Having a baby is a major event in the life of any woman. For those with bipolar disorder (formerly called manic depression) there are even more issues to think about.
When considering having a baby, women with bipolar disorder and their families have many questions but can find it difficult to get the answers they need.
A wide variety of mood and psychotic disorders occur in relationship to pregnancy and childbirth. Collectively, these conditions are sometimes known as perinatal mood disorders.
These include postnatal depression, that affects around 1 in 10 women after having a baby, and postpartum psychosis (puerperal psychosis), which affects around 1 in 1,000 women at this time.
Women with bipolar disorder are at a particularly high risk of a postpartum episode. Postpartum mood disorders cause immense suffering for women, their children and their families.
Many women with bipolar disorder are very glad that they have had a family and make excellent mothers. Indeed, most women with the illness thinking of starting a family, when presented with all the relevant information, make the decision to try for a baby.
Causes of mood disorders in pregnancy and childbirth
Research has learned a lot about the causes of bipolar disorder. We know that it can run in families, and that there are lots of factors that can trigger episodes.
But while we know that women with bipolar disorder are particularly vulnerable to becoming ill following childbirth, we don’t fully understand what it is about childbirth that triggers the illness.
It may be related to hormones, sleep disturbance or simply the fact that the arrival of a new baby is a major life event.
By doing further research, we can learn more and use this knowledge to help with prevention and treatment. This is why it is helpful for pregnant women with bipolar disorder to get involved with research.
Treatments for mood disorders in pregnancy and childbirth
Women with episodes of perinatal mood disorders can be treated using a combination of different approaches. These include medication and talking treatments and will depend on the severity of the episode.
Postpartum depression may respond to general support or particular talking treatments, such as cognitive behavioural therapy (CBT). More severe episodes of postpartum depression may require antidepressants or other medications.
The majority of women with postpartum psychosis need to be admitted to hospital and treated with medication. Where possible, women should be admitted with their baby to a mother and baby unit (MBU). Unfortunately most areas of the UK are still not served by an MBU.
Taking medication in pregnancy, or when breastfeeding, is always a difficult decision. There is often no right or wrong answer and all the risks and benefits must be considered before making a decision.
Women taking medication should talk to the professionals involved in their care as early as possible if they are considering becoming pregnant or find they are pregnant.
Resources
- NCMH leaflet: Bipolar, pregnancy and childbirth
- NCMH leaflet: Bipolar disorder
Piece of Mind podcast: Have your voice heard in mental healthcare decisions
Advance choice documents (ACDs) give people living with mental illnesses an opportunity to state their wishes and instructions about their treatment and care during future episodes of illness.
We chatted with Professor Tania Gergel about her work to raise awareness of this vital tool for people with severe mental illness.
Piece of Mind podcast: postnatal depression
Listen to our episode about postnatal depression with Laura Dernie, who experienced postnatal depression, and Professor Ian Jones, former director at NCMH.