Before becoming pregnant with my son, I thoroughly surveyed the medical research about antidepressant use in pregnancy and during lactation. Since I had a history of severe depression and suicidal ideation dating back to my late adolescence, I did not want the risk of experiencing depression during pregnancy. My review of scientific literature revealed that the antidepressant sertraline (Zoloft), an SSRI, had an extremely low serum level in breast milk, and an almost immeasurably low serum level in breast-feeding infants. Armed with this knowledge, and with my doctor’s blessing, I took sertraline when I was pregnant and nursing my son. At the time, I received no negative feedback from health care providers, but I did get questions from extended family members, “Is it OK to breastfeed him when you are taking medicine?”
After childbirth, and a pregnancy that kept me bedridden for five weeks, I returned to the workplace on a part-time basis. My job, as always, grew, consuming more and more of my time, while my son needed me home with him. When I worked first two, then three days a week, my sister and my husband cared for my son. By the time my responsibilities demanded that I work four days a week until 7pm, I put my son in a loving, home-based childcare setting. Every time I would leave my son at childcare, he would cry for a good one and a half hours. I would visit him during my lunch hour, which meant that he would cry again after lunch. It broke my heart. Finally, I decided to quit work and stay home with him full-time. But, this too, would not last.
Staying home with my son full-time lasted a year and a half. By that time, the symptoms of hypomania returned. I thought that God was calling to one Episcopal Church for spiritual direction and another church for Bible study. Though God could have been calling me to these churches, this time I recognized the euphoria as hypomania. I could not in good conscience raise my son without treating symptoms of bipolar.
I asked my husband to listen in as I called the advice nurse and described my symptoms. She told me to either see a psychiatrist immediately or go to an emergency room. Unable to get seen by a psychiatrist for the first time on a Friday afternoon, I saw our family doctor who put me on divalproex sodium (seizure medication that acts as a mood stabilizer) with the understanding that it was outside her expertise and I was to see a psychiatrist following the weekend.
When I became a mother, I didn’t know I had bipolar disorder. My diagnosis at the time was dysthymia (chronic depression). I knew I likely had, at the very least, cyclothymia (a mild form of bipolar disorder, also known as bipolar III). Once I got the diagnosis of bipolar disorder, my son was 27 months old and still nursing (he loved it and I was a pushover). I had to abruptly wean him, as the divalproex sodium (Depakote) I was prescribed as a mood stabilizer is not safe for nursing infants, or, in his case, a nursing toddler.
Fearing that I was now an unfit mother, I proceeded to put my son in daycare and reenter the workforce. Once my diagnosis changed from depression to bipolar, I believed that I could be a danger to my son and that he’d be better off in the care of someone else. I was the same person before my diagnosis changed. My stigma was internal: my own negative thoughts about what having bipolar meant, that I now had a serious, progressive mental illness, my belief that my son was no longer safe when in my own care. I was wrong. Despite the challenges of bipolar disorder — and those challenges are real — I’m a good mother. I work hard to be a good mother.
My son loved breastfeeding. He fed for twenty-seven months until it became clear that I was experiencing symptoms of hypomania and that I had bipolar disorder. To treat the manic symptoms, my doctor prescribed divalproex sodium (Depakote), an anticonvulsant commonly used as a mood stabilizer. Divalproex sodium is not recommended for use during pregnancy, for it may harm an unborn infant. This medication passes into breast milk. Consult your doctor before breast-feeding while taking this or any other medication.
Since divalproex sodium passes through breast milk, we agreed it was time to wean him. By this time my son was over two years old, and I was FED UP with waiting for him to “naturally” wean. Upon being prescribed divalproex sodium, I left my son with my husband for the weekend for cold turkey weaning while I went to my parents.
My son couldn’t believe Mommy wasn’t coming back home for the night. She had never left him overnight. Though it was raining, he insisted on sitting at the driveway, waiting for me to return, then my husband convinced him to sit under the walkway for cover from the rain, then sit in the front doorway, then at the foot of the stairs, then at the top of the stairs, then finally in the master bed with Daddy looking downstairs at the front door, until he finally fell asleep. Later, when I told this story to my psychotherapist, she found the story touching and indicative of how sensitive and caring my husband is.
The following week, I found a psychiatrist who would see me. Finally, at the age of thirty-nine with a highly active, still nursing toddler son, I was diagnosed with bipolar disorder. I went back to work because I thought my son was better off in someone else’s care, now that I was diagnosed with a chronic, severe, progressive, degenerative mental illness. I had internalized stigma against serious mental illness. For some reason, I thought it okay to be a depressed mom, but not a bipolar mom. I was the same person before and after the diagnosis. The only change was my treatment. Instead of only taking an antidepressant, now I was taking a mood stabilizer.
Keeping with my history of hypomanic workaholism, I worked increasingly long hours until I once again fell apart. I broke down crying at work and found myself unable to pull myself back together and return to the office. I tried taking a mental health week off but couldn’t even make it through the weekend without succumbing to uncontrollable crying jags. To get myself stable, I had myself voluntarily hospitalized when my son was four and haven’t returned to work since.
Excerpt from Kitt O’Malley’s upcoming memoir, Balancing Act — Writing Through a Bipolar Life