We are planning on trying for another baby August 2012. I need some experiences from others with going off of mood stabilizers. I'm on Trileptal and Cellexa currently. I decreased my meds with my first pregnancy, I didn't have any issues until after my son was born. My post partum depression almost got the best of me. I have been diagnosed with PTSD, Bipolar Type 2, and Depression. I worry about going off the mood stabilizer because I never went off completely with my first pregnancy, I was on a different med at that time. Suggestions on coping mechanisms and any other words of wisdom.
Thanks

Hi there, and welcome.

I have a Bipolar dx of unspecified type but can have prolonged manic episodes. I have not had children but I have been on and off mood stabilizers, for different reasons.

Typically, when i went off meds i was doing well. Perhaps the first most obvious thing i would suggest is, that you don't "try for this" until you have successfully tapered your meds, and are stable. You can help yourself stay stable by making sure you get enough SLEEP.

The very next thing would be to reduce the stress in your life to a minimum. For instance, depending on your lifestyle this might mean taking an early leave from work once you become pregnant. I say this thinking of a stressful work environment. However, some people get fidgety and feel more stressed if they are at home with nothing to do. If you enjoy work and it does not fatigue you, then, it might be positive for you to keep working while you can - in this case staying connected helps us keep from getting depressed. The point is to make choices (and changes if necessary) to reduce STRESS.

Plan A will be for you to be medication free during pregnancy, and if you want to breastfeed, possibly during that time too. You will need to work closely with your doctors - maybe see your pdoc more frequenly for monitoring. I would suggest having your obstetrician and pdoc work together from the outset to discuss your overall medical status as well as possible medications that can be used in the event you need to be medicated during pregnancy. Then, should you become depressed or hypomanic, you will all have to decide, based on the severity, whether it it is more important to medicate the episode and if so which meds to use depending on the gestational stage, or whether you might be "ok" enough to remain unmedicated until after delivery.

I would also suggest seeing a counselor before, during and afterwards even just for supportive therapy.

If you have family-history of postpartum depression it may be advisable to pre-emptively choose a strategy that will allow you to go back on medication right after you deliver, because as you know antidepressants take a while to "kick-in."

With regard to post-partum depression, there are a few solutions. one can be to use formula so that you can actually get back on medication right after having the baby. There are some meds (get docs advice) which don't pass into breast milk. Another thing you will need to do is make sure you get enough SLEEP and general REST after you have the baby... this means someone else gets up and feeds the child at night. If you are using breast milk, there are pumps that you can use to draw and store breast milk which someone else can then give the child during the night hours.

It just so happens i ran across an article lately about this recently. i will look for it and post it for you.

From my own personal experience, unpregnant but keeping mood charts and being OFF meds, i can say that a HUGE factor, perhaps even the BIGGEST, in retaining stability, is getting regular and sufficient SLEEP, every single night. Sleep goes off, mood goes off. (it happens to regular people too, but they just get cranky for a day, whereas we end up on major medications! ) So, if nothing else, go to the ends of the earth to ensure that you will be able to get the FULL amount of rest that you need during pregnancy and after delivery - and "FULL amount" means however many hours YOU need to feel rested. no "oughtta's" and "should's" about it.

wishing you well, and i'll be back with that article if i can find it again.

~ waves ~

Hi,

It's great that you are working on a plan and asking questions.

Find a ob/gyn who specializes in high risk pregnancies. This person will be up to date on meds and other treatment options. Make sure that this ob will work very closely with your pdoc.

Sometimes timing is important. Sometimes the ob and pdoc will put their pregnant patients on meds after the first trimester (for example).
Sometimes they want to put the mothers back on meds the first day after delivery.

I agree with Waves that you need to find ways to increase the importance of sleep in your life. You might want to plan to get help in the home during the pregnancy and more after the pregnancy.

How old is your first child?

Also, go to the psych central forums. They are busy.

M

Dear Gilspudmama

Here is the article i had run across on bipolar and pregnancy.

Treating bipolar disorder during pregnancy
CURRENT PSYCHIATRY
September 2011

Mytilee Vemuri, MD, MBA
Assistant Clinical Professor of Psychiatry

Katherine Williams, MD
Associate Clinical Professor of Psychiatry
• • • •
Stanford University
Stanford, CA

~ waves ~

Hello, and welcome to the gang.

The only info I have is much as you share with the first pregnancy. It is tough trying to balance the meds, and affect on the baby vs. going off them during pregnancy.

The long term issue is caring for the kiddos and any parents absolutly needing a dependable support system. Difficult for any parent on their own without support. But having post partum issues or balancing the body chemicals is a challange.

It takes a person that can balance and adjust, with a dependable family to be there. My dil had similar diagx as yours, not the PTSD. She was okay single, prior to the baby to care for and a home, I am not sure she took meds. After the marriage, I needed to help a lot, mostly with the baby when he came. Difficult time getting meds and chemical balance back.

Dil went back to work, son was stay at home dad on disability/wc. But the lack of sleep was a huge thing for them. DGS was born with a disordor that the tummy was coming through a hole in the diaphram, unkn if related to meds. BUT he never slept, projectile vomit after eating. It was 2 yrs before he even slept through the night.
The first 6 months, the kids had come up every afternoon for me to give them a breather, and then on weekends stayed here for me to do the night shift. I went to bed about 9 am when they got up.

I do not know how they would have met his needs without the family pitching in for them. I am sure some how they would draw on inner strength, but it was so much easier having family support AND unconditional caring.

you are a wonderful mother di.