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Bipolar Disorder in Pregnancy

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Bipolar Medications During Pregnancy continued...

Your doctor may suggest stopping gradually or changing medication. Or you may continue with medication and do regular tests to check on the health of your baby. But whatever you do, don't stop taking medications without first talking with your doctor.

Was your pregnancy unplanned? If so, know that stopping medications suddenly may do more harm than good.

Mood stabilizers. Taking multiple mood-stabilizing drugs has more risks than taking just one. Because of the rare risk for a particular kind of heart defect, lithium is sometimes not recommended during the first three months of pregnancy unless its benefits clearly outweigh the risks. Lithium may, though, be a safer choice than some anticonvulsants. And when lithium is continued after childbirth, it can reduce the rate of relapse from 50% to 10%.

To reduce its risks to you and your child:

  • Drink plenty of water and maintain normal salt intake to prevent lithium toxicity.
  • Have lithium levels checked regularly -- in you, and your child (usually every 6 to 8 weeks in infants). 
  • Also check levels of thyroid hormone and kidney function in your baby if you breastfeed while taking lithium.

Both valproate (Depakote) and carbamazepine (Tegretol) during the first trimester may lead to birth defects such as neural tube defects, affecting the formation of the brain and spinal cord. And most experts say it is a good idea to stop them at least during the first trimester of pregnancy. You may need to switch to another drug.

There is less information on the safety of newer anticonvulsants. However, lamotrigine (Lamictal) may be a useful alternative for some women.

Antipsychotic medications. Antipsychotic medications can be used during acute treatment of mania, especially to manage delusions or hallucinations. Examples of newer antipsychotics include:

Your doctor may suggest that you switch during pregnancy to an older-generation antipsychotic such as haloperidol (Haldol). This may also be a good idea if you've stopped taking a mood stabilizer but symptoms came back.

Antidepressants. There is less information about the effects of antidepressants on bipolar disorder and pregnancy. If you are on antidepressants, your doctors will watch you closely for mood switches or multiple episodes over time. Also, know that these drugs may increase the risk of mania. This is thought to be especially true if mood stabilizers have been stopped.

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