So today I went to my pdoc about the bipolar anxiety issues that have resurfaced and she was just wonderful.
I hadn't seen her since I got pg (it's really $$ to go see her so I tend to put it off too long) and we talked at length about the interim midwife giving me the Ativan prescription.
I think the "comfort level" for the m/w is that Ativan is commonly used for epileptics in preventing GMS during pg, and my pdoc doesn't deal with epilepsy, but the m/w has, and thus there's her personal experience in using the drug during pg.
It makes sense, but it also makes sense that the pdoc would remain uncomfortable about recommending the use of a Cat D drug unless it was VERY necessary, since bipolar isn't life-threatening like a Grand Mal seizure. But my emotional/mental state is very important and germane to the health and wellbeing of my unborn child. So it's a balance issue.
I agree with her 100% and wouldn't use it unless I was absolutely freaking out.
Anyway, she agreed that it was okay for me to take on an only when I desperately need it basis (haven't taken any yet and don't plan to, but just having it in my purse helps), and said if I were to take for example one a week it likely would do no harm, now that the baby is past the first trimester, but that she'd rather me take Buspar, a daily anxiety preventative, that she feels is okay during pg. (It's Cat B.)
She told me to come home and look it up on the internet. *laughs* I love doctors who encourage informed patients.
We also talked about the sleep issues I've been having. She reassured me about some of the horrid nightmares (helped me see that they are based upon quite rational fears, and I'm not a closet psycho afterall, whew!).
She told me that despite common views, in her opinion, Ambien has not yet been around long enough to know with certainty whether it's safe during pg yet (she said it's still just too new and she won't prescribe it during pg) but she feels more comfortable with Trazadone, and that my recent bouts of insomnia could very well be triggering my more manic (irritable/anxious) episodes.
I've taken Trazadone in years past for sleep issues and while it's listed at Cat C, it's an as-needed only medication and one that's been around much longer than Ambien. I feel more comfortable with her assessment of it, honestly, so I'm going to let DH get the 'script filled. Whether I end up taking any will depend upon how many more miserable 5:00am can't sleep nights I have.
Anyway, I feel better about things, though work has been really stressful lately and I'm hoping to just make it through the holidays without turning to any medication but I might break down and start the Buspar.
Anyone have any experience with Buspar or Trazadone during pg?