Pregnancy is not protective against relapses of pre-existing serious mental illness, especially where usual medication has been stopped at the outset.
“Claire,” a 40-year-old woman four to five weeks pregnant, came to a medical clinic complaining of extreme anxiety, panic, delusions, depression, and strong thoughts of suicide.
She had a long history of anorexia nervosa and depressive episodes, but not psychosis. She miscarried 6 months earlier at 4 to 5 weeks. After the miscarriage, severe anxiety and psychotic-like symptoms had developed, according to the Psychiatric Times.
Although relatively rare, pregnancy related psychosis can occur. Claire “was convinced she could not carry the pregnancy through (either physically or mentally). She exhibited violent suicidal ideation (typical of postpartum psychosis), whereas her previous episodes of suicidal ideation had been nonviolent. She was unable to eat or drink anything. She was extremely weak and had difficulty standing up and walking; her BMI was 13 to 14, and she passed out at a counseling session preceding the abortion. The pregnancy was terminated at 10 weeks.”
Jennifer Marshall writes in a blog, Postpartum Progress, that she experienced “severe psychosis” during the early weeks of her pregnancy with her daughter.
At about five weeks pregnant, she was taken to a hospital under emergency conditions, “experiencing extreme dissociation and confusion along with hallucinations.”
She felt that no medication was completely safe during pregnancy, “but together with my doctors I chose one (with which) I felt comfortable. One that brought me out of the psychosis and back to reality. Back to life, with a life growing inside me. I saw a high-risk ob-gyn, my psychiatrist, my therapist, and my regular ob-gyn throughout the duration of the pregnancy.”
She said taking medication to manage the psychosis was “gut-wrenching,” and she had no ideal way to go about having a family besides the need to work closely with her doctors and therapist to achieve the “best, safest, most ideal” outcome possible.
For the majority of women who have mental health problems during pregnancy, it’s usually “a mild depressive illness, often combined with anxiety,” according to Patient.
“Pregnancy protects against developing a serious mental illness (schizophrenia, bipolar disorder, and severe depressive illness) but is not protective against relapses of pre-existing serious mental illness, especially where usual medication has been stopped at the outset of pregnancy.”
Women with mental health problems during pregnancy often feel stigmatized and “good therapeutic relationships need to be built up.” Ideally, women who are considering having children and have significant mental health problems should discuss pregnancy plans through preconceptual counseling and have a medication review.
“Treatment decisions can be challenging, as risks and benefits need to be considered in terms of the welfare of both mother and fetus. Much research focuses on neonatal outcome, but neglects to consider maternal needs,” Patient adds.
Sometimes women who become pregnant stop taking their medication for the fetus’ sake, but this can cause your illness to return or become worse, so speaking with your mental health professional and doctor is paramount, according to the U.K. National Health Service (NHS).
“When you have your first antenatal appointment you should be asked if you have ever had problems with your mental health in the past, and whether you have been bothered by feeling down, hopeless or unable to enjoy things lately,” writes the NHS.
If you have or have had a severe mental illness, your doctor should develop a care plan with you in the first three months of pregnancy. You may be referred to a perinatal health expert or team. This should include input from family members as well.
“Sometimes – not always – a mental health problem can cause you to miss appointments. If this happens while you are pregnant, it may mean you miss important health checks. This could increase your risk of pregnancy-related complications that would otherwise have been picked up,” the NHS adds.
April 07, 2020
Janet O’Dell, RN