Lithium and Pregnancy: Second Opinion
In 1991, I was diagnosed with bipolar illness. The illness came upon me dramatically. There were lots of delusions and paranoia. In short, I lost complete touch with reality.
After I got out of the hospital in my home state, Ohio, I went back to work as an English teacher at a small university in Pennsylvania. It was decided that I would keep seeing the psychiatrist I saw in the hospital. This went on for three years, until my contract at the university wasn’t renewed. At this point, I moved back to Ohio and lived with my mother.
About this time, I met this great guy who was cool with my bipolar illness. I took him in to meet my psychiatrist who told me, "This man will never leave you." To say the least, my psychiatrist was very impressed with Steve, whom I eventually married in 1997. Then, it was about 1994, my psychiatrist cautioned me about having sex. "Be sure to use protection," he said. "If you get pregnant, you’ll have to go off your Lithium. It’s dangerous to the fetus. It can cause heart birth defects. The defect is called Epstein’s Anomaly."
The thought of going off my lithium was scary. I didn’t want to go back to that state of delusions and paranoia. Consequently, Steve and I usually used two kinds of birth control, so I wouldn’t get pregnant.
However, the thought of going off lithium, although scary, was intriguing to me. About that time, I wrote "Having Anne," which is the story of a bipolar woman who goes off lithium during her pregnancy. She subsequently goes crazy. I sold "Having Anne" to the Missouri Review in 1995. It was reprinted in For Women Only, by Gary Null and Barbara Seaman. What can I say - the idea of a pregnant crazy woman caught on.
In 1998, after a year of marriage, we decided to try to get pregnant. As a precautionary measure, we wanted to investigate again what other doctors were saying then about lithium and pregnancy. We wanted a second opinion. We made an appointment with a doctor at Massachusetts General. (We were then living in Rhode Island.)
Steve took a day off, and we drove to Massachusetts General, where this doctor kindly informed us that I could stay on lithium for the duration of my pregnancy. They had discovered that lithium was not as harmful to fetuses as they once thought.
Well, this brought get relief to me. We went home, and that night we had unprotected sex.
Flash to five years later. It’s 2002. We’ve moved back to Ohio. My current psychiatrist is on board with the idea that the risk with lithium and pregnancy is fairly low and lower than the risk of not taking lithium. But I can’t get pregnant. We are advised to see a fertility doctor.
We found doctors we liked in Cleveland. It was a little drive, but we clicked with one doctor in particular, the head of the practice. This head doctor met with us and told us his feelings about lithium and pregnancy. He told us exactly what the doctor in Massachusetts and my current psychiatrist had told us. Lithium was relatively safe for pregnancy.
We were both tested for infertility. They couldn’t find anything wrong with either of us. So they started to do artificial inseminations.
These soon became quite a pain. They didn’t work. And they had to be done early in the morning due to our work schedules.
One insemination session was particularly awful. I was seeing one of the partners of the practice. I literally had my feet in the stirrups, naked from the waist down, and was waiting to be artificially inseminated by the doctor. Well, I guess this guy read my chart and saw I was bipolar and was taking lithium. He yelled "Stop!" Then he said, "I can't inseminate you. You're on Lithium."
"Wait!" I yelled back. It was all quite melodramatic. "It's OK," I pleaded, wrapped up in my paper blanket, still naked. "They’ve found that it’s not as dangerous as they thought."
"I'm sorry. You're going to have to leave. I can’t inseminate you."
I was traumatized, to say the least.
The next day, after he looked into it and realized that he'd been wrong, I got a mild apology from the head doctor. He said that his partner only had our best interests at heart, no pun intended. The offending doctor said nothing.
What I learned from this experience is that some doctors have heard that lithium is now considered relatively safe for pregnancy, and some haven’t.
Ultimately, it didn’t matter to me because I couldn’t get pregnant. We chose not to do in vitro and chose instead to adopt. We’re now the parents of a gorgeous little boy.
Yes, I still take my Lithium.
This experience taught me to get a second opinion and that some medical news travels slowly. It’s strange to know more than the doctor.