Sue,
I was a psych nurse for 13 years b4 doing midwifery, and did have a
bit to do with women with mood disorders, before , and after birth,
especially while working in the community. Their moods tend to be
harder to control with the influence of the fluctuating hormones.
Lithium, i think from memory is contraindicated in the first
trimester due to increased risk of fetal cardiac abnormality. I met a
psychiatrist that works out of rooms attached to the melbourne clinic
whose entire practice seemed to be made up with women with mood
disorders b4 , during and after pregnancy. His approach was to make
sure they had been well controlled and stable for at least 12 months
b4 getting pregnant, but would advise them to not breastfeed and put
them on a mood stabiliser and a monophasic oral contraceptive. This
was a lot to do with being able to get their mood under control i
think rather than due to contraindications with breastfeeding. If not
managed carefully, It does seem from my experience that women with
bipolar affective disorder do either go extremely up or extremely
down relatively soon after birth.
I was case manager for a woman with a severe unipolar disorder(major
depressive illness) after she had a baby. She was returned to her
normal medications(one of the tricyclic antidepressants) after
delivering and was advised she would not be able to breastfeed due to
the array of ill effects it would have on her baby. She breastfed
anyway, and i never saw any of the ill effects in her son even though
she was on a massive dose. The specialists looking after her son were
all happy with how he was and amazed that he had no ill effects
because of how badly the warnings regarding that med was. She was on
such a huge dose, if any baby was to get ill effects it would have
been him.
The big problem i can see about changing medications to breastfeed is
that quite often with mood disorders, u are very lucky to find a
medication that controls their mood well, it is not very common that
u would find another medication that controls it as well.
I must admit that although i worked in psych for quite a while, i am
now studying natural therapies and i am believing more my feeling
that mediactions aren't the way to go, because really(for example) -
depression isn't caused by a deficiency in prozac!!!
please excuse if this is a bit jumbly , I'm in the middle of a night
shift run, and my brain is acting accordingly cos it's daylight!
Belinda
