Welcome to Bipolar and Focus, I'm Jane Pauley.
Women with bipolar disorder who wish to have a baby have some things to think about. Dr. Margaret Spinelli from Columbia University is with us today.
Making the decision to have the baby or not. What are the steps a bipolar woman should take?
Both the patient and her partner or the baby's father should obtain a perinatal consultation that means there are psychiatrists who specialize in pregnancy and postpartum disorders.
They are the psychiatrists who are going to know the very latest literature about bipolar illness during pregnancy. It's complicated because you're giving the patient a lot of information.
What are some of the special psychological issues that a woman who has bipolar might have?
Well, she obviously has all the usual concerns that any mom or perspective mom will have.
She's also worried about what are the chances or the likelihood of her baby of having bipolar disorder.
She's going to be concerned about postpartum depression, postpartum psychosis. Here's a big one, "Am I going to be one of those women who might try to kill my baby?"
What is the difference between postpartum depression and postpartum psychosis?
Postpartum depression is a feeling of sadness tearfullness, feelings of guilt over not being a good mother. It's hard to get out of bed, sometimes having very negative feelings about the baby.
A postpartum psychosis on the other hand is actually quite dangerous. The women often manifest symptoms in which they're out of contact with reality.
So they may hear voices or they may see things that are not there. They may feel a presence and some of these things might put them or their babies in danger.
How important is it to have a medication plan worked out with your doctor?
It is essential. You must find out what's right for you and what is going to work both in the antepartum period and postpartum period.
Who is on her medical team in the course of the pregnancy and what are they monitoring?
Well, there certainly should be the psychiatrist, the obstetrician -- they should be working together.
But at this particular time in a woman's life, yeah she definitely needs to have psychotherapy as well.
Can pregnancy be a trigger for the onset of bipolar of someone who hasn't ever had it before?
Newer literature is suggesting that most women that we have diagnosed with postpartum depression in fact have a bipolar too depression rather than a regular postpartum depression.
So that these women are manifesting a new bipolar illness
and one of the things you want to be very careful of is that you don't throw an antidepressant too soon and throw the woman into any kind of a hypomanic or manic episode.
This is the reason she needs to be seeing somebody regularly particularly in the postpartum period.
So, postpartum depression might be a warning sign to keep an eye out for vulnerability to bipolar?
Imagine that over the course of pregnancy there are these hormones that have gone out maybe 100 fold over the course of 40 weeks and within 24 to 48 hours, they're gone.
Now we know that these hormones affect our brain chemicals. They affect the very brain chemicals that underlie the causes of bipolar disorder.
And so for women who have any kind of vulnerably even family history, they are more likely to have a postpartum episode.
So someone who has never had a bipolar episode but it's in the family is also, has some things to think about?
Dr. Spinelli, thank you so much.
It's been a pleasure.
And thank you for watching Bipolar in Focus.