Trying to conceive with mental illness

I’m now in a new phase of my life. Last August, I came off of my bipolar disorder medication and have tried to regulate my mood through natural remedies such as taking 1000 mg of fish oil and multivitamins and by exercising regularly.

I’m also trying to get pregnant.

I haven’t wanted to discuss this particular phase of my life as I think it’s a very personal and private time. However, the emotional and mental toll that TTC (trying to conceive) brings upon someone who struggles with mental illness, I think, is worth discussion.

I wrongly assumed that when I decided that I wanted to have a child, I’d automatically be able to get pregnant. (Bristol Palin had no problem, right?) Several cycles later, I find myself still childless and even more desperately yearning for a child than the month before.

The mental anguish of TTC month after month is tough for any normal woman. During this phase of life, women may experience the following feelings:

• Anger
• Depression
• Anxiety
• Low self-esteem
• Social isolation
• Sexual dysfunction
• Marital problems

In a woman who suffers from depression, bipolar disorder, or any other mental illness, those feelings can become so intensely extreme that they can be debilitating.

I can’t even begin to explain the psychology behind the agony a women endures when she desperately hopes for a child, only to be disappointed by a negative pregnancy test or the monthly visitation from a visitor commonly known as Aunt Flo. Month after month and year after year, the pendulum of emotions range from anger to despair. How is it possible to want and love someone so much whom you’ve never met?

For me, I’ve found that I am relatively sane and able to go on with life for about a week after trying. When I am a day or two away from my expected period, I am thrown into such emotional turmoil that I am nearly inconsolable. Part of it has to do with the sadness that accompanies my body preparing itself for the beginning of a new cycle; the other part of it is the emotional roller coaster that comes along with PMS (premenstrual syndrome). Throw in a dash of bipolar disorder and there’s no limit to how despondent I can be. I can only imagine the same would be true for women who suffer from other mental illnesses.

During those times, I’ve tried turning my eyes toward God and attempting to put my faith in His wisdom for my life, but I feel so isolated and so alone that I wonder if even God could comfort me. The pain of hoping for a child each month then discovering that it is not to be brings a sense of abandonment (for some reason). Negative thoughts creep into your mind at a furtive pace:

• I’m not meant to be a mother because I’m already suffering from a mental illness and God is doing any kids I’d have a favor by not bringing them into this world through me.
• I’d be a terrible mother anyway.
• What is wrong with my body? Why can’t I conceive?
• There’s no point in me living if I can’t have a child. I want a child of my own so desperately that I just don’t want to live anymore if I can’t have one.

Each month, a woman trying to conceive goes through the five stages of grief:

1. Denial (The pregnancy test must be wrong; I’m pregnant for sure. Maybe my hormones haven’t been detected yet.)
2. Anger (Why is this happening to me? What’s wrong with me?)
3. Bargaining (I’ll do anything be pregnant. Please, just give me a baby.)
4. Depression (I’ll never get pregnant. What’s the point? I’ll be a terrible mother anyway.)
5. Acceptance (I’m not pregnant. [Some women can also say: But at least we can try again in the next cycle.])

I usually go through all that in the course of, oh, about 2 days.

I haven’t been trying for an extremely long period of time so I’m not classified as infertile but the internal and external pressure of trying to conceive can be stressful nonetheless:

• Family members ask when a little one will arrive in your family
• Friends and family members will have conceived (and even given birth) to a child within the time you’ve been attempting to conceive
• Well-meaning people offer advice to simply “relax” and go on vacation to get pregnant
• Pregnant women you know will complain about all the awful symptoms of pregnancy
• Mothers you know will complain about all the downsides of parenting and rarely offer the upsides

I haven’t fully figured out how to deal with the uncomfortable situations I find myself in with others or the drained energy that comes from learning of a barren womb. This site provides coping techniques for normal women dealing with infertility, but I want to go a step farther in specifically addressing women TTC who suffer with some kind of mental issue:

• Talk to a trusted doctor or counselor. Determine this is the path that you want to be on and discuss how to develop strategies in the face of another disappointing month.
• Determine whether you need to take medication (if you’re not already on it). I tapered off of my mood stabilizer in the hopes of being able to have a natural birth and breastfeed. I’m altering those dreams. It’s not the end of the world if I have to have a baby in the hospital and a child won’t die if I feed it formula. (Although I’ll probably catch flak in the Christian community because what self-respecting mother doesn’t breastfeed?! [sarcasm])
• Determine whether you need an adjustment in medication if you are taking something. Is the medication you are on relatively safe for pregnancy? Will you need to switch? Is the medication you’re currently on affecting your ability to adequately deal with the emotional pendulum that accompanies TTC?
• Consider using natural mood-boosting remedies to bolster your mood. I know it’s cliche to mention this, but for some women suffering from mental illness, natural remedies actually do help. (For some women, natural remedies have little to no effect.) Here are a few to try:

• • Take at least 1000 mg of Omega-3 fatty acids daily. BEWARE: 1200 mg of fish oil does not equal 1200 mg of Omega-3s! I take 900 mg capsules of fish oil that only contain 450 mg of Omega-3s each. I need to take at least 3 capsules to get more than 1000 mg of Omega-3s. You can also get the weekly required amount of Omega-3s by eating fish twice a week. (Science Daily)
  • Take daily multivitamins with at least 400 mcg of folic acid. Folic acid helps lower the risk of birth defects in a baby. For me, I need the iron supplement to help me fight fatigue as I don’t eat many foods rich in iron.
  • Exercise regularly. I’ve been exercising about 3-4 times a week for about 30 minutes. Exercising temporarily boosts my mood although that’s only been a recent occurrence (within the past year).
  • Try to steer clear of mood-altering substances. The depression that accompanies not having a child can drive a woman to smoke, drink too much alcohol, or engage in the use of illegal drugs. (I’m guilty of having a bit too much wine.) Although we all know to avoid this stuff when TTC, it’s sometimes hard to resist. But try.

I hope this post can be of some help to women who are trying to conceive but also suffer from mental illness. We may be a small minority but we’re not alone. Feel to offer feedback on this post by leaving a comment.

In Suicide’s Shadow

Today’s Christian Woman has an article about three women who have come to grips with loved ones who committed suicide and how they’ve found God faithful in the midst of it. Should be an encouraging read for Christians who have experienced the pain of suicide.

Loose Screws Mental Health News

John Grohol at PsychCentral reports that the fate of the mental health parity bill is uncertain as its main champion, Sen. Ted Kennedy, takes a leave of absence to focus on treatment of his brain tumor. I echo John’s thoughts in hoping to see that other senators are willing to carry the torch and pass this important piece of legislation.

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I came across a post from Kalea Chapman at pasadena therapist in which she linked to a WSJ article on whether veterans suffering from PTSD should be awarded the Purple Heart.

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.
…
Opponents argue that the Purple Heart should be reserved for physical injuries, as has been the case since the medal was reinstituted by Congress in 1932.

I side with the opponents. The Purple Heart should be awarded to be people who have visible evidence of bravery. With the rising number of PTSD prevalence, I’m afraid that the award would be handed out like candy. The rising number of veterans with PTSD on disability has caused enough of an issue that a Texas VA facility wanted mental health officials to stop diagnosing veterans with the condition.

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Jordan Burnham, an 18-year-old student who survived a nine-story jump from a building, plans on walking at his graduation with the assistance of two canes. A family who used to attend my church knows this family and put him on my church’s prayer list. It’s a small world, after all.

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Finally, it looks like expecting moms should have no fear of causing birth defects in their baby while taking antidepressants, according to a study being published in the British Journal of Psychiatry.

A research team from Montreal University studied more than 2000 pregnant women on antidepressants and discovered the drugs did not present any adverse effects. However, it sounds like they only oversaw the women while they were pregnant in their first trimester. I haven’t seen the actual study but it doesn’t seem to mention whether the women discontinued the antidepressants after the first trimester.

Pregnancy is NOT a mental illness

I stumbled upon Yankee Cowgirl’s blog that mentioned Congress is working on the MOTHERS (Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression) Act which would “strongly encourage pregnant women into mental health programs – that means drugs – to combat even mild depression during or after giving birth.”

She links to a column written by Byron J. Richards on newswithviews.com. He writes:

The Mothers Act is pending legislation that will indoctrinate hundreds of thousands of mothers into taking dangerous psych drugs.

He goes on to slam Big Pharma about how they control Congress and how mothers don’t need psych drugs for a natural birth process.

The Mothers Act (S. 1375: Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act) has the net affect of reclassifying the natural process of pregnancy and birth as a mental disorder that requires the use of unproven and extremely dangerous psychotropic medications (which can also easily harm the child).

These are some serious accusations. I got pretty riled up myself and decided to see what Congress said in the bill.

Women & Antidepressants

Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”

Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)

The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.

“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”

Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.

“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.

A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”

I’m sure the list goes on, but magazines have but oh so much space.

Dr. Melissa McNeil at the University of Pittsburgh points out three things:

1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
3. Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.

My take on McNeil’s points (I’ll try to keep them brief):

• Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
• Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
• Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.

Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.

Dr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:

“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”

Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.

McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.

“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”

Oh, for more doctors like Haltzman and Bouquette.

UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.

Loose Screws Mental Health News

Women who are binge drinkers are more likely to be clinically depressed, according to a joint U.S. and Canadian study. I find it funny that they’ve got a photo of a middle-aged (or senior) woman with the captions, “Binge drinking adversely affected women’s mental health, the study suggested.” It’s possible, but HIGHLY UNLIKELY that the woman in the picture is representative of a binge drinker. A picture of a female binge drinker would look more like this:

That’s better. (source: The Trouble With Spikol)

On a Spikol trip, she writes that she questions a bipolar diagnosis in children and young adolescents (as in 14 or 15). I wholeheartedly disagree. Once I received a bipolar diagnosis, I realized that it wasn’t something that I’d developed out of nowhere. I often thought that I began suffering from manic depressive episodes when I was 14. Looking into my childhood, I realized that there was so much more to it: the temper tantrums, the sudden happiness and instant withdrawal. Constant paranoia that no one liked me (which no one did because I was super smart as a child). My parents described me as a “happy” kid, but I remember my tumultous childhood from 6 years old and on. I was raised in Brooklyn until I was 5 and then moved to Long Island. Even though I attended kindergarten in Brooklyn, the LI school district insisted that I was too young for first grade and made me repeat kindergarten. This apparently angered me because my parents claim that the second time around, I didn’t do any of the work because I’d done it before. After an encounter with my teacher (and seeing my father cry for the first time in my life), I shaped up my act in time to move on to first grade.

So I disagree that a bipolar diagnosis in children would erroneous or inaccurate. However, it’s possible they may be misdiagnosed and find out later on in life that they really had ADHD or some other kind of mental illness. But that doesn’t mean they weren’t mentally ill at all; it simply means they weren’t diagnosed properly.

Women in the Sciences

Not directly related to mental illness but a good article by the NYT on women in the sciences and why they are sorely lacking:

"Yet studies show that women in science still routinely receive less research support than their male colleagues, and they have not reached the top academic ranks in numbers anything like their growing presence would suggest."

And something that can’t help but remind me of my former employer:

"’Women in science are in a double bind,’ Dr. [Madeline] Heilman, [psychologist at New York University], said. ‘When not clearly successful, they are presumed to be incompetent. When they are successful, they are not liked.’"

It makes me wonder why the mental health industry is so effed. Is it because we don’t have women (who are more emotional and sensitive creatures) in biochem, biophysics, and neuro? The withering feminist in me can’t help but wonder.

Either way, women just can’t win.

ADDENDUM: Okay, I waited too long to post this and now, it’s apparently only available through TimesSelect. Bummer. Regardless, it was a good article. One of these days, I’ll anonymously type up the article, disseminate it all over the Internet and THEN link to it.