Friday, October 7, 2011

Managing pregnancy and BP meds

Status update on what's going on with this Bipolar pregnancy:

I've stayed on almost all of my meds throughout pregnancy. Tapered off Zoloft but still on Lorazepam, Trazadone, Risperdal, Lamictal. Class C drugs all, which is scary as hell, but we've tried the alternative with my first pregnancy and stopping all meds nearly killed me. 18 months of dead man walking post-partum depression.

My docs had an idea that of the meds I am on I should try to taper off Lorazepam because they did not want the new baby to have withdrawal when he is born. So in May I slowly tapered from .5 mg to .25 mg and then off completely. A disaster. I got frantic and paranoid and saw hate from my family when they were just trying to love. I lashed out at Nathan and could not sleep and my brain was on fire, boiling over with anxiety and fear. I wanted out of all of it....being a mom and wife and BP sufferer. I wanted to thumb a ride on HWY 67 and just get the hell out of my life. Instead, they put me on a plane to go home to Virginia for a week to try and recover with my parents. Also after doctor's recommendation we went right back up to .5 mg Lorazepam. These tactics saved me from ruining my life forever.

My psychiatrist and ob gyn have generally been on the same page with a minor difference. Psych is a bit more focused on me when ob gyn is focused on baby and me, naturally. Psych says if I need lorazepam, I need it and it's best for me and baby and family if I stay on. Ob gyn still wanted me off of it at delivery. Interesting theory of Psych: if I am on Loraz and breastfeed, baby will still get small dose in first few months, so he won't suffer withdrawal. When I wean him, he will naturally taper off of it. I love this theory and am clinging to it.

Anyway, I tried to taper on Loraz again in September. Probably a bad idea since Fall is always a tricky season for my illness. Well within a couple of weeks I started to go back down the dangerous road: not sleeping, paranoid, pissed off at Nathan for no good reason. These periods cause terrible stress in our marriage. I immediately knew I had to go back up to .5 mg on Loraz, which I did. So grateful for my marvelous Ob gyn because when I told him I had gone back up on Loraz he said no big deal, "you tried your best, twice, and that is all we can ask. You and baby look great and everything will work out just fine." For me, worry undiluted is a knife-edged assassin in my brain, so when a provider can do or say the smallest thing to abate worry, it means the world to me.

But, this summer I felt very sluggish and tired, sleeping on the couch during the day, unable to put one foot in front of the other at work. No focus, no organization, no motivation. And I had zero creative inspiration, no prophecies, no dreams of heaven, no epiphanies, no love songs playing in my mind. I know I know, that's a good thing and means I am not manic. But I had swung too far in the other direction. Nothing moved me. So I tapered Trazadone, from 200 mg to 150. For a few weeks I was great...more energy, better focus, happier, more social, and for one blissful half-day, I went back to heaven on earth. I had missed it. But then I started to lose sleep and get anxious again, and felt particularly stressed about my work load, so I went back up to 200 mg.

Note that a lot of my symptoms can have more to do with pregnancy than BP, but who's to say. All I know (what's taken me 11 years to figure out) is that the fastest way to curb escalating BP symptoms is to refine my medications. We can talk all we want to about non-pharmacological treatments like exercise and talk therapy and taking a break from work and journalling. But those do not address the brain illness with the precision and speed of an adjustment in medication. Let's be realistic, I know when I am starting to wig out, and riding it out for one more night or seeing how I feel in the morning is not the answer. It's a brain chemistry question and the meds are the answer.

So baby Carter Martin Chaney looked good in his 28 week ultrasound. I am now 31 weeks and am feeling really good. I don't pray, but I am talking to Mother Love, the goddess that rules us all, and putting in a special request for a healthy boy in spite of my medications. It used to scare the shit out of me and drown me in guilt to think of the damage I could do to my darling boy by staying on medication. But as Dr. Priya and many more in the medical field are saying these days, we have to keep the mother well first. All will suffer if she loses her grip. I'm tearing up right now with hope that all will work out, and that I can be a success story for others fearful of staying on meds during pregnancy. Please contact me with thoughts, questions or simple encouragement.

I hope you all have a great weekend and bounce back the love that all of us feel for you.

God, to have these guys in a room together again....