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.
Highlights for me were the following:
- The importance of having regular discussions about birth control and pregnancy risks with any woman of reproductive age being treated for bipolar disorder. Women with bipolar disorder have a higher risk of irregular menstrual cycles, as well as patterns of impulsive behavior as part of manic episodes, which increases the risks of unplanned pregnancies.
- The fact that some medications, such as Tegretol, can decrease the effectiveness of birth control pills.
- The fact that some medicines, including Lamotrigine, are less effective when combined with birth control pills.
Pregnancy Planning Goals for a Woman Taking Medication for Bipolar Disorder
Goals of planning a pregnancy for a woman on medications for bipolar disorder include the following:
- Stable mood for several months before conception.
- Lowest number of medications at the lowest possible doses.
- Avoiding certain medications that have the most well established risks of causing specific birth defects, if at all possible, is optimal. These medications include Depakote, Tegretol, and Lithium.
- Non medication interventions such as increased monitoring with the doctor and therapist, family involvement, and regulating sleep and stress levels are also very important.
Planning for Postpartum and Breastfeeding
In my practice I have seen several severe post-partum mood episodes – depressed, manic, and mixed. These can be very difficult to treat and present significant risks to mother and the newborn. Careful planning and monitoring are essential. Plans regarding possible breast feeding should be in place early on, including back up plans if there is an episode in postpartum and medications must be restarted or increased.
A Valuable Resource
I have saved this article to my reference file – it is full of key data points and practical guidance. If you are a young woman with bipolar disorder, I recommend that you read it now and file away a copy that you can pull up in the future if you are thinking about getting pregnant. It will be a valuable resource for you, your family, and your doctors.
Photo by Germano Bisson, available under a Creative Commons attribution license.