Mental Illness: The Decision to Have Kids

Phobias Slideshow

If you have a mental illness, what do you need to think about before making this life-changing decision?

By Carol Sorgen
WebMD Feature

Reviewed By Brunilda  Nazario, MD

Aubrey Cichelli a Salt Lake City public relations account coordinator has experienced the extreme highs and lows -- including a suicide attempt -- of bipolar disorder since she was diagnosed with the illness while still in college. Medication eventually evened out her emotional swings and after graduation she married a man whom she knew "was in it for the long haul." When talking together about having children, Cichelli and her husband discussed whether her condition was hereditary, but what they never discussed, she says, is whether or not to have children at all.

"My mother has dealt with depression, and her mother dealt with depression [which was probably bipolar disorder]," says Cichelli, who is now 23. "So there's a good chance some mental illness will pass along to my kids." That's a risk Cichelli says she was more than willing to take, and is now the devoted mother of a 1-year-old son.

"I want to make very clear that I think people with mental illnesses -- whether it's depression or bipolar disorder or something else -- should not let that prevent them from having a family if they want one," Cichelli says. "Mental illness does not mean mental incompetence.

"I love my baby and feel that I'm a great mother," she explains. "I'm more concerned that I have to work and send him to daycare ... that's what's most hard for me, not that I'm sick."

Cichelli says that it's important for someone with a mental illness to have it under control, as she did, before starting a family. "You can't take care of someone else if you aren't capable of caring for yourself."

Mental Illnesses Vary in Severity

Delbert Robinson, MD, agrees. Robinson, associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and a research psychiatrist specializing in schizophrenia at The Zucker Hillside Hospital of North Shore-LIJ Health System on Long Island, N.Y., explains that as with any disease, those with mental illness vary in the severity of their condition and their response to treatment. "There are those who do very well, those who do extremely poorly, and those who experience a waxing and waning of symptoms," he says. "What's important to recognize when deciding whether to have children is how well your particular case is managed.

"Some people do very well with their illness, work full time, manage a household, and live relatively normal lives," Robinson adds. "Others, however, can be totally disabled by their condition. If that's the case, it would be difficult to take on the challenging role of raising a child."

Knowing your own limitations is only one of the factors in deciding to have a child. Passing that illness on to your offspring is another. Many mental illnesses have a genetic component, says clinical psychologist Lee Jampolsky, PhD, author of Walking Through Walls. If one (or both) parents suffers from bipolar disorder, anxiety disorder, attention deficit hyperactivity disorder (ADHD), schizophrenia, depression, or alcohol and drug abuse, the child has a higher than normal risk. While there's no guarantee the child will develop the same condition, it's important to recognize the risk, says Jampolsky.

Parents-to-be who do have a mental illness would do well to discuss their condition with a genetic counselor, Jampolsky says. In general, genetic counselors provide prospective parents with an assessment of their heritable risk factors and offer information concerning the consequences of a disorder, the probability of developing or transmitting it, and ways in which it can be prevented, treated, and managed.

While a fetus can't be tested for a mental illness in the same way it can for other conditions such as spina bifida, it's still a good idea for would-be parents to meet with a counselor, says Jampolsky. "They probably won't tell you anything new about your own condition, but just sitting down and talking over not only the facts but your feelings can be helpful."