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Women With Bipolar Disorder

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Treatment During Pregnancy

Treatment for bipolar disorder is generally the same for men and women. But special treatment considerations are necessary for some women, particularly during pregnancy.

While it is crucial that women continue treatment during pregnancy, risks to the baby are also considered. So treatment regimens may change to minimize risk.

In general, doctors prefer lithium and older drugs such as Haldol (haloperidol), as well as many available antidepressants during pregnancy. That's because these drugs have shown less risk than some other drugs to the unborn baby.

Also, because they have been used for longer than the newer drugs, their effects in pregnancy are better established. If women choose to try stopping treatment during pregnancy, doctors often use these drugs if treatment must be resumed. A number of newer atypical antipsychotic medications have been studied during pregnancy and, to date, have demonstrated no known risks for birth defects or developmental abnormalities.

Some drugs, such as valproic acid and carbamazepine, have been shown to be harmful to babies and contribute to birth defects. If a woman taking valproic acid discovers she is pregnant, her doctor may change her medication or adjust the dosage and prescribe folic acid to help prevent birth defects affecting the development of baby's brain and spinal cord.

Most experts avoid carbamazepine during pregnancy unless there are no other options. Carbamazepine not only poses risks to the unborn baby, but can also cause complications such as a rare blood disorder and liver failure in the mother, particularly if begun after conception.

Some drugs taken in late pregnancy may cause the baby to experience abnormal muscle movements, called extrapyramidal signs (EPS), or withdrawal symptoms at birth. The drugs include Abilify (aripiprazole), Haldol (haloperidol), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).

The symptoms for the baby may include:

  • agitation
  • abnormally increased or decreased muscle tone
  • sleepiness
  • difficulty breathing and feeding
  • involuntary muscle contractions or twitching

In some babies, these symptoms go away within hours or days on their own. Other babies may need to stay in the hospital for monitoring or treatment.

In general, doctors try to limit the amount of medications a developing baby is exposed to during pregnancy. That is because even among drugs that have no known risk to the fetus, there are always unknown risks, which can be minimized by keeping an existing medicine whenever possible rather than adding new ones.

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