Research has long shown an association between low folate levels and depression, particularly depression that’s more severe and less responsive to medical treatment. (Folate is a water-soluble B vitamin in its natural form. Folic acid is the synthetic version found in supplements.)
Folate is critical in the development of the human nervous system, so pregnant women must take folic acid supplements. People who abuse alcohol, people with certain illnesses, and those who take a number of different medications are at risk for folate deficiencies, which can present with a variety of cognitive, emotional, and behavioral symptoms. Doctors may check folate levels as part of an initial workup of depression.
In a recent article published in Current Psychiatry Online, entitled “Treating bipolar disorder during pregnancy,” assistant clinical professors of psychiatry at Stanford University Mytilee Vemuri, MD, MBA and Katherine Williams, MD provide an excellent summary of the risks and benefits associated with bipolar disorder and its treatment during women’s reproductive years, particularly during pregnancy and the postpartum period.
Their article offers detailed information about the relative risks of the most commonly prescribed medications, and provides clear recommendations regarding working with young women with bipolar disorder before, during, and after pregnancy.
February’s online edition of The American Journal of Psychiatry contains an article entitled “Longitudinal Follow-Up of Bipolar Disorder in Women with Premenstrual Exacerbation: Findings from STEP-BD,” by Dr. Rodrigo Dias and colleagues. The objective of their research was to shed light upon “the impact of hormonal fluctuation during the menstrual cycle on the course of bipolar disorder,” frequency of relapse, and severity of symptoms.
The study followed 293 pre-menopausal-age women with bipolar disorder for one entire year as part of the Systematic Treatment Enhancement Program for Bipolar Disorder, commonly known as STEP-BD, and compared mood episode frequency and severity between 191 (65.2%) of the participants with premenstrual exacerbation (significant mood changes around their menstrual cycle) and 102 without.
The study examined the baseline hormone/mood relationship during each woman’s regular monthly cycle and whether that relationship could be related to the severity of her mood disorder.
The U.S. Food and Drug Administration (FDA) is informing healthcare professionals that it has updated the Pregnancy section of drug labels for the entire class of antipsychotic drugs. The new drug labels now contain more and consistent information about the potential risk for abnormal muscle movements (extrapyramidal signs or EPS) and withdrawal symptoms in newborns whose mothers were treated with these drugs during the third trimester of pregnancy.
For details, see http://www.fda.gov/Drugs/DrugSafety/ucm243903.htm
Important: Do not stop taking your antipsychotic medication if you become pregnant. Consult your healthcare professional before making any changes to your medication. Abruptly stopping antipsychotic medication can cause significant complications in your treatment.
Photo by Frank de Kleine, available under a Creative Commons attribution license.
I recently noticed an article on the Web entitled “Psychotropic drugs can cause birth defects.” The article reports that “Researchers at the University of Copenhagen (UC) have documented the serious side-effects that can be associated with these types of medications.”
The trouble with articles like this is that they often cause unnecessary anguish and can be counterproductive in managing a healthy pregnancy while effectively treating psychiatric conditions of the expectant mother.
I’m a female of child-bearing age… who has been diagnosed as Bipolar II. The message that the different doctors have given me so far has been “don’t get pregnant.” (In fact, one offended me so much with how she delivered this message that I cancelled my follow-up appointment and got a new psychiatrist!)