Managing bipolar disorder in pregnancy

Bipolar disorder does not go away on its own, so treatment is essential. The faster the symptoms are recognised, the faster treatment can occur. So, being aware of the signs is the first important step, followed by seeking appropriate professional help. Initially this help may be accessed through a GP, mental health service or hospital emergency department.

Because bipolar disorder is a biological condition, medication is required as a first step. This is no different to other biological conditions like diabetes or asthma that require medication.

In some instances if your symptoms are very severe, you may need to go to hospital where you are safe. Being in hospital will allow your symptoms to settle down. It will also allow health professionals to identify the most effective type of treatment for you. Furthermore, it will allow health professionals to monitor your progress while ensuring you remain safe. From there your mental health is likely to be continually monitored by a medical health professional throughout the rest of your pregnancy.

Medication

Medication is used to treat and manage bipolar disorder during pregnancy.  These medications work to stabilise your symptoms and help reduce the chance that the symptoms reoccur (relapse).  Bipolar disorder can have a broad range of symptoms. As such, there are a number of different types of medications used to treat them. These medications are likely to include:

• Mood stabilisers – Help stabilise your mood and reduce the likelihood of relapse.  Lithium is the most common mood stabiliser.
• Antidepressants – Reduce the symptoms of depression which are part of the depressive phase of bipolar disorder
• Antipsychotics – These can assist with manic symptoms. (For example, racing thoughts, speech, high energy.) Antipsychotics can also assist with the effects that bipolar disorder can have on your thinking, particularly seeing or hearing things that are not there (hallucinations) and/or having strange, unrealistic beliefs (delusions).

The type of medication that you are prescribed for biplolar disorder during pregancy can be affected by your symptoms and your circumstances. For example, if you are planning to become pregnant or already pregnant.  This is why it is very important that you or your partner/family member/friend talk to your health professional if you are planning to become pregnant, and let them know if you are already pregnant.  For further information and advice on antipsychotic medications visit the National Registry of Antipsychotic Medications in Pregnancy. 

Electroconvulsive Therapy

Electroconvulsive therapy or ECT is a specialist treatment that involves activating electro-currents to the brain. It can relieve a range of severe symptoms of bipolar disorder.  Electroconvulsive therapy is generally used if and when it is considered to be very necessary to prevent the woman from harming herself in some way.

ECT is conducted in a specialist hospital setting. During pregnancy, it can only be prescribed by a perinatal psychiatrist.  The psychiatrist is also usually accompanied by other specialist health professionals. This can include an obstetrician and specialist obstetric anaesthetist to monitor you and your unborn baby.  While the risks to the mother and her unborn baby are low, special care is taken to monitor this specialist treatment.

Psychological Therapies

As you begin to benefit from the medication or ECT and your symptoms of bipolar disorder become more stable, some psychological treatments may be helpful to provide you with strategies to keep on top of things and cope from day to day.

• Cognitive Behaviour Therapy: Helps you to gain insight and understanding into the thoughts, feelings and behaviours that are likely to relate to the various symptoms of bipolar disorder.  The cognitive component of the therapy involves teaching you to become aware of your thinking, and challenge whether you are being realistic, versus having deluded thoughts, or being paranoid.  By teaching you how to challenge and change unhelpful thinking and how you respond to these thoughts you can begin to develop strategies to get on top of this thinking that is part of bipolar disorder.  In addition, behaviour therapy can provide you with strategies to help you manage periods of mania and depression.
• Interpersonal Psychotherapy: This type of therapy can assist you to find new ways to get along with others. It can also help address any conflicts or issues that you may currently have which can be impacting on your emotional and mental health.

Social Support

Minimising stress and maximising sleep is very important – for everyone. Take time out to do things that you enjoy. Doing so can also provide time for quality interaction with your partner, family and supports. If you already have other children, involving extended family or drawing on childcare services in these circumstances can give everyone the breathing space they need to recover.

Find out about accessing treatment here.