I was diagnosed with major depression and an anxiety disorder. Bottom line: I attempted suicide while on Prozac.
Later I was on Paxil and it lead to severe mania with psychosis. Which is no surprise since it is risky to put bipolar patients on antidepressants without a mood stabilizer.
Later I was on Wellbutrin and had a seizure.
I was recently on Zoloft and my depressions got worse not better.
What is your experience with antidepressants?
Before you Quit Antidepressants
My personal experience with antidepressants has not been that positive, granted I have bipolar disorder and not major depression.
As a teenager I was on Prozac, and looking back I'm not sure that it did any good. At the time I was diagnosed with major depression and an anxiety disorder. Bottom line: I attempted suicide while on Prozac.
Later I was on Paxil and it lead to severe mania with psychosis. Which is no surprise since it is risky to put bipolar patients on antidepressants without a mood stabilizer.
Later I was on Wellbutrin and had a seizure.
I was recently on Zoloft and my depressions got worse not better.
What is your experience with antidepressants?
Thursday, January 7, 2010
Sun Exposure and Exercise as Treatment Options
The past 7 weeks has been very challenging for me. When I look back I realize that almost all Nov/Dec for the past 6 or 7 years has been a major challenge. This year I threw into the mix stopping meds right before Thanksgiving. It may not have been the best timing, but I don't regret that decision.
This year I suffered from varying levels of depression for most of December and had some mild hypomania for the second half of Nov. Throw into the mix all the family obligations, holiday hoopla and you have a recipe for disaster.
My psychiatrist's solution was to suggest going on Geodon or Lithium or Seroquel. All of which I have decided not to do. Why? Even though I have had big problems for the past few weeks, I'm not willing at this point to put more medicine in the mix. Don't get me wrong, I'm not anti-medicine. I'm still on Lamictal daily Ativan and Sonota as needed, however I have been trying to keep those at a minimum.
My doctor's latest thought is that I might have problems with Seasonal Affective Disorder. So his recommendation is that I sit in the sun for 30 minutes a day, every day, regardless of the weather. Another option is to get a light box. The problem with the light box, seen here, is that they have been known to switch people who have bipolar into mania. So instead I'm sitting in the sun, well this weekend I wasn't because it was way to cold - so I need to find a sunny window somewhere for times like these. Luckily I live in South Florida which is normally warm and really sunny.
The other thing my doctor has "prescribed" is more regular exercise. I've written about exercise many times on this blog. I'm a big believer that exercise can be a better treatment than drugs ... and the research shows that to be true. Here's an excellent article about bipolar disorder and exercise from McMan Web. In that article they talk about a study which showed that study participants who were put on a exercise regimen had lower relapse rates than people taking Zoloft for depression.
Anyone who knows me knows that before having my daughter I used to exercise 1-2 hours a day 6 days a week. And since I had my daughter I certainly haven't maintained that level of disciple. Back then I was stable for 5 years only on Lamictal. Now I wonder if it was really the exercise that kept me sane.
So my New Year's Resolution, 30 minutes of sun and 45-60 minutes of exercise every day. And to keep on track I've got a chart that lists the week and a column for exercise and for sun. And everyday I get a star when I do them. The chart hangs right above my daughter's potty training chart.
This year I have vowed to staying mentally healthy my top priority. I really would love to have a second child, however I know that I can't do that if I keep up my current cycle of depression and hypomania.
So here's to a new year, with new goals.
This year I suffered from varying levels of depression for most of December and had some mild hypomania for the second half of Nov. Throw into the mix all the family obligations, holiday hoopla and you have a recipe for disaster.
My psychiatrist's solution was to suggest going on Geodon or Lithium or Seroquel. All of which I have decided not to do. Why? Even though I have had big problems for the past few weeks, I'm not willing at this point to put more medicine in the mix. Don't get me wrong, I'm not anti-medicine. I'm still on Lamictal daily Ativan and Sonota as needed, however I have been trying to keep those at a minimum.
My doctor's latest thought is that I might have problems with Seasonal Affective Disorder. So his recommendation is that I sit in the sun for 30 minutes a day, every day, regardless of the weather. Another option is to get a light box. The problem with the light box, seen here, is that they have been known to switch people who have bipolar into mania. So instead I'm sitting in the sun, well this weekend I wasn't because it was way to cold - so I need to find a sunny window somewhere for times like these. Luckily I live in South Florida which is normally warm and really sunny.
The other thing my doctor has "prescribed" is more regular exercise. I've written about exercise many times on this blog. I'm a big believer that exercise can be a better treatment than drugs ... and the research shows that to be true. Here's an excellent article about bipolar disorder and exercise from McMan Web. In that article they talk about a study which showed that study participants who were put on a exercise regimen had lower relapse rates than people taking Zoloft for depression.
Anyone who knows me knows that before having my daughter I used to exercise 1-2 hours a day 6 days a week. And since I had my daughter I certainly haven't maintained that level of disciple. Back then I was stable for 5 years only on Lamictal. Now I wonder if it was really the exercise that kept me sane.
So my New Year's Resolution, 30 minutes of sun and 45-60 minutes of exercise every day. And to keep on track I've got a chart that lists the week and a column for exercise and for sun. And everyday I get a star when I do them. The chart hangs right above my daughter's potty training chart.
This year I have vowed to staying mentally healthy my top priority. I really would love to have a second child, however I know that I can't do that if I keep up my current cycle of depression and hypomania.
So here's to a new year, with new goals.
Saturday, November 14, 2009
When Medicine Makes You Worse Not Better
The past year has been both one of the most amazing and hardest years of my life. And I realized when I talked to my doctor last week that I have been getting worse not better with all the meds.
I reached a high point of 5 different medicines. Three I take everyday and 2 as needed. This is the most I've been on since I came out of psychosis 6 years ago.
We decided together that we need to re-evaluate. So I am getting off Abilify and Zoloft. Amazingly enough being on Lamictal, Abilify and Zoloft has made me MORE depressed not less.
In the two weeks since we started reducing my dose ... I feel amazing. Like the old Rachael.
Anyone else have a situation when you got worse not better on meds?
I reached a high point of 5 different medicines. Three I take everyday and 2 as needed. This is the most I've been on since I came out of psychosis 6 years ago.
We decided together that we need to re-evaluate. So I am getting off Abilify and Zoloft. Amazingly enough being on Lamictal, Abilify and Zoloft has made me MORE depressed not less.
In the two weeks since we started reducing my dose ... I feel amazing. Like the old Rachael.
Anyone else have a situation when you got worse not better on meds?
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