Hi again,
Rodney whyte is fabulous with drugs - good one Barb. He will be able to
discuss safe dosage levels re breastfeeding.
Re changing meds - this can be a minefield to get balance - if it aint broke
dont fix it would be my maxim. I have been to hell and back with my family
member ( as has he!) on meds that didnt work well - Valproate was used for
years with him and dosages were frequently adjusted without good balance
between a therapeutic dose and side effects -side effects included weight
gain ( severe); lethargy ( not easy to be responsive to a baby if you are
comatose much of the day); and after several years he has drug induced
hepatitis from the valproate ( biopsy diagnosed)- liver count has been high
for almost a year now - ALT went up to 900 ( normal is 50; still hovering
around 300 - 400) so all meds were removed ( thanks gastroenterologist!) and
of course severe mania/ psychosis ensued. Lithium has been a godsend - as
he now cant take any antidepressants because those that arent metabilised by
the liver seem to create severe side effects. On lithium he only needs a
very low dose of an antipsychotic - he had to come off a very effective one
due to liver metabolism - was on antipsychotic and antidepressant while on
valproate. I say lithium is great -so far..moods are stable (highs and lows
seem to be minimised) ; side effects are minimal in comparison to all the
other cocktails he was on - the bigger the mix of drugs the more side
effects ( he is already on thyroxin -your client will need thyroid level
checks too).
I too find it crazy that each Dr cares for a small portion of the whole
person when it comes to mental illness - dont get me started -I case manage
because it seems there isnt a professional who can manage the total
wellbeing or knows which drugs may affect the other bodily organs/
functions - have had psyciatrist prescribe drugs which cant be taken with
poor liver function and gastros who remove psych drugs that are vital for
sanity. I would trust the womans family members if they are invloved in her
care and she sounds like she knows her body and how the drugs work for her
(non pregnant at least). It is all so individual - not an exact science at
all with psych meds.
Good luck,
Pinky
----- Original Message -----
From: "Sue Cookson" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Wednesday, January 03, 2007 9:43 PM
Subject: Re: [ozmidwifery] birth and mental health
Thanks Pinky,
That's great information and very insightful.
I didn't know about increasing the lithium - she talked about decreasing
it as it takes 6 months off lithium for her to become symptomatic. It's so
hard to work through all the conflicting research and getting info from
practitioners who specialise in one area only - like the psychiatrists who
want to change her meds so she can breastfeed - surely we can milk bank or
whatever initially to prevent baby's dehydration/ maternal sleep
deprivation - the two main problems that I can see - and meantime keep her
on meds that she is confident with and keep her well balanced.
Any further info or stories would be very welcome,
Sue
Hi Sue -I have vivid memories of a mum who came off lithium so she would
be able to breastfeed- went into psychosis and didnt even recognise her
bub. It was years ago .
According to Hale(Medications in mothers milk. 11th edition) - lithium
is generally increased (dosage) during preg due to increased renal
clearance . After birth, levels need to be closely monitored as mother's
renal clearance drops to normal. Several cases of lithium toxicity have
been reported in newborns. According to Hale, breastfeeding is not
necessarily contraindicated as long as babys levels are monitored and
there are no symptoms of toxcicity but other anti manic drugs such as
valproate may be a better option for breastfeeding mums. Of course this
depends how confident the woman is re changing meds if the lithium is
effective and balanced for her.
Living with a family member on lithium ( male so not giving birth) the
sad thing I have observed is that as people with mental illness become
unwell they lose the insight that would tell them they were becoming
unwell and so tend to blame others around them to rationalise their
symptoms. I would suggest the woman and her partner/ family member give
you a list of 'early warning signs' of her illness before she has her bub
and that she keeps in good contact with her psychiatrist throughout
pregnancy and postpartum. Home birth may be much better than hospital as
she will be in familiar surroundings so will be monitored by loved ones
who know her well and not treated with 'kid gloves' for what may well be
'normal' postpartum mood changes. Except of course that severe mania can
happen very quickly and be very scary for everyone around to contain.
What would be their plan if she became unwell? Get them to write this as
they woudl a birth plan.
Pinky
----- Original Message ----- From: "Sue Cookson"
<[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Wednesday, January 03, 2007 6:03 PM
Subject: [ozmidwifery] birth and mental health
Hi,
Do any of you have stories relating to the use of Lexapro and Lithium
(two different women) and birth - particularly homebirths.
Would appreciate any feedback re outcomes and neonatal well being.
Also how the women manage their medication both pre and post birth.
As usual there is a lot of info out thereand a lot of it conflicting,
Thanks,
Sue
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