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Bipolar Disorder (Children and Adolescents)

Handling Bipolar Disorder and Pregnancy

07/05/2005

Question:

I am currently on Lexipro 20mg and Lamictal for bipolar disorder. I am finally very happy in life and want to keep it that way. I found out yesterday that I am pregnat and I am terrified because I do not want to discontinue this new found life that I have created. Is there anything that I can take for bipolar that is not so harmful? Also, I have insomnia and have been taking trazadone. Is there anything that I can take for that as well that is safe? Thank you for your help.

Answer:

Hello, Thank you for your excellent questions and congratulations on your wonderful news re your "new found life" and pregnancy! As I am an expert on childhood bipolar disorder and not adult bipolar disorder and am a clinical psychologist and not a M.D., I strongly encourage you to communicate your concerns to your prescribing physician, who will be able to discuss your treatment options. If he/she is unable to help you, I suggest contacting your local university medical center to find a psychiatrist who really knows enough to counsel you about your options. However, I hope the following article from the website, http://bipolar.about.com/od/pregnancy/ , is helpful. "Pro's and con's of mood stabilisers and other medication during pregnancy: Once you have decided to try to become pregnant, the following questions about medication are to be considered. It is an acknowledged fact that all medications, including those commonly prescribed in mood disorders, are a potential but unpredictable danger to the child in the period of conception and during the early development of growth of organs. At the final stage of pregnancy, psychiatric medications affect the new-born in a more predictable way that can be related to the dose, distribution and its effect on cerebral functioning. First of all a choice has to be made between: Discontinuing mood stabilizing medication and face the risk of relapsing. If that happens it may be unavoidable to introduce new medications, either antipsychotic in case of manic or psychotic signs, antidepressants or sedatives in agitated situations or insomnia. Continuing mood stabilizing medication and adapt the dosage prior to and during pregnancy. In the second situation the expert opinion is: To reduce the daily dose to its minimum while maintaining a necessary level. In order to avoid peaks a 'slow-release, several times daily' type of tablets be prescribed. A balance has to be achieved between: The advantages to the mother of having a stable mood during pregnancy and delivery. The disadvantages to the child with unavoidable use of psychoactive medications. We will discuss these advantages and disadvantages first in more detail for each type of medication. Resolving the issues: To help you to reach a decision and, in case of pregnancy, to prepare for it in the best possible way, we recommend you to pursuit the following guidelines: Look for proper guidance on the genetic issue on the basis of your personal and family history Discuss the use of medications in case of pregnancy and the additional safeguards of scheduled controls Try to get reliable information on a hospital service that has experience in combining the psychiatric, obstetric and pediatric services, and how to have them at hand when you will need them April 1997 Authorship: This information summarizes the studies in a workgroup chaired by Ed van Gent, Pieternel Kolling and Elise Knoppert-van der Klein, psychiatrists. Translation and editing of the English version was done by Janus Oomen and Bert Luttmer on behalf of the homepage of the NSMD. You can contact them by email on this homepage, a/o dr. Ed van Gent or by writing to the following postal address: LithiumPlusWerkgroep, a/o dr. E.M. van Gent, Slingeland Hospital, p.o.b. 169, 7000 AD, Doetinchem, The Netherlands." I hope that helps! My best wishes to you for "continuing your new found life."

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Response by:

Nicholas   Lofthouse, PhD Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University