‘I was managing my bipolar disorder. Then I decided to get pregnant’

There’s no right answer when it comes to navigating your mental health and pregnancy, says Jennifer Pollack, all you can do is try your best

Sunday 26 January 2020 14:57 GMT
Limited data around some medication and pregnancy means women have to attempt motherhood on a trial and error basis
Limited data around some medication and pregnancy means women have to attempt motherhood on a trial and error basis

At 31, I was diagnosed with bipolar II and generalised anxiety disorder. At first I hated the powerful drugs I was prescribed. They scared me. But the black moods, hypomania and panic attacks that almost landed me in the psych ward scared me more.

After years of trial and error, I landed on the right combination of meds. Seroquel tamed mood swings, Lamictal regulated the full-body agitation that comes with bipolar, Remeron helped anxiety and depression. Combined with a great support system, the meds helped me make critical lifestyle changes so I could finally stabilise. I got out of a bad relationship. I stopped “working hard and playing hard”, the credo among my Silicon Valley co-workers. I married a wonderful man. We bought a house with a little backyard.

But the next natural step, having a baby, was an unsettling question mark. Google was useless. Is Seroquel safe for pregnancy? (“Not enough data.”) Does Remeron affect a foetus? (“Possible association with premature birth.”) If I clicked around long enough, the answers became inconclusive. It seemed that my meds had a “small chance” of harming a foetus, but the research was hazy. So I asked my psychiatrist.

“There is no right or wrong answer,” he said with a sigh, like he’d been waiting for this question. “The research sample sizes are incredibly small. Because who would want to sign up for that test?”

Exactly. Who would? Would I?

“But we do know that depression and anxiety affect a foetus,” he continued. “I tell my patients to do the pillow test: which choice allows you to sleep better? The risk of being on the drugs or the risk of being off them?”

A pillow test? That sounded like a trite way to make this decision. There had to be more data, more science, more concrete answers. He referred me to a specialist at the University of California at San Francisco Women’s Mood and Hormone Clinic.

The specialist confirmed my bipolar and GAD diagnosis but concluded that I was on the wrong cocktail of drugs to begin with. What I needed, she said, was Lithium – which came with “a small risk” of congenital malformation.

Why did no medical professional have an answer? Was it morally wrong to get pregnant on these drugs? Should I adopt instead? Forgo motherhood altogether?

I fought back tears. I had come for clarity, and instead, I was thrown back to square one. Why did no medical professional have an answer? Was it morally wrong to get pregnant on these drugs? Should I adopt instead? Forgo motherhood altogether?

“You seem upset,” the doctor said.

“I just don’t understand how I’m supposed to navigate this.”

“The most important thing is a mother’s health during pregnancy,” she said. “Ultimately, the choice is up to you.”

After the appointment, I went to the hospital bathroom and cried until I felt empty. Then suddenly, I was clear. The choice was up to me. I wanted to have a baby, and I didn’t want to do it on any of these drugs. I’d been stable for over a year. I could do this. I actually looked into the fluorescent-lighted mirror and said: “You can do this.”

When I next saw my psychiatrist, I told him I wanted to wean off everything. “OK,” he said. “We can try, but we’ll have to do it slowly and check in often.”

For a while, things were smooth. I began to wonder whether I’d really needed the medications at all. I was achieving at work, sleeping well and generally content. I started seeing an acupuncturist and healer who agreed that I should “absolutely not get pregnant on pharmaceuticals”. Her plan to naturally combat bipolar involved a combination of acupuncture, diet and herbs.

Six months later, I had weaned off both Seroquel and Remeron, leaving only Lamictal in my system. But one morning, on my train commute, I started to obsess about whether I’d turned off my iron. This again. Soon, I was flooded. My vision blurred, my heart drummed, nausea swelled into my throat and the walls closed in. The next thing I knew, I was lying on the filthy floor, dripping with sweat, staring up at a flock of concerned strangers. I’d passed out for a good two minutes – the result, the ER doctors later concluded, of a massive panic attack. They gave me Klonopin and told me to call my psychiatrist.

Though he had been patient with my attempt to go the natural route, my psychiatrist pointed out that paramedic-level panic attacks and long bouts of unconsciousness were definitely not good for a baby. Exhausted and defeated, I thought back to my friend Mills, one of the warmest and wisest people I knew, who also happened to be bipolar and who had become a pro at managing his illness. When I was first diagnosed, Mills told me: “This illness is like flying a plane through weather. You can’t foresee the whole trip. You’ve just got to handle what’s right in front of you.”

Okay, just fly the plane, I thought. I need meds. I want to have a baby. The risks are small.

Instead of putting me back on Remeron, my psychiatrist started me on Celexa which was backed by a bit more data on pregnancy. And after a few months of feeling well on Celexa, I had the confidence to go off birth control, thinking it would take at least a year to conceive at 36. But the first time we had unprotected sex, I got pregnant. With twins. After the ultrasound, I couldn’t stop laughing at the absurdity of it all. My husband went home and obsessively mowed the lawn.

‘The first time we had unprotected sex, I got pregnant. With twins. I couldn’t stop laughing at the absurdity of it all’

My first trimester, all I could do was vomit. Severe morning sickness, which actually lasts around the clock, is common in twin pregnancies. In one month, I lost 12lb. Then I developed hives all over my body. Most medications have at least one five-alarm-bell side effect. With Lamictal, my bipolar medication, it’s an extremely uncommon but potentially deadly rash known as Stevens-Johnson syndrome. Anytime I developed even the most minor rash while taking it, I was instructed to immediately text a picture of it to my psychiatrist.

So I did. The response: “Go to the ER.”

That day, after all my weaning and adjusting, I had to stop Lamictal cold turkey. My husband, who’d seen me through bipolar episodes, turned a little grey. “Don’t worry,” I said, “we’ll figure it out.” At this point we didn’t have a choice. We had to fly the plane.

The rash disappeared within a few days, leaving just Celexa in my system. I spent the rest of the pregnancy doing everything in my power to stay sane and healthy. I went to the hundred doctor appointments that came with my high-risk status. I ate clean and drank gallons of water. I waddled my enormous belly through parks to get a dose of nature. I went to prenatal yoga classes.

I delivered via planned C-section at 38 weeks, full-term for twins. They were identical boys, both approaching 7lb, wailing with verve the minute they hit the air. They did no neonatal intensive care unit (NICU) time and we went home to spend their first weeks in a haze of love, joy and sleep deprivation. Although my husband and I were delirious, the twins were thriving.

But when the boys were about 3 months old, my mood shifted. I suddenly felt panicky, obsessed with bottle sterilization and convinced that our part-time nanny was going to kidnap the babies. I couldn’t sit still, and when I did, I bawled uncontrollably. I needed to sleep but couldn’t. All of these symptoms felt very familiar.

My psychiatrist put me back on Lamictal, and within weeks, I stabilised. I fell in love with the boys all over again. Every new thing they did fascinated and delighted me. We took family walks around the neighbourhood with our boat-size double stroller. In selfies, we looked tired but happy. The boys looked like curious angels.

What do you do when you can’t possibly know the best choice about something as important as your own health and the health of your babies? I did my homework. I tried to plan it all out. But in the end, I had to adapt to changing circumstances, take it one day at a time, and go with the information I had in front of me. Fly the plane. Do the pillow test. In other words, like most mothers throughout the ages, I did my best.

© Washington Post

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