[AliRBailey]

Hi All,

I'm new to this site HOPING I can find some answers or a direction to go in.

I have been a stable bipolar for 3+ years dx'ed for 7-8 years. I currently take 400 mgs of Tegratol, split morning and bedtime, 3 mgs of Klonopin, split 3x a day and 300 mgs of Seroquel XR at bedtime. This regime works really well for me and has for almost a year.

My husband and I are using IVF in August to start our family, but all of my meds are not recommended for a fetus, not even in smaller doses. I really want to do what is best for my planned baby, but I also want to remain stable and healthy. I've talked to my pdoc and she said to talk to my fertility doctor about my meds (which isn't his speciality...seems like an OB would be the reasonable person to ask, BUT I don't have one yet!!! And I am on the road for work with my husband, so finding one is right now is out of the question). My fertility doctor said to talk to my pdoc.

I have tried and tried to find anything, something on the 'Net and keep coming up empty handed...

I have two months until the procedure, so I have a little breathing room if I need to taper down my meds. Where do I go for answers? Does anyone know of an expert in this area who I can call? Any personal experiences?

All conscructive info is VERY much appreciated!

~Alicia

[Amazonmom]

I wonder if Lamictal would work for you instead of Tegretol. Lamictal is safer in pregnancy. Women can and do have children while taking Seroquel, Tegretol, and Klonopin.

People are going to get tired of me saying this but if you can find a perinatal psychiatrist they specialize in meds during pregnancy and breastfeeding.

If you are taking an anticonvulsant during pregnancy you will probably want to take lots of folic acid, above what is recommended for the average pregnant woman. You may want to pick an OB when you can so you can get specific recommendations.

www.womensmentalhealth.org is a wonderful site full of good info.

I am obsessed about the topic of meds in pregnancy- being a Neonatal ICU nurse and a bipolar mom who wants more kids in the future....and I have access to scientific literature on the topic.

[BlackPup]

For anticonvulsants the recommended dose of Folic Acid is 5mg, compared with 0.5mg that is usually recommended.
My doctor has said he will put me on Seroquel when I get pregnant (not quite yet!) coz its really safe, he wasn't to happy about Lamactal or Tegretol (but I hate tegretol so I am never taking it again!) as a antidepressant SSRI and SNRIs are safer and have been used for longer during pregnancy.
Haven't heard of Klonopin, must be marketed under a diff name here.

[PufNStuf]

Ali,

I take Lamictal (50 mg) and Lexapro (10 mg) along with PRN Klonopin. I'm also worried about the interaction for pregnancy. We aren't doing fertility treatments yet, but perhaps next year. I'm going to stay on my meds. Lamictal does have a cleft-palate risk...and I know this is horrible of me, but I need to be stable...and there's always surgery. I'm horrible. I think you should talk to your doc, but there is article after article that says it's worse for a baby if the mother is in a very bad emotional state than it is just to take the meds.

I think you should make sure you're stable...that's way important during pregnancy. You'll already be dealing with hormonal ups and downs.

Just my two cents.

[AliRBailey]

AmazonMom: that web site ROCKS! Thank you!!

I'm really trying to remain *stress-free* per my RE (Reproductive Endocrinologist) for the most successful outcome in August (HURRY UP AUGUST!) and were it not for Klonopin (Blackpup, it's a benzo with minimal risk for addiction and seems to work well for bipolars), I'd be a wreck with worry over all this. I have been stable for what feels like so long and guess what: I like stable.
I have taken Lamictal in the past, but was switched to Tegratol because it's on the $4 WalMart plan. I liked Lamictal too, it was purely a financial gamble and it worked.
So now I'm feeling a new slight niggling in my brain: how to make the new meds come together. I don't have an appt with my pdoc (5 states away) until August 30th and my IVF is mid August.
In the beginning of my bp journey, I was in and out of hospitals and put on so many different meds that I started my own research and really put my foot down on what side effects I was willing to live with and some meds I flat out refused to take, when I knew there was an alternative I could live with. I'm not a lab rat. Funny, at my last appt I was called "A Highly Functioning Bipolar", while in the back of my mind I'm remembering the dark places I've been, the damage I've done and the whittled fingernails from scraping my way to where I am now. Today I felt like crap, kinda down, kinda overwhelmed, pressure from wanting a child and a successful IVF cycle (my pressure, not my husbands), a healthy child...weighing the risks of taking the bare minimum, just to keep them in my blood. A sorta bad day.
But it's OK, I feel human and I really want to be here. I need to be here . It's taken me a long time to say I want to be here.
And dammit, even longer to say: I LIKE BEING ODD!!

[kadesgirl09]

I took zyprexa and prozac per my ob's advise not to quit those meds. I was high risk for other reasons and that was the least of my doctors worries. She said the risks of not taking my meds far outweighed the risks of taking them. The zyprexa sucked cause it caused so much extra weight gain. That was the only side affect and only for me none for the baby so it really is awesome. I switched to geodon after the baby was born though cause I couldnt keep gaining weight. Good luck finding something that works!

[musikcrazy]

Alicia,
I cannot tell you how happy I am to see your post because I am in the same situation! First, I want to recommend a website to you called mybipolarpregnancy.com This girl has great information and it is neat to see her progress. My OB sent me to a perinatologist and a genetic counselor in regards to meds. They absoultely advised me not to take any meds and to try biofeedback. So, in April I tried going off of my meds. My pdoc took me off of them fairly quickly and it did not end well. Part circumstance and part lack of meds. I went into a terrible depression that took me a month to recover from. My pdoc and I have decided we are going to try again to come off of the meds this summer, but much slower. My pdoc is very supportive of my desire to have a baby and he wants me to try Deplin, which is a natural form of folate (already needed in pregnancy). He also wants me to stay on my Lamictal. Yes, there is the risk of cleft palate, but we have decided that the benefits of me being stable are more important. He now has to get my OB to see that. My OB is at the top women's hospital in Orlando and they are very good. I am already high risk because I had severe preeclampsia with my first child, so add in the Bipolar and it is even more risky, but I know that I have to try. I currently take four meds (Lamictal, Geodon, Xanax XR, and Pristiq). I feel safe staying on the Lamictal because there is much more research about it in pregnancy than the other meds. I will add Deplin to use as an antidepressant. Please personal message me and let me know how everything is going. I know it is tough, but you can do it!

[bananna215]

when I was pregnant, I researched what meds I definitely didn't want 2 take during my pregnancy before I saw my obgyn 4 the 1st time. I was on 6 different meds & was able to wipe out 3 of those & my ob & midwife both agreed with my decisions. alls I know is that they told me the worst thing 4 me 2 do was 2 go off my meds completely, because that would be far more stress on me... which would put more stress on the baby & that just wouldn't be a good thing. I'm sure i'll probably get fussed at 4 what I'm about 2 write, but I also continued 2 smoke cigarettes during my pregnancy. they still helped with some of the stress I was still experiencing from lack of the meds I gave up & of course the everyday stresses of just being pregnant. my ob & midwife both told me to just cut back... but aiden michael came into this world healthy, normal, & still weighed 6-6 after being born 3 weeks early.

[Moreta]

What about not having children? That's always an option.

That's the option I'm going to go with. Since Bipolar has a tendency to be genetic, I couldn't bear to think that I would have a child and they would have to suffer the way I have.

[AliRBailey]

Musikcrazy, I am aware of mybipolarpregnancy.com and have emailed the blogger with this very question, which she's answered. Deplin is something I'm definately looking into.
I think it's going to be adding Deplin, switching back to a low dose of Lamictal and figuring where I can keep Seroquel somewhere in the mix. I can drop the Klonopin for the pregnancy (or on a sparingly used level), then gradually reintroduce my meds to a more normal level during the last trimester. Since my IVF is before I see my pdoc again, I'll call in for a phone consult and have her switch everything and call it in for me, then when I'm home I'll just go in and see her more often for closer monitoring and therapy. This sounds like a good plan! So we'll see if I'm off my rocker or if this is indeed something that'll work.
QueenAccountant: not having children is an option, and given your personal concerns, hopefully it's one you've made for yourself. My husband and I are obviously aware of the risks involved with being bipolar and passing it on and we've chosen to have a family. I'd also like to adopt, so that's another option after we have this first child. My mother in law is bipolar and raised 5 amazing sons, none of which are bipolar. Neither of my parents are bipolar, yet I am...it's kind of like saying you aren't going to drive a car because you might get into an accident. I don't live my life based on what might happen. But that's just me.

[musikcrazy]

I admire your courage and wish you the very best! I strongly believe that it is possible! I have a beautiful four year old who is full of life. When I expressed my concerns that she might inherit my bipolar disorder my pdoc told me that I could be there for her to help her if need be. I don't worry about her being bipolar as I know that everyone has their own cross to bear and no matter what I will be there to help her along the way.

[Amazonmom]

You aren't horrible Pufnstuf. The worst number I could find for cleft palate and Lamictal were about 9 cases in 1000 births. That number came from a drug registry. Registries are almost always biased towards reporting negative outcomes (when nothing goes wrong people don't report it).

I want to type more about what I found about Lamictal and pregnancy but I don't want to bore people

[Martina]

Since you have to do an IVF to get pregnant anyways (do you?) then it would cost just as much to adopt. I would go with adoption, rather than having your own child.

Like others have mentioned, not only are there the risks of the medications, but the risk that your illness is genetic and could be passed on to your child.

I know that's one of the main reasons why I have chosen not to have any more children - but that's my decision, not yours.

You could also check into the surrogacy laws in your state, and if you feel comfortable, find a surrogate where you could implant your egg and your husband's sperm into the surrogate's body to carry the child to term. There is still the genetic risk that you could pass on the illness, since the baby carries your genes. Or you could get a donor egg.

Surrogacy might be a better option than adoption because some adoptive parents (birth parents) may not want to give their baby up to a "crazy woman."

You will want to be clear with the surrogate about your mental status from day one so there is no problem in the end and you do end up getting the baby. There was an actual news story about this, I think it ended up on Dr. Phil, about a surrogate who wouldn't turn over the babies because the adoptive mother had a psychotic illness - but the illness had been controlled for YEARS yet she still refused to hand over the children. Huge mess.

In other words...I don't know what to tell you!

My heart sometimes aches for another child, but I've realized it's just never going to happen for us.

[AliRBailey]

Thank you everyone for the CONSTUCTIVE information on meds during a pregnancy. AmazonMom, please PM with any info you have on lamictal, I think I'm going to switch back to it for my pregnancy...we can exchange regular emails to continue this conversation.
For everyone else who is suggesting I NOT have a child, whether it be cost, genetic issues etc...I have explained my stance on the issue of genetics.
My husband and I have been unable to have a child, so we are choosing IVF for our family. Period.
We will pay less than $15,000 for 4 tries (if it takes all four to become pregnant), otherwise, it's around $10,000.
Adoption costs $30,000 for a healthy child.
Surogacy costs $70,000, unless I outsource to India or find a friend to carry the child.
These aren't numbers we can work with.
I really appreciate the input, but the original post was for "constructive" idea's on how other women have dealt with medications during a bipolar pregnancy. I'd like to keep this thread open, but please, refrain from commenting if you suggest I shouldn't be a mother, or to try surogacy or anything else other than the decision my husband and I have made. I do appreciate the concern. Being bipolar doesn't remove me from experiencing all life has to offer. I'm stable, "highly functioning", have healthy relationships. I want to be a mom and I will have what I desire. Thank you everyone.

[bananna215]

amen! my bipolar didn't stop me... nor did any of my other diagnoses. some may see it as selfish, but my son is a perfectly happy, healthy & thriving 3 yr old now... he may have issues later on, & that worries me everyday, but I've been through it & so has my mother, & there are docs out there 2 help as well. 1 day at a time... anything like this can be conquered.

Look for a website by a Dr. Hale (I think it is Thomas Hale). He has done extensive studying about meds and breastfeeding. He also has information about pregnancy.

[musikcrazy]

I am seeing my pdoc today to start Deplin and hopefully go off of the Pristiq. Good for you for standing up for your decision!

[kadesgirl09]

((((AliRBailey))) I'm proud of you for standing up for what you believe in. I honestly would have another kid if the 3 I have werent so difficult. Maybe in 5 or 10 years I can have another. Once the baby is old enough to help out with getting himself dressed and stuff. My children are all very happy and healthy (the middle one is not my birth son and he is the most difficult but it has nothing to do with bipolar). Good luck in finding the right med combo!