Pregnancy and bipolar disorder

Bipolar disorder has been the focus of BBC One’s EastEnders recently, as Stacey Branning tries to manage her condition during pregnancy.  Dr Neelam Sisodia is a Lead Consultant with the Trust’s Perinatal Psychiatric Service, which works to prevent and treat serious mental illness during and after pregnancy.

We caught up with Neelam to find out more about bipolar disorder during pregnancy.

What is bipolar disorder?
Bipolar disorder is a serious mental illness which affects mood. Someone with a bipolar illness will have periods of depression, periods of elation (known as mania) or a mixture of the two. In severe cases, it can also be accompanied by psychotic symptoms, such as hallucinations and/or delusions.

Women are often diagnosed with bipolar disorder in their 20’s or 30’s. A woman who has not previously suffered from it, but has a family history of mood disorder, may develop a bipolar illness for the first time during pregnancy.

Usually bipolar disorder is treated with either a mood stabilising medication or a combination of antidepressant and antipsychotic medication. Some people may also use psychological treatments, such as talking therapy, or find lifestyle changes can help. All women are informed about the risks of conceiving whilst taking medication and are encouraged to discuss plans to become pregnant with their psychiatrist beforehand if possible, so that adjustments can be made to their treatment plan.

How is bipolar disorder managed during pregnancy? 

This can be very complex and challenging. Women who have bipolar disorder are more likely to become unwell during pregnancy or after childbirth, than at any other time in their lives. Some are also at risk of developing a psychosis postpartum (the period immediately after childbirth.)   

Treatment during pregnancy will vary, just as the needs of each woman will vary. An individual treatment plan is developed between the woman, her perinatal consultant psychiatrist and her Community Psychiatric Nurse (CPN). She’ll also be supported by a specialist midwife.

What about medication?
The decision about taking or not taking medication is always difficult. The balance of risk and benefit will vary between medications and will be different for each woman. Some of the mood stabilising medications used to treat bipolar disorder can cause serious foetal abnormalities however a relapse can have a significant impact on the mother’s wellbeing, which could, in turn, also have adverse effects on the unborn baby.

If you become pregnant whilst taking medication for bipolar disorder, it’s very important that you do not stop taking it until you have discussed it with your prescribing doctor. You will then be referred to a perinatal consultant psychiatrist. Suddenly discontinuing medication greatly increases the risk of relapse which is extremely risky for you and your baby.

What are postpartum psychosis and postnatal depression? 
Around the time of childbirth, high and low mood episodes can occur in women with mood disorders, including bipolar disorder. Psychotic symptoms such as hallucinations, delusions and persecutory ideas may also occur and can be very frightening. When symptoms are this severe, it is called postpartum psychosis. Postpartum psychosis is a relatively rare, but serious, illness affecting 1 or 2 women in every 1,000 women who give birth. A woman could develop postpartum psychosis without having had or developing bipolar disorder.

Postnatal depression is a depressive illness like any other, but is called postnatal depression when it occurs after a woman gives birth. It is more common and often more easily treated than postpartum psychosis. For most women, antidepressant medication, along with support from family, a GP and health visitor is enough to help them recover. In severe cases, a woman with postnatal depression may also be referred to her local Perinatal Mental Health Service.

What happens after the baby is born? 
This is a particularly risky time; hormone imbalances, disturbances to sleep and changes to medication can all trigger illness.  The treatment plan agreed during pregnancy will include plans for after birth. A mother who has just given birth will also be monitored closely by her CPN, midwife and health visitor so that if she becomes unwell, she can get treatment quickly.  If she needs admission to hospital, this may be to a Mother and Baby Unit, staffed by mental health nurses and nursery nurses.

What about breastfeeding? 
A mother can breastfeed her baby whilst taking some medications. Your perinatal psychiatrist or CPN will be able to discuss this with you. If a woman has expressed a wish to breastfeed she can usually be supported to continue with breastfeeding, even if she becomes unwell. Medications not suitable in breastfeeding are only used if there really is no other option.

How can a woman minimise the risk of becoming ill during and just after pregnancy?
We offer pre-conception counselling for women with bipolar disorder who are considering having a baby. This helps to manage medication and minimise risk before a woman becomes pregnant. Once pregnant, referral to the specialist Perinatal Psychiatric Service as soon as possible is essential as mental illness can complicate pregnancy and put a woman at higher risk of relapse.

If you have a history of serious mood disorder or other mental illness, be open with your GP and midwife, so they can access the most appropriate services for you. Working with mental health professionals allows for your treatment to be planned and implemented, helping to minimise the risk to you, your child and the rest of your family.

Where can I get more information? 
Open House is a peer support group in Nottingham for those affected by maternal mental health problems. You can also find further information on the NHS Choices and Bipolar UK websites.
Action Postpartum Psychosis (APP) campaign nationally for the development of services for women with serious mental illness related to childbirth.

Above all, don’t be frightened. If you’re concerned about your illness and how it may affect your ability to get pregnant and cope with motherhood, talk to you psychiatrist, CPN or GP. There will be someone locally who can help you access the care most appropriate for you.