Last Saturday (Dec. 15) I woke up with contractions at around 5:30 a.m. and I knew my big day had arrived. The night before I felt like something big was going to happen. Around 6:30 I started writing down the contraction time & length they were at 12 minutes apart, then 10 minutes, then 8 minutes ... by 9 a.m. I decided I should probably wake up my husband to let him know. This whole time I felt very anxious -- I honestly started thinking "oh no -- what have I done!" Followed by -- "baby can't you just stay inside another 6 months maybe then I will feel ready".
We left for the hospital at 10:45 when the contractions were 5 minutes apart, for more than an hour. When we got there I was hooked up to a fetal heart monitor and contraction monitor and all the sudden the experience really started to feel surreal. I also felt detached from the whole process -- all the while I started to think - what if I don't make a good parent? What if my life changes too drastically? Things progressed along and I finally got an epidural around 3:30 pm (I HIGHLY RECOMMEND the epidural.)
At 7:20 I started pushing. This is when I really started to feel like I was not even mentally there. During the delivery my doctor was talking to me about the show "Flipping Out" and we were laughing about some of the interesting personalities. It was a total distraction from the exhaustion that I felt. My husband later told me that was the most unexpected thing that here I was having a baby and had HGTV on in the background and was discussing a real estate show with my OB/GYN. At 8:05 Leila was born. MY first reaction was relief -- I was thankful it was over, and tired and really hungry.
And then they handed me my daughter. And I looked at her and felt like she was this little creature that I didn't know what to do with. The nurse showed me how to breastfeed her -- and I thought it was the weirdest sensation. I was expecting to be flooded with feelings of love and affection -- and yet I really didn't feel any of that initially.
At the hospital I delivered at they never take the baby out of your room (unless there is a problem with the baby) so from delivery to checkout she's there. Which is great -- except when you are so tired and all your baby wants to do is cry.
The day after delivery was the hardest. Physically I felt bad and then Leila refused to breastfeed. And I started getting worried and nervous. In fact she went 13 hours without eating. And I tried to feed her every 2 hours -- to say I was frustrated would put it mildly. I was also angry. I'm not sure at who -- her or me. And I seriously considered giving up on breastfeeding and it hadn't even been 24 hours since delivery!
Luckily we kept trying and then miraculously she finally got the hang of it. I am so glad I decided to breastfeed. Breastfeeding is what started the bonding process between Leila and I. The skin-to-skin contact made me feel better.
Fortunately all the feelings I had about not knowing who this creature was, was unfounded. I am madly in love with my baby now ... so next up how I overcame the emotions I was feeling.
Sunday, December 23, 2007
Saturday, December 22, 2007
Surprising Emotions During Pregnancy.
I was prepared to be weepy or depressed. I knew I had the chance of getting manic. I was ready to be an emtional basketcase during this pregnancy. I was worried that my pregnancy could trigger a bipolar episode. But it never did.
I am amazed. My sister told me when she is pregnant she starts crying at TV commercials, she is very emotional. So I figured this too would happen to me. And yet it never did.
So what did I feel. Pretty stable almost the entire time. Don't get me wrong there were days were I felt a little down. Days I felt a little up. And days I felt really angry for no reason. But I never felt weepy.
What I was suprised at was how physically demanding pregnancy has been. I developed Hyperemesis (excessive vomiting) around week 7. By week 8 I was on zofran to control the nausea. I remained on zofran until the day I gave birth. Whenever I tried to stop it I would start vomitting again. And when I say excessive I mean by the time I went to the doctor to discuss the vomiting I was throwing up 10-12 times a day. I couldn't even keep down water. When I got to the doctor I was dehydrated and was in a starvation mode (evidence by the ketones in my urine). MY doctor diagnosed me very quickly and I was put on the right medicine and was then able to eat - however for the first half of my pregnancy I was still nauseated everyday while on the medicine but it wasn't bad enough to make me throw up. It was manageable.
In the first trimester I went to a conference in June and caught a nasty cold -- I ended up in the ER one night with symptoms like menegitis (luckily I didn't have that). But I was sick for over two weeks. I couldn't do anything and especially not sleep. My doctor even thought I was starting to get manic becuase I wasn't sleeping. And I became scared that he would put me in the hospital. Luckily he finally realized my problems were physical not mental.
During the second trimester I started getting pretty bad heartburn. It would be so bad I couldn't sleep. Then I had an allergic reaction to Zantac. And had to switch to Pepcid -- eventually that started working and I was able to once again sleep through the night.
In the third trimester the nausea increased ... and once again I had to start learn how to control it better.
In the last month, I had my sciatic nerve bother me every day. Which disturbed my sleep however I was taking long naps to make up for it.
The point of this is -- I expected pregnancy to be mentally challanging for me given my history of depressions, mania and psychosis. And yet -- that was stable. It was the physical issues that were a problem.
I am amazed. My sister told me when she is pregnant she starts crying at TV commercials, she is very emotional. So I figured this too would happen to me. And yet it never did.
So what did I feel. Pretty stable almost the entire time. Don't get me wrong there were days were I felt a little down. Days I felt a little up. And days I felt really angry for no reason. But I never felt weepy.
What I was suprised at was how physically demanding pregnancy has been. I developed Hyperemesis (excessive vomiting) around week 7. By week 8 I was on zofran to control the nausea. I remained on zofran until the day I gave birth. Whenever I tried to stop it I would start vomitting again. And when I say excessive I mean by the time I went to the doctor to discuss the vomiting I was throwing up 10-12 times a day. I couldn't even keep down water. When I got to the doctor I was dehydrated and was in a starvation mode (evidence by the ketones in my urine). MY doctor diagnosed me very quickly and I was put on the right medicine and was then able to eat - however for the first half of my pregnancy I was still nauseated everyday while on the medicine but it wasn't bad enough to make me throw up. It was manageable.
In the first trimester I went to a conference in June and caught a nasty cold -- I ended up in the ER one night with symptoms like menegitis (luckily I didn't have that). But I was sick for over two weeks. I couldn't do anything and especially not sleep. My doctor even thought I was starting to get manic becuase I wasn't sleeping. And I became scared that he would put me in the hospital. Luckily he finally realized my problems were physical not mental.
During the second trimester I started getting pretty bad heartburn. It would be so bad I couldn't sleep. Then I had an allergic reaction to Zantac. And had to switch to Pepcid -- eventually that started working and I was able to once again sleep through the night.
In the third trimester the nausea increased ... and once again I had to start learn how to control it better.
In the last month, I had my sciatic nerve bother me every day. Which disturbed my sleep however I was taking long naps to make up for it.
The point of this is -- I expected pregnancy to be mentally challanging for me given my history of depressions, mania and psychosis. And yet -- that was stable. It was the physical issues that were a problem.
Friday, December 21, 2007
A Healthy Girl is Born!
Last Saturday, December 15 at 8 p.m. my new daughter was born. She was perfect in every way. The model of health. Which is such a relief. During this whole pregnancy I was worried that the medication I take to control my bipolar disorder (Lamictal) or the medicine I take to control the hyperemesis (Zofran) would affect her -- even though statistically they are safe.
An interesting thing happened -- I had a nurse whose daughter was on Lamictal during her pregnancy. Her daughter has actually been part of a research study on Lamictal use during pregnancy. She told me her daughter has heard as part of this study there are trying to get Lamictal classified as a Cat B drug instead of the current Cat C classification.
She also told me that her daughter used Lamictal while breastfeeding and had no issues. Which was nice to hear since I too am now breastfeeding.
I'll post soon about -- my emotions towards the end of the pregnancy and also about how I felt after the birth.
An interesting thing happened -- I had a nurse whose daughter was on Lamictal during her pregnancy. Her daughter has actually been part of a research study on Lamictal use during pregnancy. She told me her daughter has heard as part of this study there are trying to get Lamictal classified as a Cat B drug instead of the current Cat C classification.
She also told me that her daughter used Lamictal while breastfeeding and had no issues. Which was nice to hear since I too am now breastfeeding.
I'll post soon about -- my emotions towards the end of the pregnancy and also about how I felt after the birth.
Wednesday, November 28, 2007
Can you Breastfeed on Lamictal?
Deciding to take Lamictal during my second and third trimester was a big decision, but at least when making the decision I could turn to the pregnancy registries to see what data existed -- and those numbers are based on hundreds of women who have taken Lamictal during their pregnancies.
Deciding to breastfeed while on Lamictal is almost as difficult of a decision except there is NO "registry" to turn to for answers. My psychiatrist requested the information about Lamicatal during lacation and the data is pretty skimpy.
Here's what they know:
1. Lamictal does pass into breast milk.
2. The effects of infants exposed to Lamictal through breastmilk is unknown.
3. The concentration in a breast-fed infant is somewhere between 16-60% of the concentration found in the mother's blood.
4. No siginficant adverse effects were reported in infants exposed to Lamictal through breastmilk.
Out of the 5 studies that have been done there have only been 41 women followed. That is not a typo the scientific data that exists is about only 41 women.
So the question is do the benefits of breastfeeding which are numerous -- outweigh the risks (which are basically unknown)?
Some doctors believe that because a baby has already been exposed while in the womb there is really no additional risk since the baby will get less Lamictal through breastmilk than she was getting while inside.
I discussed this with my OB/GYN who advice basically was do what you feel is right, my babies future pediatrician who pulled out a book and said "says here it isn't recommended" and my psychiatrist who has reviewed the current studies with me. My psychiatrist beleives that the benefits DO outweigh the risks especially since their isn't any data that shows it is bad for the baby -- just data that says it passes into breastmilk. Since my baby has been exposed to Lamictal in utero for the last 6 month I can't imagine that a little pass through in the milk is going to be anymore harmful than being exposed directly.
Here are some helpful links I found:
- Lamtical & breastfeeding message board post at Epilepsy.com
- Lamictal and breastfeeding question (towards the bottom of the page)
- Center for Women's Mental Health Blog Post on Lamictal & Breastfeeding
UPDATE: August 2011
I wanted to post a long overdue follow-up to this post. I did end up breastfeeding for 1 year while taking Lamictal. My daughter had no side effects from an exposure in breastmilk.
She is now a very healthy 3 1/2 year old who just started preschool. She has always been ahead of every developmental milestone from walking to talking to writing her name.
When we eventually have a second child, I do plan on taking Lamictal during the pregnancy and during breastfeeding.
Deciding to breastfeed while on Lamictal is almost as difficult of a decision except there is NO "registry" to turn to for answers. My psychiatrist requested the information about Lamicatal during lacation and the data is pretty skimpy.
Here's what they know:
1. Lamictal does pass into breast milk.
2. The effects of infants exposed to Lamictal through breastmilk is unknown.
3. The concentration in a breast-fed infant is somewhere between 16-60% of the concentration found in the mother's blood.
4. No siginficant adverse effects were reported in infants exposed to Lamictal through breastmilk.
Out of the 5 studies that have been done there have only been 41 women followed. That is not a typo the scientific data that exists is about only 41 women.
So the question is do the benefits of breastfeeding which are numerous -- outweigh the risks (which are basically unknown)?
Some doctors believe that because a baby has already been exposed while in the womb there is really no additional risk since the baby will get less Lamictal through breastmilk than she was getting while inside.
I discussed this with my OB/GYN who advice basically was do what you feel is right, my babies future pediatrician who pulled out a book and said "says here it isn't recommended" and my psychiatrist who has reviewed the current studies with me. My psychiatrist beleives that the benefits DO outweigh the risks especially since their isn't any data that shows it is bad for the baby -- just data that says it passes into breastmilk. Since my baby has been exposed to Lamictal in utero for the last 6 month I can't imagine that a little pass through in the milk is going to be anymore harmful than being exposed directly.
Here are some helpful links I found:
- Lamtical & breastfeeding message board post at Epilepsy.com
- Lamictal and breastfeeding question (towards the bottom of the page)
- Center for Women's Mental Health Blog Post on Lamictal & Breastfeeding
UPDATE: August 2011
I wanted to post a long overdue follow-up to this post. I did end up breastfeeding for 1 year while taking Lamictal. My daughter had no side effects from an exposure in breastmilk.
She is now a very healthy 3 1/2 year old who just started preschool. She has always been ahead of every developmental milestone from walking to talking to writing her name.
When we eventually have a second child, I do plan on taking Lamictal during the pregnancy and during breastfeeding.
Wednesday, October 24, 2007
Sleep Tips for Pregnancy
Perhaps it is becuase I can't sleep I keep finding tips on how to sleep better during pregnancy. This article in the Cincinnati Post is specfically about sleep problems in bipolar pregnant women.
See the Article:
Natural Aids to sleep during pregnancy
Update: When I was at the OB/GYN yesterday he said that most likely the Ambien wasn't going to help (he was right I tried it and it put me to sleep but I still woke up two hours later to pee except then I had a hard time walking to the bathroom because my limbs weren't cooperating!). He said since my sleep problems are mostly related to physical discomfort there is only one solution -- have the baby. Then he joked that I would then have another reason for not sleeping.
See the Article:
Natural Aids to sleep during pregnancy
Update: When I was at the OB/GYN yesterday he said that most likely the Ambien wasn't going to help (he was right I tried it and it put me to sleep but I still woke up two hours later to pee except then I had a hard time walking to the bathroom because my limbs weren't cooperating!). He said since my sleep problems are mostly related to physical discomfort there is only one solution -- have the baby. Then he joked that I would then have another reason for not sleeping.
Tuesday, October 23, 2007
News: House passes bill on post-partum depression
Congress is taking steps to help women suffering from post-partum depression.
Chicago Congressman Bobby Rush has sponsored a new bill to provide screening and treatment for women who suffer severe depression after giving birth to a child.
The bill is named in memory of Melanie Blocker Stokes of Chicago, who committed suicide while suffering from the mental illness.
She left behind a daughter, Summer, now 6, and a husband.
Her family is celebrating the bill's passage in the House and is hoping it will soon pass the Senate.
Currently, less than 15 percent of new mothers receive treatment for the illness, which is the most frequent serious complication of pregnancy.
Chicago Congressman Bobby Rush has sponsored a new bill to provide screening and treatment for women who suffer severe depression after giving birth to a child.
The bill is named in memory of Melanie Blocker Stokes of Chicago, who committed suicide while suffering from the mental illness.
She left behind a daughter, Summer, now 6, and a husband.
Her family is celebrating the bill's passage in the House and is hoping it will soon pass the Senate.
Currently, less than 15 percent of new mothers receive treatment for the illness, which is the most frequent serious complication of pregnancy.
I wish I could SLEEP
For the last week and a half I have had horrible sleep. At a maximum I can sleep for 3 hours straight and then I wake up uncomfortable, or I have to go pee, or I have stabbing pain in my ribs. Once I wake up I can't go back to sleep for a while. Luckily I've been able to string some naps together to get 4-6 hours per day.
I was at first worried becuase lack of sleep has in the past triggered manic episodes. The good thing is I don't feel energized - I feel tired so I know I'm not getting to have a problem yet.
I have 60 days till my due date. I sure hope that this doesn't last the whole time.
I do have a prescription for Ambien that my psychiatrist wrote. The nurse at my OB/GYN said it was safe to take, but I still feel hesitant. I've got an appointment with my OB/GYN this after so I'll discuss what any risks are with taking sleeping pills.
It's funny how I was prepared to deal with emotional issues during pregnancy -- I was not prepared for all the physical discomfort.
It's ironic that today USA TODAY ran an article "Lack of sleep sends emotions off the deep end"
Click here to read the article
I was at first worried becuase lack of sleep has in the past triggered manic episodes. The good thing is I don't feel energized - I feel tired so I know I'm not getting to have a problem yet.
I have 60 days till my due date. I sure hope that this doesn't last the whole time.
I do have a prescription for Ambien that my psychiatrist wrote. The nurse at my OB/GYN said it was safe to take, but I still feel hesitant. I've got an appointment with my OB/GYN this after so I'll discuss what any risks are with taking sleeping pills.
It's funny how I was prepared to deal with emotional issues during pregnancy -- I was not prepared for all the physical discomfort.
It's ironic that today USA TODAY ran an article "Lack of sleep sends emotions off the deep end"
Click here to read the article
Sunday, October 21, 2007
New Book on Pregnancy and Bipolar
I just found this book which was published in August 2007 -- Bipolar and Pregnant: How to Manage and Succeed in Planning and Parenting While Living with Manic Depression
I wish I would have found it sooner. I'm anxiously awaiting its arrival it should be here next week.
I wish I would have found it sooner. I'm anxiously awaiting its arrival it should be here next week.
Saturday, October 20, 2007
Study: Mental problems in teens hard to diagnosis
I've recently heard a lot more about the difficulty doctors have in diagnosing teens with bipolar. I'm glad that they are finally talking about the issue. It took almost 10 years (I started seeing a psychiatrist when I was 14), two hospitalizations, and several sucide attempts before I was properly diagnosed. The signs were there -- the doctors I was seeing just never put two and two together until I finally had a true psychotic break in 2003. I wonder if I had been diagnosed and treated properly earlier if I ever would have become psychotic. Needless to say psychosis was extermely devasting to my life at the time. It took months for me to get back on track. Actually maybe as long as a year.
Here's the Article:
Study: Mental problems in teens hard to diagnosis
HOUSTON, Oct. 20 (UPI) -- Pinpointing a diagnosis of psychiatric and behavioral problems in teens can be tricky, even for experts in mental health, a U.S. expert says.
Dr. Norma Clarke, medical director of the Adolescent Treatment Program at The Menninger Clinic in Houston, says the human brain is still developing during adolescence and mood and behavior can fluctuate wildly at this age.
"Teens are by nature secretive and it is sometimes very hard to figure out what is normal and what is not about teen behavior," Clarke said in a statement. "Also, teens can behave very well in a psychologist’s or counselor’s office, which makes it harder to arrive at a diagnosis."
By adolescence, many teens in treatment for behavioral or psychiatric issues have received multiple diagnoses -- ranging from attention-deficit hyperactivity disorder to bipolar disorder.
When individuals don’t respond to treatment, they can feel like failures, Clarke says.
"They feel that they are broken for life," Clarke says. "They feel hopeless and think there is something so wrong with them. It affects their self-esteem and their ability to make friends and become the best they can be."
Here's the Article:
Study: Mental problems in teens hard to diagnosis
HOUSTON, Oct. 20 (UPI) -- Pinpointing a diagnosis of psychiatric and behavioral problems in teens can be tricky, even for experts in mental health, a U.S. expert says.
Dr. Norma Clarke, medical director of the Adolescent Treatment Program at The Menninger Clinic in Houston, says the human brain is still developing during adolescence and mood and behavior can fluctuate wildly at this age.
"Teens are by nature secretive and it is sometimes very hard to figure out what is normal and what is not about teen behavior," Clarke said in a statement. "Also, teens can behave very well in a psychologist’s or counselor’s office, which makes it harder to arrive at a diagnosis."
By adolescence, many teens in treatment for behavioral or psychiatric issues have received multiple diagnoses -- ranging from attention-deficit hyperactivity disorder to bipolar disorder.
When individuals don’t respond to treatment, they can feel like failures, Clarke says.
"They feel that they are broken for life," Clarke says. "They feel hopeless and think there is something so wrong with them. It affects their self-esteem and their ability to make friends and become the best they can be."
Hyperemesis
So I haven't posted in a long time. I intended to regularly track my pregnancy through this blog -- but that didn't happen. Now I'm going to go back and fill in the details of my pregnancy. Currently I am 31 weeks ... just 9 weeks to go.
When I was at 8 weeks I was diagnosed with hyperemesis gravidarum (excessive nausea and vomitting). Around week 6-7 I started feeling some morning sickness which quickly progressed into severe nausea and then frequent vommitting. By the time I went to the doctor during week 8 I was throwing up 12 times a day and was dehydrated. I had ketones in my urine and had lost 5 pounds in a week.
Prior to going to the dr. I had tried all the suggestions for morning sickness -- I ate crackers before getting out of bed, I drank ginger ale, I ate crackers before getting out of bed, I tried sea bands, I tried vitamin b6 -- none of it helped.
My doctor prescribed zofran which is used for chemotherapy patients and it has been a miracle. Although I was still having some nausea the vomitting became only once a day which was manageable.
Hyperemesis (HG) has been extremely hard. I had a lot of sensitivity to food and smells and for a while even with the zofran could eat very few foods.
My HG did get somewhat better during the second half of the second trimester -- however now that I am in my third trimester it has returned.
My mother never told me until after I was pregnant that she too had a problem with nausea and vomitting when she was pregnant with me. In fact she was on nausea medicine throughout her whole pregnancy.
There is little research on what causes HG -- however it is thought to have a genetic component. I also wonder if being bipolar contributes to the likelihood of getting HG.
There is a great organization I found called the HER Foundation (Hyperemesis Education & Research). Visit there website at http://www.helpher.org/
Oprah had a special on HG that was really enlightening as well it aired a few months ago.
When I was at 8 weeks I was diagnosed with hyperemesis gravidarum (excessive nausea and vomitting). Around week 6-7 I started feeling some morning sickness which quickly progressed into severe nausea and then frequent vommitting. By the time I went to the doctor during week 8 I was throwing up 12 times a day and was dehydrated. I had ketones in my urine and had lost 5 pounds in a week.
Prior to going to the dr. I had tried all the suggestions for morning sickness -- I ate crackers before getting out of bed, I drank ginger ale, I ate crackers before getting out of bed, I tried sea bands, I tried vitamin b6 -- none of it helped.
My doctor prescribed zofran which is used for chemotherapy patients and it has been a miracle. Although I was still having some nausea the vomitting became only once a day which was manageable.
Hyperemesis (HG) has been extremely hard. I had a lot of sensitivity to food and smells and for a while even with the zofran could eat very few foods.
My HG did get somewhat better during the second half of the second trimester -- however now that I am in my third trimester it has returned.
My mother never told me until after I was pregnant that she too had a problem with nausea and vomitting when she was pregnant with me. In fact she was on nausea medicine throughout her whole pregnancy.
There is little research on what causes HG -- however it is thought to have a genetic component. I also wonder if being bipolar contributes to the likelihood of getting HG.
There is a great organization I found called the HER Foundation (Hyperemesis Education & Research). Visit there website at http://www.helpher.org/
Oprah had a special on HG that was really enlightening as well it aired a few months ago.
Thursday, October 18, 2007
Study: Severe Mental Illness In Mothers Can Affect Long-Term Health And Development Of Children
It's not surprising that a mother's mental health affects her children. The research shows that the important issue is the interaction the mother has with her children.
Although this could be seen as un-positive news. I actually think the real message here is that it is so important to keep yourself healthy and stable.
Here's the article:
Severe Mental Illness In Mothers Can Affect Long-Term Health And Development Of Children
Babies' early experiences with a mother suffering from severe mental illness, such as schizophrenia, other psychotic disorders, bipolar disorder or severe major depression disorder may affect their future health and development.
Dr. Susan Pawlby, of the Institute of Psychiatry in London, emphasises that complex issues surround the study of the impact of a mother's severe mental illness on her child. Among them are genetic risks, poor health practices, psychiatric medication, breast-feeding, and the physical and emotional care of the baby.
Infants are entirely dependent for their health and well-being on those who care for them, and those whose mothers suffer from mental illness are at risk if the care provided does not meet their developmental needs. In such instances, she warns, the long-term implications for the child are potentially devastating.
Click here for full article
Although this could be seen as un-positive news. I actually think the real message here is that it is so important to keep yourself healthy and stable.
Here's the article:
Severe Mental Illness In Mothers Can Affect Long-Term Health And Development Of Children
Babies' early experiences with a mother suffering from severe mental illness, such as schizophrenia, other psychotic disorders, bipolar disorder or severe major depression disorder may affect their future health and development.
Dr. Susan Pawlby, of the Institute of Psychiatry in London, emphasises that complex issues surround the study of the impact of a mother's severe mental illness on her child. Among them are genetic risks, poor health practices, psychiatric medication, breast-feeding, and the physical and emotional care of the baby.
Infants are entirely dependent for their health and well-being on those who care for them, and those whose mothers suffer from mental illness are at risk if the care provided does not meet their developmental needs. In such instances, she warns, the long-term implications for the child are potentially devastating.
Click here for full article
Friday, October 5, 2007
Oprah runs two shows on bipolar disorder
Oprah recently ran two shows on bipolar disorder. One featured Sinead O'Connor on October 5 (see show details here) and then other featured various people with bipolar disorder including General Hospital star Maurice Benard (see show details)
The first show also featured a woman who said her bipolar disorder caused her to kill her child. Being that I'm pregnant now the story was distrubing to me.
The first show also featured a woman who said her bipolar disorder caused her to kill her child. Being that I'm pregnant now the story was distrubing to me.
Saturday, June 16, 2007
Article: When Conception is the Question
In the Spring 2007 issue bp Magazine had an article about the decision to have children when you are bipolar. I found it really sad the number of people who think that because they are bipolar -- they couldn't have children. I feel like there is a ton of misinformation about the chances of passing on the disease and how you can keep yourself well during pregnancy.
They now have the article online at:
BPHope.com
They now have the article online at:
BPHope.com
Friday, June 15, 2007
Close Monitoring of Pregnant Women with Bipolar Disorder Improves Outcomes
Interesting article from Medscape Today:
Close Monitoring of Pregnant Women with Bipolar Disorder Improves Outcomes
May 29, 2007 (San Diego) — Careful follow-up of pregnant women with bipolar disorder (BPD), with close monitoring of their medication and compliance with outpatient psychiatric care, results in obstetrical outcomes similar to both women with major depressive disorder (MDD) and national population statistics, according to a study presented at the American Psychiatric Association 2007 Annual Meeting.
"The outcomes of the bipolar women who were treated carefully were the same as, if not better than, the women with major depression," said lead author Yara Betancourt, a graduate student in the department of psychiatry at Emory University in Atlanta, Georgia. "The national population statistics are not controlled for mental illness. Our study suggests that we can [at least] mimic national statistics by careful monitoring."
Pregnancy Outcomes
Although there is a burgeoning literature on the effects of maternal depression and anxiety on perinatal outcomes, "very limited research" addresses the issue of adequate treatment for BPD during pregnancy and the effects that it can have on outcomes for mother and newborn at the time of delivery, the authors write.
Read full article
Close Monitoring of Pregnant Women with Bipolar Disorder Improves Outcomes
May 29, 2007 (San Diego) — Careful follow-up of pregnant women with bipolar disorder (BPD), with close monitoring of their medication and compliance with outpatient psychiatric care, results in obstetrical outcomes similar to both women with major depressive disorder (MDD) and national population statistics, according to a study presented at the American Psychiatric Association 2007 Annual Meeting.
"The outcomes of the bipolar women who were treated carefully were the same as, if not better than, the women with major depression," said lead author Yara Betancourt, a graduate student in the department of psychiatry at Emory University in Atlanta, Georgia. "The national population statistics are not controlled for mental illness. Our study suggests that we can [at least] mimic national statistics by careful monitoring."
Pregnancy Outcomes
Although there is a burgeoning literature on the effects of maternal depression and anxiety on perinatal outcomes, "very limited research" addresses the issue of adequate treatment for BPD during pregnancy and the effects that it can have on outcomes for mother and newborn at the time of delivery, the authors write.
Read full article
Why I decided to Stop my Bipolar Meds for the FIrst Trimester
I've discovered that planning for a pregnancy can be difficult for anyone, but being bipolar and on medication presents an extra level of challenges. Since 2003, when I had a severe manic episode, I've been stable. In part because I was on medication. In part because I learned to take care of myself.
Years ago I asked my psychiatrist about having kids, and he suggested I should adopt. Now he is working with me on a plan to go off Lamictal for the first trimester. It's a little scary to think that I will be medication free for months -- it is a risk. I hope I am prepared for the challenge.
Some people in my life have questioned my decision to stop medication for part of the pregnancy and then go back on. I realize that it is a chance some people aren't willing to take -- and there is little concrete data to really guide someone.
So why did I decide to quit meds? Lamictal is a Class C drug during Pregnancy. This really means they don't know if it is safe or not. Of the various pregnancy registries that tracks Lamictal exposure only one has shown an increase in birth defects -- particularly Cleft palate. Exposure to that type of birth defect is only in the first trimesester. Some researchers actually think it is not true due to the sample size. Statisically the latest report from the lamictal registry shown the risk of birth defects at 3% -- the baseline risk across the board is 3% - so it is entirely possible that it is completely safe. However I wanted to minimize the small risk anyway.
Click here to learn more about Lamictal and cleft palate
Years ago I asked my psychiatrist about having kids, and he suggested I should adopt. Now he is working with me on a plan to go off Lamictal for the first trimester. It's a little scary to think that I will be medication free for months -- it is a risk. I hope I am prepared for the challenge.
Some people in my life have questioned my decision to stop medication for part of the pregnancy and then go back on. I realize that it is a chance some people aren't willing to take -- and there is little concrete data to really guide someone.
So why did I decide to quit meds? Lamictal is a Class C drug during Pregnancy. This really means they don't know if it is safe or not. Of the various pregnancy registries that tracks Lamictal exposure only one has shown an increase in birth defects -- particularly Cleft palate. Exposure to that type of birth defect is only in the first trimesester. Some researchers actually think it is not true due to the sample size. Statisically the latest report from the lamictal registry shown the risk of birth defects at 3% -- the baseline risk across the board is 3% - so it is entirely possible that it is completely safe. However I wanted to minimize the small risk anyway.
Click here to learn more about Lamictal and cleft palate
Sunday, March 18, 2007
Early Detection for Bipolar Kids
I've always beleived that life would have been so much easier if I had been diagnosed with bipolar earlier. Although I had seen a psychiatrist since I was around 14-15 I wasn't diagnosed as bipolar until I was 23. My life totally changed once I finally started getting the right treatment. So, I think the news that some researchers have made real progress toward early detection -- is huge news. Here's the story:
Toward a test for detecting in childhood the risk of developing bipolar disorder and schizophrenia
Quebec City, March 14, 2007—A team from Centre de recherche Université Laval Robert-Giffard (CRULRG) has made significant progress toward finding a way to determine whether a child is likely to one day suffer from bipolar disorder or schizophrenia. The findings of the research team supervised by Dr. Michel Maziade, director of CRULRG, professor in Université Laval’s Faculty of Medicine, and Canada Research Chair in the Genetics of Neuropsychiatric Disorders, will be presented at the International Congress on Schizophrenia Research on March 31 in Colorado Springs.
Schizophrenia and bipolar disorder are problems that emerge early on in life, but that are usually not diagnosed before the age of 20 or 25. The participants in Dr. Maziade’s study—a group of 45 children from families densely affected by schizophrenia or bipolar disorder—had not yet been diagnosed for the diseases. However, they came from families where the prevalence of these illnesses was 15 to 20 times higher than in the general population and, in each case, one of the parents suffered from either bipolar disorder or schizophrenia.
A battery of neurological tests revealed that these high-risk children performed much more poorly than a control group in memory tasks and executive functioning (planning, classifying, and interpreting information). “These tests show quantifiable dysfunctions in the brain of children or teenagers that could be used as early warning signs for the disease,” explains Dr. Maziade. “The ultimate goal is to use them to estimate the risk for a child as young as three or four years old and start preventative treatments.”
Schizophrenia and bipolar disorder take on many different forms and, as of yet, there are no biological tests to rapidly confirm diagnosis with certainty. About 1% of the population suffers from schizophrenia. As for bipolar disorder, it is estimated that 2.6% of people between 25 and 64 are affected by it at least once in their lifetimes.
A genetic study of 2,000 people from 46 Eastern Quebec multigenerational families severely affected by these diseases has been conducted by CRULRG since 1989. It has allowed the discovery of ten genomic susceptibility sites shared by the two diseases in the genetic make-up of the participating families. The dysfunctions revealed through neuropsychological testing also proved to be very similar whether the children were from families at risk for schizophrenia or for bipolar disorder. “The two diseases have a lot in common. One can assume they have a common origin and that something eventually happens to trigger the onset of a specific illness,” suggests Maziade.
Dr. Maziade is confident the results of this study will bring hope to those afflicted by the diseases. “Medication currently available can treat symptoms, but not the disease itself. Our results are encouraging because they give us a glimpse of the causal mechanisms and thus bring us closer to a more effective treatment. They also pave the way to better prevention because early identification of at-risk children will make it possible to help them more effectively, especially in school, where they often exhibit learning problems.”
In addition to Dr. Maziade, the members of the research team were Nancie Rouleau, Chantal Mérette, Marc-André Roy, Nathalie Gingras, Marie-Eve Paradis, and Valérie Jomphe.
Toward a test for detecting in childhood the risk of developing bipolar disorder and schizophrenia
Quebec City, March 14, 2007—A team from Centre de recherche Université Laval Robert-Giffard (CRULRG) has made significant progress toward finding a way to determine whether a child is likely to one day suffer from bipolar disorder or schizophrenia. The findings of the research team supervised by Dr. Michel Maziade, director of CRULRG, professor in Université Laval’s Faculty of Medicine, and Canada Research Chair in the Genetics of Neuropsychiatric Disorders, will be presented at the International Congress on Schizophrenia Research on March 31 in Colorado Springs.
Schizophrenia and bipolar disorder are problems that emerge early on in life, but that are usually not diagnosed before the age of 20 or 25. The participants in Dr. Maziade’s study—a group of 45 children from families densely affected by schizophrenia or bipolar disorder—had not yet been diagnosed for the diseases. However, they came from families where the prevalence of these illnesses was 15 to 20 times higher than in the general population and, in each case, one of the parents suffered from either bipolar disorder or schizophrenia.
A battery of neurological tests revealed that these high-risk children performed much more poorly than a control group in memory tasks and executive functioning (planning, classifying, and interpreting information). “These tests show quantifiable dysfunctions in the brain of children or teenagers that could be used as early warning signs for the disease,” explains Dr. Maziade. “The ultimate goal is to use them to estimate the risk for a child as young as three or four years old and start preventative treatments.”
Schizophrenia and bipolar disorder take on many different forms and, as of yet, there are no biological tests to rapidly confirm diagnosis with certainty. About 1% of the population suffers from schizophrenia. As for bipolar disorder, it is estimated that 2.6% of people between 25 and 64 are affected by it at least once in their lifetimes.
A genetic study of 2,000 people from 46 Eastern Quebec multigenerational families severely affected by these diseases has been conducted by CRULRG since 1989. It has allowed the discovery of ten genomic susceptibility sites shared by the two diseases in the genetic make-up of the participating families. The dysfunctions revealed through neuropsychological testing also proved to be very similar whether the children were from families at risk for schizophrenia or for bipolar disorder. “The two diseases have a lot in common. One can assume they have a common origin and that something eventually happens to trigger the onset of a specific illness,” suggests Maziade.
Dr. Maziade is confident the results of this study will bring hope to those afflicted by the diseases. “Medication currently available can treat symptoms, but not the disease itself. Our results are encouraging because they give us a glimpse of the causal mechanisms and thus bring us closer to a more effective treatment. They also pave the way to better prevention because early identification of at-risk children will make it possible to help them more effectively, especially in school, where they often exhibit learning problems.”
In addition to Dr. Maziade, the members of the research team were Nancie Rouleau, Chantal Mérette, Marc-André Roy, Nathalie Gingras, Marie-Eve Paradis, and Valérie Jomphe.
Thursday, February 22, 2007
The Decision to Get Pregnant
There are two issues I have been grappling with in deciding to start a family. So today I'll tackle the first one -- should someone who is bipolar have kids.
This is a very complicated and personal decision and also one that lots of people like to weigh in on. Countless people in depression and bipolar support groups and on various message boards have said they can't ever imagine bringing a child into the world who may inherit a mental illness. And for a while I too thought the same thing. But over the last few years as my illness stabilized my opinion changed.
So here are my answers to the questions my people have asked:
1. Aren't you worried that your child will be bipolar?
I'm really not that concerned for several reasons. Although bipolar disorder does have a strong genetic risk -- according to many doctors and scientists the risk of passing the disease is 10%. Some geneticists say it may be as high as 15%. Many people with the disorder exaggerate the number and are concerned that it is around 50%. It isn't
To put it in perspective - The risk really isn't that large. Currently 31% of Americans are obese. So statistically speaking my child will have a more than three times the of risk of developing obesity. Obesity greatly increases the risk of other serious medical conditions including diabetes which is the 6th leading cause of death in this country. Obesity also increases the risk of cancer, heart attacks and strokes.
I beleive in 15 years the advances of science will make living with bipolar a non-issue. Doctors and scientists are greatly expanding their understanding of how the brain works and how it misfunctions.
Only 13 years ago there was one medication approved for bipolar (lithum). Just 10 year ago there were only two medications (lithium and depakote). Now there are more choices and better treatments. Currently the following are approved for different phases of bipolar: Lithium, Depakote, Lamictal, Symbyax, Seroquel, Risperdal, Geodon, Abilify and Equetro (extended release version of Tegretol). And many more drugs are used "off-label." If so much has changed in the last 15 years, what do you think will happen in the next?
Aren't you concerned you will get depressed or manic while pregnant?
I realize that going off meds is a risk. However, I have full faith that if something happens my doctor will be able to get me back on track. I believe that eating right, exercising, maintatining a regular sleep schedule and keeping stress levels in check will affect my ability to stay well. I also don't intend to stay off my meds for the entire pregnancy.
Aren't you worried that the medication could be bad for a developing fetus?
I've read the studies, poured over the data from the pregnancy registries and I think that my medication (Lamictal) is actually fairly safe. So far the statisics show a 2.9% incidence of major birth defects. The baseline rate for the general population is 3%. Which means that if the data is correct -- you do not have a greater chance of birth defects than someone who is not on meds. I've also decided to go back on medicine the second trimester. Although at a lower dose than I was on before.
This is a very complicated and personal decision and also one that lots of people like to weigh in on. Countless people in depression and bipolar support groups and on various message boards have said they can't ever imagine bringing a child into the world who may inherit a mental illness. And for a while I too thought the same thing. But over the last few years as my illness stabilized my opinion changed.
So here are my answers to the questions my people have asked:
1. Aren't you worried that your child will be bipolar?
I'm really not that concerned for several reasons. Although bipolar disorder does have a strong genetic risk -- according to many doctors and scientists the risk of passing the disease is 10%. Some geneticists say it may be as high as 15%. Many people with the disorder exaggerate the number and are concerned that it is around 50%. It isn't
To put it in perspective - The risk really isn't that large. Currently 31% of Americans are obese. So statistically speaking my child will have a more than three times the of risk of developing obesity. Obesity greatly increases the risk of other serious medical conditions including diabetes which is the 6th leading cause of death in this country. Obesity also increases the risk of cancer, heart attacks and strokes.
I beleive in 15 years the advances of science will make living with bipolar a non-issue. Doctors and scientists are greatly expanding their understanding of how the brain works and how it misfunctions.
Only 13 years ago there was one medication approved for bipolar (lithum). Just 10 year ago there were only two medications (lithium and depakote). Now there are more choices and better treatments. Currently the following are approved for different phases of bipolar: Lithium, Depakote, Lamictal, Symbyax, Seroquel, Risperdal, Geodon, Abilify and Equetro (extended release version of Tegretol). And many more drugs are used "off-label." If so much has changed in the last 15 years, what do you think will happen in the next?
Aren't you concerned you will get depressed or manic while pregnant?
I realize that going off meds is a risk. However, I have full faith that if something happens my doctor will be able to get me back on track. I believe that eating right, exercising, maintatining a regular sleep schedule and keeping stress levels in check will affect my ability to stay well. I also don't intend to stay off my meds for the entire pregnancy.
Aren't you worried that the medication could be bad for a developing fetus?
I've read the studies, poured over the data from the pregnancy registries and I think that my medication (Lamictal) is actually fairly safe. So far the statisics show a 2.9% incidence of major birth defects. The baseline rate for the general population is 3%. Which means that if the data is correct -- you do not have a greater chance of birth defects than someone who is not on meds. I've also decided to go back on medicine the second trimester. Although at a lower dose than I was on before.
New Mothers Vulnerable to Mental Illness
Here's a recent article about the mental health risks after pregnancy:
Major study finds issues go beyond postpartum depression
New moms face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.
New dads aren’t as vulnerable, probably because they don’t experience the same physical and social changes associated with having a baby, the researchers and other experts said.
The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That’s when the tremendous responsibility of caring for a newborn hits home.
During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared to women with no children, new mothers were four times more likely to be hospitalized with mental problems.
Read the full story
Major study finds issues go beyond postpartum depression
New moms face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.
New dads aren’t as vulnerable, probably because they don’t experience the same physical and social changes associated with having a baby, the researchers and other experts said.
The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That’s when the tremendous responsibility of caring for a newborn hits home.
During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared to women with no children, new mothers were four times more likely to be hospitalized with mental problems.
Read the full story
Tuesday, February 20, 2007
Folic Acid and Antiepileptic Drug Interaction
An interesting article I just came across about anticonvulsants (many of which are used for bipolar disorder):
In the general population, when a woman takes a daily multivitamin tablet with folic acid just before and at conception, her risk of having a child with spina bifida and other birth defects is decreased. However, for women taking AEDs, it is not yet clear if taking a daily multivitamin with folic acid will decrease their risk of having a baby with a birth defect. One concern is that some anticonvulsant drugs, like phenytoin (Dilantin®) and carbamazepine (Tegretol®) are folic acid antagonists, meaning that they counteract the effects of folic acid supplements. But, some other AEDs, like lamotrigine (Lamictal®) are not folic acid antagonists.
Very few research studies have addressed this issue. In one study, researchers at Boston University showed that folic acid supplements did not affect the risk for heart defects, oral clefts or urinary tract anomalies in children born to mothers taking some AEDs. However, in that same study these researchers found that taking a folic acid supplement decreased the risk for spina bifida in infants born to women taking carbamazepine (Tegretol®).
Click here to read the full article from the Antiepileptic Pregnancy Registry
In the general population, when a woman takes a daily multivitamin tablet with folic acid just before and at conception, her risk of having a child with spina bifida and other birth defects is decreased. However, for women taking AEDs, it is not yet clear if taking a daily multivitamin with folic acid will decrease their risk of having a baby with a birth defect. One concern is that some anticonvulsant drugs, like phenytoin (Dilantin®) and carbamazepine (Tegretol®) are folic acid antagonists, meaning that they counteract the effects of folic acid supplements. But, some other AEDs, like lamotrigine (Lamictal®) are not folic acid antagonists.
Very few research studies have addressed this issue. In one study, researchers at Boston University showed that folic acid supplements did not affect the risk for heart defects, oral clefts or urinary tract anomalies in children born to mothers taking some AEDs. However, in that same study these researchers found that taking a folic acid supplement decreased the risk for spina bifida in infants born to women taking carbamazepine (Tegretol®).
Click here to read the full article from the Antiepileptic Pregnancy Registry
Sunday, February 18, 2007
Recommended Reading
I just finished reading The Panic-Free Pregnancy: An OB-GYN Separates Fact from Fiction on Food, Exercise, Travel, Pets, Coffee, Medications and Other Concerns You Have When You Are Expecting
The book was done in a Q&A format which allowed for quick reading -- and allows you to easily just read the things you are interested in. One of the things I liked is he discussed the actual studies -- and dispelled the hype. The bottom line -- there is no reason to live in a bubble just because you are pregnant. You can still drink coffee, exercise intensely and do weight training, and you can take many medicines like pain killers and other prescription drugs. And you can keep your cats! I've had numerous friends tell me that I may need to get rid of my cats while I'm pregnant -- it's a complete overreaction to the risk of Toxoplasmosis.
The book was done in a Q&A format which allowed for quick reading -- and allows you to easily just read the things you are interested in. One of the things I liked is he discussed the actual studies -- and dispelled the hype. The bottom line -- there is no reason to live in a bubble just because you are pregnant. You can still drink coffee, exercise intensely and do weight training, and you can take many medicines like pain killers and other prescription drugs. And you can keep your cats! I've had numerous friends tell me that I may need to get rid of my cats while I'm pregnant -- it's a complete overreaction to the risk of Toxoplasmosis.
Medication Pregnancy Registries
Information on effects of psychiatric drugs in pregnancy is very limited. This is because drugs are not tested on pregnant women. It would be seen as unethical to use pregnant women as guinea pigs. What is known about the effects of drugs in pregnancy comes almost entirely from anecdotal reports and clinical experience documented in various pregnancy registries.
Many medications have registries set up to collect data. Some registries require health care providers to do the enrollment while others allow the patient to enroll.
It's important if you do decide to take medicine during pregnancy to register with the registries. The results from these pregnancy registries help answer the common question "Is this medicine safe for my baby?"
Here are links to various registries for drugs used for bipolar disorder:
Lamictal:
http://pregnancyregistry.gsk.com/lamotrigene.html
Wellbutrin
http://pregnancyregistry.gsk.com/bupropion.html
North American AED (antiepileptic drug) Pregnancy Registry (covers Klonopin, Depakote, Neurontin, Lamictal, Ativan, Topamax and more. )
http://www.massgeneral.org/aed/
The AED registry is not just for women with epilepsy it is also for women taking AEDs to treat bipolar or other mood disorders.
FDA List of Other Pregnancy Registries
http://www.fda.gov/womens/registries/registries.html
Many medications have registries set up to collect data. Some registries require health care providers to do the enrollment while others allow the patient to enroll.
It's important if you do decide to take medicine during pregnancy to register with the registries. The results from these pregnancy registries help answer the common question "Is this medicine safe for my baby?"
Here are links to various registries for drugs used for bipolar disorder:
Lamictal:
http://pregnancyregistry.gsk.com/lamotrigene.html
Wellbutrin
http://pregnancyregistry.gsk.com/bupropion.html
North American AED (antiepileptic drug) Pregnancy Registry (covers Klonopin, Depakote, Neurontin, Lamictal, Ativan, Topamax and more. )
http://www.massgeneral.org/aed/
The AED registry is not just for women with epilepsy it is also for women taking AEDs to treat bipolar or other mood disorders.
FDA List of Other Pregnancy Registries
http://www.fda.gov/womens/registries/registries.html
Saturday, February 17, 2007
Why I started this this blog
The decision to start a family can be a nerve-wracking time for many women. I think it is even more so for someone who is diagnosed with a condition like bipolar disorder.
Instead of just fretting about if it is safe to drink caffeine or take Advil (like many of my friends) -- I am also faced with deciding if I should remain on my medication while pregnant. Is it better to stay on my meds to ensure more mood stability or should I forgo medication because it might affect the baby? Am I more likely to become manic or depressed during pregnancy? How will I deal with sleep? Will a lack of sleep throw me into mania?
And of course there is the struggle with the bigger question of is it right to bring a child into the world when there is the chance they could inherit this condition.
I've spent countless hours searching the internet and reading books -- and although there is a ton of information about pregnancy and tons of information about bipolar disorder. There is very little information about managing bipolar during pregnancy. So my mission is to have a place where I can share all the information I find in one central place.
Share your thoughts by emailing me at bipolarpregnancy@gmail.com
Instead of just fretting about if it is safe to drink caffeine or take Advil (like many of my friends) -- I am also faced with deciding if I should remain on my medication while pregnant. Is it better to stay on my meds to ensure more mood stability or should I forgo medication because it might affect the baby? Am I more likely to become manic or depressed during pregnancy? How will I deal with sleep? Will a lack of sleep throw me into mania?
And of course there is the struggle with the bigger question of is it right to bring a child into the world when there is the chance they could inherit this condition.
I've spent countless hours searching the internet and reading books -- and although there is a ton of information about pregnancy and tons of information about bipolar disorder. There is very little information about managing bipolar during pregnancy. So my mission is to have a place where I can share all the information I find in one central place.
Share your thoughts by emailing me at bipolarpregnancy@gmail.com
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