Hiatus over??

Well it was a forced hiatus. Sorry I was away for a whole bloody year and more, but I have been reading and keeping up with all you amazing bloggers surviving and (somehow) thriving and being generally inspirational 🙂

I was super ill. I had a massive manic period, followed by a bout of deciding to stop eating, followed by getting better and realising that I had to do something to get my family out of the trap we’d found ourselves in, so I returned to work. Fuck mental health my god if there is anything that will put a person into poverty – which yes, exists in in developed countries too, all things being relative – it is shitty mental health.

Did I also mention I melted off my hair nearly a year ago? I was trying to go blue and made the mistake of leaving the bleach on for too long. So as well as feeling like crap I had Doc from Back to the Future hair for ages (well I still do but at least I can tie it back into a pony tail now!). I literally did not leave the flat for 4 months till I had to at Christmas.

So far so good ish? It’s a senior role, it’s tough and I have been in floods of tears and had to take days off when I just could not get out of bed, but I am doing it and have lasted beyond six months in a role for the first time in Fundraising since I was 30 (I am 38 this year – actually in less than a week). I have so much I want to share on my blog and so many ideas for things I want to do – but the good thing is that I am on Fluoxetine which has helped with the crippling anxiety and paranoia I was getting on top of the lithium and quetiapine, and we stopped psychotherapy because regressing was was actually making me worse.

We are MOVING HOUSE which such a big deal I cannot even begin to tell you how much I have come close to committing suicide because of our horrendous neighbours (and you know, it is serious not just an expression – their shit dance music is blaring and keeping my baby awake as I write but NOT FOR MUCH LONGER WOOOO). Once I am into my new house, hoping work does not kick my ass too much and so on, I want to return to this blog properly.

The most important thing is that my beautiful baby girl is thriving and doing so amazingly well. I am proud to say she is a typical toddler now at 2 and so gorgeous she makes my heart burst every time I look at her. So, more to follow, I will return to this slowly. Thanks for hanging in there with this blog of mine 🙂

It’s not Chariots of Fire

Not by any stretch of the imagination, but I did something today that I believe is the first step towards getting better. I’m on the right path now.

A full eight hours of sleep helped massively with my state of mind (I love my husband). But I have also been getting to the point where I am so full of self loathing that something had to be done.

We Brits are renowned for whinging and with good cause. We are a nation of moaning Minnies. If it’s not the weather it will be the awful traffic on the M4 by Chipping Sodbury (I am sure you can get to Chipping Sodbury from the M4 somehow), or the coffee is too cold or these new shoes are pinching too much or the buses are late or there are leaves on the line. It could be perfection, such as a train running to schedule, and we would still find something to complain about.

I’m no different. I had a draft post called Fat where I bemoaned how trapped I was in my body. Reading it now, it was a pity fest of epic proportions and I am glad I didn’t put it out there for the rest of the world to see. I am a rolling tub of lard and no longer can blame it on my thyroid, pregnancy or post pregnancy. My thyroid is ticking along nicely and a year down the line, that post pregnancy thing just doesn’t wash. I am out of reasons for doing fuck all apart from eat Nutella with a spoon. 

By the way, I am no Katie Hopkins about food and fat. DH has a huge problem around his weight and eating which is for him to deal with (and he is trying) – a combination of learned very bad habits and psychological comfort eating. But I love him for him and size doesn’t come into it for me. I don’t judge anyone else as I see it as irrelevant. I hate how hung up on bodies we are as a society and am frightened for my daughter in this regard.

Where it does matter to me is the connection between diet and physical and mental health. It’s all part of the same package – one affects the other.

Now, with mental health to contend with, I am aware I have huge issues with body image and food. So it’s not just my inbuilt cultural instinct to bitch on about my size that’s the problem. In a manic phase I become anorexic. I stop eating for months at a time. Two pieces of Nutella on toast a day or less is my sum total. I don’t need food. I binge drink, that’s for sure. But food becomes a poison to me. Then, when it flips, I can’t stop eating. Anything that comes into my path I devour mindlessly. I crave carbs and nothing makes that go away. I put all the weight back on and more.

So in amidst this mix of random food chaos was, in the past, my check and balance. And that was exercise. I have exercised regularly for as long as I can remember. I used to train long hours at swimming as a child and then as a teen walked a good two hours a day just to and from school (who does that these days? Such good exercise!). As a student I hit the gym to battle the bulge and managed to get to a good weight. Then in my early 20s I started running.

My mother has been a runner for many decades now and still runs half marathons in her sixties. I didn’t run because I wanted to be me not her. But then I decided that was silly and put on a pair of trainers and off I went. I think that running, above all else, has helped with the stability over the years before my diagnosis, more so than anything.

I have gone from regularly doing half marathons to barely being able to walk up a flight of stairs. I wanted to try out fell running it looked so cool. Now I am scared of going somewhere unfamiliar, let alone up and down Mount Snowdon for a race.

Then I got really sick around five years ago and moved here. I picked it up again and then ran in lunch breaks and before or after work. Sure, lithium makes it harder but not impossible to lose weight. I didn’t get any larger because I started medication. Then I got pregnant. And then we moved. So always an excuse.

I tried to run in Scotland. But in the grip of such severe postnatal depression I felt every agonising minute I was away from my baby for. I also pushed myself too much – I wasn’t even three months postpartum when I was out trying to lose weight. My body was still wrecked from pregnancy and a very difficult labour. Looking back now I realise how ill I was and how dangerous things were. But when you are in the grip of it – and hey exercise is good for you right so it can’t be a sign of something bad? – it’s impossible to see and get out of.

Then the crash came and I was so ill. We left and came back to The Netherlands. Life became a misery of putting one foot in front of the other, just to get through the day. It had been this way for a good few months until something in me snapped yesterday. I decided enough was enough.

I tidied up all our stuff so our room was lovely and neat, blogged a bit about what I wanted to achieve yesterday which I did 🙂 and that really helped. Some good sleep also bought clarity. Oh blessed sleep!

But really for me this is it. No more excuses. I am tired of being this shadow of a person, this half-being that operates in the background. I don’t want to feel like an observer in my daughter’s life, unable to participate and letting others make decisions for her I should be making. I need to shake this sense of detachment, that I am just watching whilst everything happens around me. It’s my choice. It won’t be easy. There will be setbacks. But I am prepared to try.

It’s not just because I’m whingy and British – it is genuinely harder to get exercise regularly when you struggle with your brain. Also ladies don’t rush back into your size 10 jeans straight after labour – give it time. Enjoy your baby. You’ll know when it feels right to work out again.

Twenty minutes today is all it took. And I felt glorious. I was knackered after a combination of walk-run but I have still this lovely feeling of having done something positive. I’ll never be a Roger Bannister or Paula but that doesn’t matter.

I plug myself into my music, plonk shades on and off I go in my own world. It gives me a break. I think through so much. And when I finish I have a sense of achievement.

I looked absurd today as these trainers are stupidly expensive but look horrible. I had DH’s shorts and shirt on as all my stuff is in storage. My norks are enormous as I couldn’t breastfeed and haven’t really shrunk since pregnancy and I had to stuff them into a substandard sports bra (DH is being despatched to storage later today to get my stuff). Gawd make sure you have a good sports bra! I managed but you know…..

image

There’s a pic of two essential parts of my therapy. One is far cuter than the other, and I’m looking forward to taking him to the beach to do long runs again like we used to. I’m cautiously excited about the future again. That can only be a good thing 🙂

Bipolar and Postnatal Depression

I am sorry again it has been some time since a post. Things have been quite crazy and I find I don’t have nearly enough time to devote to my blog as I would like! Sometimes if I am not feeling great then I find it hard to get the motivation to do anything and unfortunately that phase has lasted a few months this time. But here I am! Please note I discuss suicidal thoughts in this blog so if that is a trigger or distressing I’d advise not reading on.

I posted some time ago about being away and how bad things had been. I said I would share when I could a bit more detail, in the hope that whoever reads this might avoid the huge mistakes DH and I made. How badly we misunderstood and underestimated bipolar and postnatal depression.

I was excited for a short burst of time after having made a catastrophic decision to leave The Netherlands and move to Scotland. See, I thought I could have it all. My new baby, a new shiny job, nice house, nice car, nice life, self-respect for having a decent job. Husband able to stay at home and enjoy the baby. And look at me, the great provider, the super mum. My ego needed a boost. Nothing could possibly go wrong could it?

Before I am too hard on myself, we had the very best of intentions. Our tiny apartment had the neighbours from hell who were driving me literally mental with their partying day and night. Money was so tight as to be unfunny. I figured I might have at tops 3-4 years left of work before my next episode and DH wanted to be in a position where he had the qualifications to be able to provide for us. Neither of us wanted to see our baby in childcare from such a young age – nothing against mothers who did it but for us we wanted one of us to be with her. And, seeing as I had the experience and the qualifications to land a good job then it was logical I would be the one to do it. I didn’t want to have a big commute and my Dutch is really really bad so I couldn’t find work locally.

That meant a return to the UK where DH could study and stay at home, and I could find work at a convenient location so travel time would be minimal. I could earn enough to keep the family in the UK happily as well as send money back to cover any extra bills back home. I had in my head we could move back as soon as DH had finished at uni. I got offered what I thought was the ideal job in the ideal location. My confidence took a great boost, something sorely needed after the disasters at work over the last few years.

See, it all adds up on paper doesn’t it? Of course it does. How dumb could we have been to not realise NEVER to make any life-changing decisions until AFTER the baby has arrived?! In our defence, we were just trying to provide our child with what we thought was the best possible life. But did I pay any attention to the horrendous statistics – that I blogged myself – about postpartum depression? Which, as a woman with bipolar meant I had a significantly increased chance of getting (around a half to two thirds of women with bipolar are at risk of postpartum depression – see below article)? Of course I did not. Looking back, underneath I was so uneasy about the path we had chosen. So was my DH. But foolishly we did not discuss it with each other, although one word from either of us could have ended the madness. Lesson to self – communicate more with my partner and vice versa.

Anyway. We went. After a traumatic birth and time in NICU for our baby. I was, and remain, besotted with her. I had no idea such a small creature could bring me such joy. As we packed up to leave (which was left to the very last minute, as if we did not really want to bring ourselves to do it), I carried her and crooned to her and just loved every minute of being with her. This was a far cry from the woman I thought I would be, frighted and anxious of holding my own child, fearful that I would somehow damage her and be repelled by her somehow. As we went through the move process and wound our way towards our new destination in the UK, I savoured every moment I had with her, fully expecting to be still as engaged as I was at that moment. Not realising the pain I would feel at leaving her, when she had not been out of my sight the moment we left the hospital. Not realising how much support I needed from professionals to manage this bipolar successfully. Not realising that I had so much work to do to address issues from my childhood and the impact that would have on me now. Not realising how bloody long it takes to physically recover from pregnancy and giving birth! Not realising either, how utterly shit  mental health services would be in the UK. I mean I wasn’t expecting it to be up to the Dutch standard. But it wouldn’t be that bad would it?

We signed up with the GP and explained my circumstances. I was referred straight away to the psychiatric team. All good so far, we thought. We just had to wait for the appointment to come through.

I started work. The first couple of days were actually ok. Kind of a honeymoon period. I felt really quite dizzy and crap, which later transpired to be my thyroid medication being too high and the dosage was promptly reduced. I had two months of sickness as a result of that but that is by the by. By the end of my first week at work I knew I had made a hideous mistake.

Let’s just leave the job as it was not worth in any way shape or form leaving my baby behind. Let’s just say I didn’t fit in. And I saw the writing on the wall well before my bully of a boss began to try and discredit me. All of these things do not help someone with bipolar in the workplace whatsoever, but when you add the chances of postnatal depression to it, the situation becomes unmanageable. But suffice to say, it didn’t work on a personal or professional level.

I think postnatal depression just kind of sneaks up on you. It’s a gradual thing. Well DH noticed it a lot more than I did before it twigged as to what the problem might have been.  I was in tears every day at work. I felt physical pain in my chest every time I saw DH drive off with my daughter in the back. I felt like I had FAILED as a mother – how could I have left her? Every day when we got home I would get her out of her pram and then cuddle her and sing to her, but after about five minutes hand her back to DH and I couldn’t hold her as I was too afraid to. I turned into that woman I was so frightened of becoming when pregnant.

I was afraid of my own child. A four-month old baby.

Why was I afraid? I was convinced she didn’t love me. She only wanted DH. I was not what she needed, that somehow by going back to work I had rejected her and she picked up on this. I would lie on the sofa looking at her and DH together, marvelling on the one hand at how amazing she was and then crying because I couldn’t bring myself to go near her. I simply couldn’t relate to this growing baby which I had left pretty much still as a newborn and was now gurgling, laughing, chatting and wriggling at alarming speed on her playmat. I was stuck in a past and couldn’t drag my brain with me to the present that my daughter now inhabited. And it was all I could do to get out of the house every day. The only time I found a bit of peace was when she would be asleep in her cot next to me, tiny hand holding my finger, and I lay there looking at her, marvelling at her perfection. We have a sleep sheep that makes the sound of the doppler, and it reminded me of hearing her heartbeat when I went into labour and I remembered the time when she was still inside me, both of us soothed by the sound of each other’s heartbeats. Most of the time though, I just wanted to die.

I don’t think this is the same as hallucination but in a very depressive or very manic state I have very strong visualisations. And I hear things. For many weeks all I visualised were huge metal spikes coming out the ground to impale me. I could hear the noise of the spikes clanging loudly every time they shot out of the ground and thumped back in again. Almost like a cartoon or in a computer game. But very, very real in my head. And I could hear it almost everywhere I went. I had to stop driving for a while as it was so distracting. I also thought about driving off a cliff edge too. And also grabbing my daughter and driving off somewhere with her, anywhere where no one could reach us. I even wanted to leave my DH as I just needed to be with my baby so badly all alone.

In my head, this went on for quite some time. I had better days of course, where we would all go out for a walk and even maybe venture out to do some swimming at a special baby class on the Sunday. Our activity together. I felt like we needed that for her to love me. But there were many very bad bad days.

The turning point came where we were all in bed and I went, mentally, into a different place. Often in life, and even now, I fell like I walk a very fine knife-edge. The smallest thing could just tip me over the edge. And I don’t know what it was, but something that night did.

Before I continue with the story, people might wonder where the mental health professionals were in this scenario. Well, funny that. They were nowhere to be seen. I got HALF AN HOUR with a psychiatrist for an appointment that was supposed to be an hour. I had to have my lithium dose reduced as it was making me too sick to continue on the very high dose I had during pregnancy. A side effect of lithium for me is extreme anxiety when it is too high. Bear in mind I was used to seeing a psychiatrist weekly or bi-weekly during pregnancy and once a month prior to my pregnancy, more if I needed it. So to get one half hour appointment on the NHS was beyond a shock.

I was pescribed anti-anxiety medication to use on an as-needed basis, shortly before my episode. It is one of the strongest and I had to be careful as it could make me very dopey. And then my next appointment, for mid-January, was cancelled and I was offered one in APRIL. When I hadn’t even had a proper assessment in the first fucking place! I was so shocked and really quite afraid. How could I be on such strong medication with no support? We knew something was very wrong with me and we knew that I needed help.

Anyway, that night I went to a different place. It was a happy place in my head, that I remember. My daughter was with me too. DH was on the verge of calling an ambulance when I conked out from the anti anxiety medication. Which did its thing in that it cut off all feeling from everything, but at the time that was what was needed. And when I came to in the morning we talked properly for the first time in weeks and agreed that we needed to go home to The Netherlands. Within three weeks of making that decision we were on the boat back.

Depression is a creeping, twisting thing. DH has depression now as a result of what we went through. It was an isolating experience as it was just us, no support network, no friends, no help from health professionals. We are in a worse place than when we left. Depression seeps through your pores and gnaws at your insides, making you question every little thing you do – when you can actually find the strength to do something.

Postnatal depression is, of course, similar. For me, my guilt over leaving my baby was amplified beyond all reason. My GP explained that all mothers have to deal with guilt when they return to work but, because of my biploar and the depression things were out of all proportion. I was unable to communicate, to continue to bond with her. I felt shut off from this wonderful creature, desperate to come back into her sunny, happy universe but incapable of understanding how to do so. I never once wanted to harm her in any way – in fact it was because I was so paranoid about harming her that I couldn’t bear to touch her some of the time.

Bipolar and postnatal depresssion lead you to an exceedingly dark place, a deep pit I am still trying to climb out from. I have guilt at leaving my baby. I have guilt at putting DH through such difficulty. I have guilt at wrecking our lives when actually what we left was not so bad, but trying to get that back again is incredibly hard. I have guilt at ruining us financially – this very much a bipolar symptom that reared its head with me in January. I felt cold inside, physically icy cold. My mind felt black. Even surrounded by the natural beauty of where we were, I saw black everywhere I looked.

This has left its scars. I thought DH and I might end up divorced. I know it crossed his mind – he says fleetingly but I am sure he thinks it still. The last two nights I have been very close to my knife edge again and I know he is at his wits end. I know he doesn’t see a way out of our current mess. And I find that I don’t have the strength to pull him through along with me. He did strongly refute earlier that he had been thinking of divorce and I believe him. We are in this together or not at all. We still love each other greatly. Every time we have been tested (and there has been plenty and I’d kind of like it to stop!) we come out stronger. And I know this will be no different.

Is there a ray of light as I climb painfully out of my pit? There is most definitely. Since December I have spent every day and night with my girl and marvel at her wonderfulness. I had no idea how becoming a mother would help with my bipolar journey, improving me as a person and how healing I would find spending time with my child. Every day her laughter and smiles and watching her progress warm me up a little bit more on the inside. All parents rightly say this about their offspring, but really, what a little miracle she is. My daughter makes me want to be a better person, makes me want to get better for her sake.

I wept as I met with my old therapist and case worker last week. To talk through with professionals what had happened was in itself such a relief. We talked a lot about the guilt and the confusion I felt about being a mother. I am seeing a psychiatrist soon and starting my psychotherapy again. I can’t believe how much I underestimated bipolar. If anything taught me from my time back at work, was how not to go about living with bipolar. Not for me anyway. Stress wow, what a trigger. I had no idea. What is very difficult for me is the life I had always planned to live is not open to me. I can’t do it, not the way I thought. So now I have to figure out the alternative path. There will be one and at least I know now what not to do.

There is hope. In the depths of the darkness, it’s easy not to see the little chink of light at the door you think is firmly shut. Which it’s not really. I feel so so lucky that finally, the help is there that I need to get better. I might never work again but I can become the best stay at home mother I can be for my baby. She deserves it.

http://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-and-postpartum-depression.aspx

Tired. Tired. Tired. Did I mention I’m tired?

Here’s a post I was in the middle of typing when pregnant, around March I think, and then never got around to finishing. So I have finished it now. It might be useful for those ladies considering an increased dose of their medication during pregnancy 🙂 I do talk about thoughts of death, paranoia and suicide in the context of adjusting medication so please don’t read on if that could trigger you in any way. 

I’m sorry it has been some time since I last posted. I have been surprisingly busy and I find these days my brain can only process one thing at a time.

It has been a nice time. I have done job interviews, unexpected as I am so big now people need a periscope to look around me. I’ve seen friends. I’ve hung out at home with the dog. I’ve helped DH with his studies and even picked up my own books once or twice. The online book thing is going well. I’ve had a TON of appointments at hospital.

And I have not slept. I’ve had my medication upped twice in the last three weeks.

Insomnia is a killer for anyone at the best of times. When you’re lugging round an extra 20 kilo and your lithium levels are falling then it becomes a playground for dark creeping thoughts in the middle of the night.

I was very resistant to my medication being increased the first time round. I’ve got a little one to think of inside me. I am the kind of girl who deals very well with a lithium count of 0.4-0.5ish. I don’t deal well at the higher end of the range. I was therefore pretty upset at the thought of more drugs.

As it turns out it is, of course, fine. Basically the volume of fluid in your body increases, which in turn then decreases the potency (for want of a better word) of the lithium in your blood stream. I was reading at 0.2 which is basically nothing. But, because I was irrational and tired and lacking in hormones, I didn’t make the connection to a dip in lithium altering my perceptions. It wasn’t until I was sat with my psychiatrist that I realised all those thoughts of having a suicide pact with DH so he wouldn’t die before me were not in the normal way of thinking.

Because those thoughts weren’t along the lines of ‘oh, I’m going to kill myself now’, I didn’t think anything of it. I thought it was normal to plan my death, and because I was thinking waaaaay ahead into the future, such as in my sixties and seventies when it might have happened naturally at some point anyway, I didn’t see a problem with it. I created elaborate schemes in my head about euthanasia (legal in The Netherlands), car crashes, train accidents, travelling somewhere where there was a high incidence of plane crashes, so I wouldn’t have to live if DH died before me when I was old.

I also had increased anxiety, and DH retrieved me from the supermarket a couple of times as I couldn’t cope with the amount of people around me. I started, for the first time, to understand what paranoia in bipolar really meant. I was convinced that people walking past me on the street were about to come and do me harm, and that I couldn’t trust the doctors and nurses in the hospital to do what was right for me.

All of it, my psychiatrist assured me, was completely not normal thinking. And all that was because of a dip in my lithium levels.

What was impressive to me was the rapid turnaround in my thought process once they increased my lithium. Eventually I went up to 1000mg per day spread out over five lots of 200mg. It was amazing how much better I started to feel again. What I found as well towards the end of my pregnancy was how high they wanted to keep my lithium count – as high as possible – to avoid any potential psychotic episodes immediately after the birth. I really am a girl who doesn’t do so well on a higher count, so it goes to show how massive the changes in my body were that being around the 0.8 mark was absolutely fine for me in my last month or so.

Throughout all of this, my baby, of course, was completely 100% unaffected by it. They are tough little creatures, babies, designed to survive some pretty extreme conditions. As an expectant mother none of that matters whatsoever so there is no point in trying to reassure yourself in that way!

I have also resolved to not be one of those mothers that dishes out completely useless advice. Unless you’re the one living it, it’s almost impossible to understand what someone is going through, so therefore the only thing to do is emphathise (as a bipolar mum to be you are not alone) and offer a shoulder of support. The only advice I will give is keep an eye on those lithium levels. If you start to suddenly see the sky turning purple with pigs serving champagne, find yourself plumbing the darkest parts of your brain, doom scenarios marching through on a frequent basis at 3am, or even convinced that the old lady in the apartment opposite you has a incredibly sophisticated camera setup just to record your every move with the ultimate aim of taking your baby away (yes, that was me to the last two), then please get to your GP or psychiatrist asap and talk it out. Cortisol is not good for our growing little ones and particularly not for you.

So, to sum up:

– monitor your lithium every week or two weeks, following your doctor’s advice to the letter
– try and sleep as much as possible. Rest during the day. Take it easy. Get someone else to do the hoovering/housework/walk the dog

And that’s it 🙂 Having a successful pregnancy on medication can be done and I am very glad I continued with my lithium.

I’m back!

I will write more. I am sorry I haven’t posted for months! But such is the joy and bittersweet elation of becoming a new mother. I have a gorgeous beautiful baby girl who is the light of my life and oh crumbs is six months old soon. But my word, the ups and downs of bipolar and pregancy and the whole WHAT THEY DON’T TELL YOU AFTER  YOU GIVE BIRTH. I want to make a whole website dedicated to it just to help other women – and their partners – who have to go through it all. Labour was actually a hugely cathartic experience. And the sheer bliss and joy of holding my newborn in my hands was the most transformational, wonderful moment.

As to all that happened afterwards, I will leave it for now. Writing is my release so perhaps I will find the words to describe the final months leading up to the birth, and the months after, to give me some form of therapy. At the moment I waver between sheer happiness and crying nonstop at nothing in particular. It has taken me a long time to adjust.

For now though, let’s just say that I have overdone it. My medication has been adjusted. I am back in the UK. My husband has been my rock but even so has come close to breaking. But we look at our sweet adorable baby and feel so humbled and blessed, and we find the strength to get up and go on again. Just a cuddle or shy smile or giggle from her transforms my whole day. Becoming a mother was the best thing that could have happened to me. And, when all is said and done, I look at my little family and know that, once I am out of my thick, black pea soup in my head (the only way I can describe my world at the moment) all is well in the real world.

I will return……

My baby will be damaged blah blah blah

I was going to write about something else today, but it requires me putting on my new yoga dvd and actually doing it. I’m a bit too comfy on the sofa to have gotten around to that so far! I was looking through images for my page to make it a bit more attractive (expect to see many theme changes over the coming weeks as I have a playaround), and I saw so many pictures of bumps and pills it really got me thinking about medication and bipolar. It also is helping me build up to a big post around the psychology of trying to conceive which I hope to write about soon.

But in the meantime, here’s the question of the day – how much harm do bipolar medications do to the conception process and the unborn baby? As ever, links to relevant articles will be at the bottom of this blog.

For many, many years, women with bipolar disorder were told not to have children. It was too dangerous, the risks were through the roof, we would pass this onto our kids, they would be blighted forever with cardiac issues, psychological issues, we wouldn’t be able to look after them…..the list goes on.

Fortunately, we live in more enlightened times where a woman has more control over her decisions and her own body. We aren’t treated like idiots because we have a mental illness. Ergo, we can choose whether we feel able to manage the rigours of family and child rearing and, in that process, whether we decide to stay on medication or not. I can only share things from my own personal experience (and please note that I’m not a doctor so it’s all what I have been advised/experienced/read up about), but thought I would tackle this in a two-phase article; before pregnancy and during pregnancy.

Before I begin, just to put my medication into perspective. I live in a country which gives out paracetamol as a cure all for every illness and to get any extra medication is a big, big deal. The Dutch are big on self-help, medical intervention only where absolutely necessary, and not medicating unless it’s super serious, much to the horror of us expats who move here. I used to long for Boots and Superdrug where I could get something to fix any ailment I had over the counter, My poor DH, for example, had bad tonsillitis for two weeks and was told to go home and it wasn’t until he went spotty with a rash all over  his body that they finally gave out antibiotics. It took me a LONG time to get medication for my thyroid as well which was more frustrating as that I found more debilitating than the bipolar in some regards.

On the flip side, however, I am glad I am not on a huge drug regime. I was very reluctant to take anything and am glad I finally gave in and tried the lithium out. I have responded very well to it and, fortunately, have only had one psychotic episode which we were able to control without drugs since. I will talk about that another time though!

Pre-pregnancy

I could look at this in two ways but actually they all end up as a positive. At the time, I was on 600mg of Camcolit (lithium) a day. I’m definitely a ‘low dose’ kind of girl. When they increased me to 800mg I was sick as a dog and it made all my bipolar symptoms worse. I spent a week shivering at my desk convinced the whole office was out to get me!

I am pretty sure this accelerated my thyroid collapse. Now, all my research and speaking to my doctors told me that lithium wouldn’t cause miscarriages or make me infertile. On the contrary, as my moods were more stable so were my hormones, freeing up my body to focus on producing the right hormones at the right time and bringing me more into balance.

As for my thyroid, I really really need to do a long old post on this. But I firmly believe this is the reason that my miscarriage happened and why I struggled to conceive for so long. How else can I explain when, being put onto 125mg of levothyroxine, I was then testing positive six weeks later? I had made life changes as well, such as going gluten-free (again I will explore this later), and being generally more positive and happier. I had also done a lot of positive thinking exercises which again I will write about later. Given that I live with something that affects my mind, I am a strong believer in what the brain can do!

I should also comment that I didn’t discuss really with my doctors that I wanted to get pregnant. The scant advice I have read for women wanting to start a family with bipolar is to talk to your psychiatrist or GP. My care team certainly knew I was ttc, but I didn’t get any extra advice apart from that they would need to do more blood tests and I would be referred to the perinatal psychiatric services at the main hospital here. I suppose I should have taken their lack of concerned-ness as a positive sign that they weren’t phased at my wishes to have a family and if they thought there would have been any issues then it would have arisen.

What they did say after my miscarriage was that my thyroid would have played a part. So again, there you go. I can’t emphasise enough how important it is to keep an eye on those TSH and T4 levels if you want a successful pregnancy.

So, did taking lithium affect my conception chances? It’s a resounding NO.

Pregnancy

Now, this is where there is a ton of advice. And a lot of it I think VERY scary and intimidating and unnecessarily so. I feel so fortunate to be in such a no-nonsense country. I have stayed on my lithium and confess to gibbering with fear at every scan, terrified that I’m going to see a problem with my baby’s heart. That is the largest risk factor with taking lithium and one that was, until very recently, considered very high risk.

But why continue with medication? Well, mainly to stop another episode. We have to have ourselves in balance to deliver a healthy baby to the world. There’s also a 1:4 risk of postpartum psychosis immediately after the birth. There’s also a 1:4 chance of postnatal depression. So yep, that works out that, of all the ladies with bipolar having babies and giving birth, there’s a whopping 50% chance of a serious episode right after the birth.

Recent research that came out (I think) of the Netherlands (yay) showed that the chances of the baby being affected by lithium were much lower than originally thought. They are, I have been told, 1:2,000 which is less than 1%. My consultant also said he’d never seen a baby with the heart defect in all his years of practice and he must be in his sixties. So I felt pretty secure in taking it. I was actually more worried about my thyroid not working properly so I was very careful about taking that little pill every morning and following the instructions to the letter.

What I found funny was that the NHS do not recommend taking lithium in pregnancy which really surprised me. How can drug regulation and guidance be so completely different from country to country in the EU? But that’s a blog article for another day….

My medication got spread out so I had to take 200mg 3 times a day at regular intervals. It helped as the lithium dosage needed to be spread evenly so as not to cause a spike, which would have more impact on the growing foetus. I had blood tests every four weeks to monitor both thyroid and lithium and regular checks for liver, glucose, antibodies, and I have no idea what! For my first two rounds of blood tests they took 8 vials. For someone who hates needles this was really quite a trauma, particularly when you have a noob nurse digging around in your arm saying there’s no vein when you know that’s your ‘good’ arm!

Anyway…..

Basically, what happens in pregnancy is that as your volume of liquid goes up (so far I have gained 14 kilo, sadface), so the effectiveness of your lithium goes down as it decreases in strength in your bloodstream. We have to maintain a steady supply of lithium above 0.4 for it to be within the clinical treatment range. I’m going to talk about depression and pregnancy and hyperemesis in another post, but suffice to say it is horrible. I couldn’t do anything but focus on keeping a bit of water down. Around Christmas much to my relief my work contract finished and I was able to rest and recover from the hyperemesis. Except I was still very down. I was very frantic, I was very anxious. I was filled with nervous energy and no outlet for it. I hated EVERYTHING. Nothing was good enough. I wasn’t good enough. I had doom scenarios in my head, and would go from A-Z in less than a second, convinced everything was going wrong. I started behaving erratically again. I was convinced every man and his dog were out to get me. DH was beside himself with worry. And I was suicidal. These were such unwelcome emotions that I hadn’t experienced for over a year, I was devastated. And I was powerless to stop them.

Some part of my brain acknowledged that possibly maybe my lithium might be a bit low. It wasn’t until my later round of blood tests showed that it was at a paltry 0.2 in my bloodstream that I realised where it was all coming from. Reluctantly I agreed to an increase of lithium to 800mg a day, taken 4 times a day in 200mg doses. After all, I had read about the devastating effect of lithium on babies, right? Awful stuff. Why would I pollute myself with that?

I saw the head psychiatric honcho at the hospital who made me cry he was so nice. He said that the hormones in my body, namely the stress hormone cortisol, would have such a negative impact on my foetus, far more damaging than taking lithium, He said it was important to keep me in balance so the baby would be able to grow and thrive. They couldn’t do that unless I took my medication.

That was three weeks ago. Lithium count is now 0.35 and I am a different person. DH said it was like night and day again and was so glad to have me back. My liver is doing strange things but apparently that’s just because it is working harder to process the extra lithium.

So, is it worth it, this drug taking whilst pregnant? 

Yes, 100%. I wish I could advise on other types of drugs as I know there are many that aren’t safe. Particularly some of the anti-psychotics. But what I can say is that lithium is working well for me and I’m so glad because to be back in my black space was beyond awful.

This is already a bit long, but I am going to do a separate piece on the risks of lithium compared to other things during pregnancy. You have to do what feels right for you. Be guided by your doctors but also by your own instincts. Do you want to go to those crazy highs and crushing lows during pregnancy? We are at such risk and, if like me, you are already super protective of the growing life inside you, you’ll do anything to make sure your baby is ok.

So go with it. Don’t google stuff. Don’t feel pressured by idiots who get all sniffy at you taking medicine. Or your family. Or anyone who is basically uneducated about bipolar which would be (sadly) the vast majority of the world’s population. Do what is right for you. If you think you can manage without medicine then great, go for it. But don’t feel bad if you keep taking your pills.

Links

Bipolar UK – pregnancy leaflet
http://www.bipolaruk.org.uk/assets/uploads/documents/information_leaflets/bipolar_uk_bipolar_disorder_pregnancy_childbirth.pdf

OTIS – Lithium and pregnancy
http://www.mothertobaby.org/files/lithium.pdf

National Alliance on Mental Illness – Managing pregnancy and bipolar disorder
http://www.nami.org/Template.cfm?Section=bipolar_disorder&template=/ContentManagement/ContentDisplay.cfm&ContentID=17899

National Center for Biotechnology Information – Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies.
http://www.ncbi.nlm.nih.gov/pubmed/22000820