Dear Dr. SerVaas: After severe bouts of depression and mania, I was diagnosed as having bipolar disdorder at age 27 and was put on lithium. Then I fell in love and married at age 30. When I became pregnant, I was concerned about the adverse effects on the fetus and the concept of the lithium babies registry and stopped taking lithium against my psychiatrist's advice. Despite his dire predictions, I was OK all during pregnancy, birth, and breast-feeding without the drug. The psychiatrist told me that people could have "years of normalcy sandwiched between episodes" but that the disorder would always return. I nursed my son for three years, then became pregnant again. I nursed my second son for three years. Our children are now 10 and 14. I've had no episodes and have been drug-free since 1988.
Can pregnancy and breast-feeding change your brain's chemistry permanently? Is it possible to "outgrow" bipolar disorder?
name withheld
via e-mail
Dear Reader: Bipolar expert and genetic researcher Dr. John I. Nurnberger of Indiana University Medical Center responds to your questions:
"It's probably overstating the case to say that 'the disorder will always return.' We do know that persons with one episode of mania will have a second episode (of mania or depression) about 90 percent of the time. And in general, the more episodes one has had, the more likely that another will follow. We also know that some persons may go many years without an episode. So, one might weigh (ideally, together with a medical professional) the risks and benefits of preventive medication.
"If you have truly been symptom-free for 15 years, there would be some reason to consider medical monitoring without maintenance medication. This would assume that you have a relationship with a doctor who could start medication quickly, if necessary. That type of relationship might be with a family practitioner, internist, or psychiatrist, but it would involve having some conversations ahead of time so that an emergency strategy would be in place. Spouses may also be extremely helpful in developing and maintaining an 'early warning' system. Professional therapists with training in psychology, social work, nursing, and other fields may also be part of this support system.
"The point is to be prepared. Hopefully, things will go just as well as they have been. But if not, get help sooner rather than later."
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