Two years ago, Meredith, 26, of Dix Hills, N.Y., was diagnosed with bipolar disorder and began taking lithium. Now she is planning her wedding and, each night, takes a cocktail of mood stabilizers, antidepressants, and antipsychotics: lithium, Abilify, propranolol (Inderal), and escitalopram (Lexapro). "I was grateful for the lithium at first," she says. "But then I was like, 'There go all my options for having kids.'"
The risk of birth defects is small, yet the decision to stop taking medication is common, even among women with severe psychiatric illness. Last year, after she got engaged, and after consulting her psychiatrist, Meredith decided to start tapering off lithium. "I, personally, would like to not be on any medication," she says, when considering a future pregnancy. "I just don't want to take any chances."
A complication-free pregnancy with or without medication doesn't mean a woman is in the clear. For any bipolar mother, the trickiest time is not the pregnancy itself but the postpartum period.
Breast-feeding presents another challenge. Even though some medications are safe while nursing, feeding a baby requires waking up often throughout the night. And in people with bipolar disorder, sleep deprivation can trigger a manic episode.
Sally, who lapsed into depression after the lithium got her mania under control, still struggles with the ups and downs of bipolar disorder. Because she is committed to being a great parent to Stella, she has made what she says is the most difficult decision of her life.