Rebecca Jo Manzella, 31, of Mount Clemens, was diagnosed with bipolar depression her junior year of high school. Lithium, the medication doctors prescribed for her, was the game changer. Its therapeutic benefits allowed her to return to her studies and continue to maintain healthy relationships with family and friends.
But in 2017, when Manzella and her husband were ready to conceive, her psychiatrist insisted she go off the medication due to the risk of possible birth defects. Manzella agreed, but without lithium's stabilizing influence, her suicidal thoughts returned.
The darkness that threatened to destroy her as a teenager had come back with a vengeance.
"To say it was a scary time for me is an understatement," Manzella said.
Fortunately, her therapist referred her to the Maternal Fetal Medicine department at Beaumont, Royal Oak, where she was able to receive care for her physical and psychological needs. They also connected her to Beaumont psychiatrist, Lopa Rana, M.D.
While many psychiatrists shy away from treating pregnant women and mothers-to-be, or only work with patients willing to spend their pregnancy medication-free, Dr. Rana was different.
Dr. Rana's passion for treating mood and anxiety disorders in women had taken root nearly ten years ago.
I had become increasingly aware of the high depression rate in women. One in three take anti-depressants. Many suddenly stop taking the medication when they become pregnant, especially if the pregnancy is unplanned. In other cases, doctors remove their patients from the medication. Add in drastically shifting hormones, and the risk of relapse is quite high."
Lopa Rana, M.D, Beaumont psychiatrist
It's important to note that according to the research, mental health relapse in the mother isn't only detrimental to her. It can lead to negative outcomes for the baby, including preterm birth and difficulty forming a strong bond with mother during post-partum.
"As I became aware of these situations, it was difficult for me not to be there for my patients," Dr. Rana said. "Many women with mental health challenges defer pregnancy or don't have children at all."
Dr. Rana begins with a thorough review of each patient's medical history. Then, she looks at the research related to specific medications and birth defects.
"We look at the big picture together, but the most important aspect is putting women in the driver's seat," Dr. Rana explained. "Every mother-to-be is worried about birth defects. But, someone also needs to worry about them and be there to help minimize their suffering."
Together, Manzella and Dr. Rana determined the best course of action for Manzella to remain on a low-dose of lithium throughout her first trimester, as cardiac development in her baby took place. Then, when fetal ultrasounds and echocardiograms came back good, the medication dosage was increased to better meet Manzella's mental health needs.
"We look at risk to the baby as compared to the consequences of untreated depression in the mother," Dr. Rana said. "There's a lot of balancing and close patient management throughout the first trimester."
Initially, Manzella had her blood drawn and tested once a month, then every two weeks as her due date drew closer.
In October 2018, she gave birth to a healthy baby girl.
Manzella's joy and relief were palpable.
But, the hard work was not yet behind her.
"Postpartum was challenging," Manzella said. "It took a bit to rebalance the medication. We were trying to bring the lithium to an appropriate level in combination with the anti-depressant."
With time and attention, the pair found a middle ground.
"Dr. Rana was accessible and supportive throughout," Manzella said. "I trust her."
Like Manzella, Allison Bennett, 31, of West Bloomfield, was afraid to get pregnant.
Diagnosed with generalized anxiety disorder and a specific phobia of vomiting, Bennett said she warmed to Dr. Rana's ability to tune into her patients' needs.
"I've had psychiatrists my entire life," said Bennett, the mother of three-year-old Tatum and four-month old Sloan. "The one I had before Dr. Rana wasn't listening. Dr. Rana spent a full hour with me on our first visit. She listened to my concerns and reviewed my history. The medication I used to keep my anxiety at bay had a slim chance of causing birth defects. At the same time, the risk of vomiting during pregnancy is high. We determined the benefits outweighed the risks. She kept me on the medication, then added a second medication for nausea. It made all the difference and set my mind at ease."
Dr. Rana believes there is help and hope for every woman with mood and anxiety disorders who wishes to start a family.
"Being there for them during this critical part of their life has been humbling. When everything turns out well, the joy they experience is indescribable. It's so gratifying to be able to hold their hands throughout the journey," Dr. Rana said. "It's an evolving field, but women with mental health concerns should not fear pregnancy."