- Joined
- Jan 6, 2005
- Messages
- 43
- Reaction score
- 0
How are pregnant pts with bipolar disorder managed? Do you continue to take lithium?
bipolar disorder and pregnancy
- Thread starter chngsr
- Start date
Bipolar disorder during pregnancy cannot be treated with any of the "traditional" mood stablizers. Lithium (Out! Causes Ebsteins anomoly, particularly if taken during the first trimester.) ; Valproic Acid (Out. Teratogen that can cause Spina bifida secondary to folate depletion); Carbemazepime (Out. Teratogen associated with many anatomical defects.). What you must do is wean patient off of whatever mood stablizer she is currently taking preferrably when she offers that she is trying to become pregnant, and then substitute with an atypical antipsychotic which have generally been shown to be safe during pregnancy. If she hasn't known she was pregnant, then the drug must be stopped abruptly once she tests positive for pregnancy. Then substituted with an atypical psychotic and have serial ultrasounds and Biophysical profiles to rule out structural defects. If there are structural defects then it is the mother's decision on whether or not to abort. It's ALWAYS the mother's decision...Unless she is deemed by psychiatric evaluation to NOT have capacity to make the decision and her fetus put's her health in imminent danger....I think.
- Joined
- Sep 27, 2007
- Messages
- 1,369
- Reaction score
- 6
That isn't completely true. Mood stabilizers are commonly used in pregancy, but it is a risk benefit thing. A woman with one manic episode a decade ago should be weaned off if planning to conceive. However, a severe bipolar patient should be kept on. A patient with some mood stabilizers is a more hospital home for a fetus than a dead patient.
As far as management, lithium increases the risk of ebsteins by 20x. Which means the chance is still something like 1:1000. Not very high if you ask me. Try treating patients with very low dose though. For anticonvulsants, 4mg folic acid daily to reduce NTDs. Again, risk vs benefit.
As far as management, lithium increases the risk of ebsteins by 20x. Which means the chance is still something like 1:1000. Not very high if you ask me. Try treating patients with very low dose though. For anticonvulsants, 4mg folic acid daily to reduce NTDs. Again, risk vs benefit.
the above poster has the essence of the issue, speaking from knowing 2 bipolars, and their doc's. Risk vs. benefit and all the risks a mod to severe bipolar can be to the fetus (hyper sexual->VD, physical injury -> malformations, or depressed -> suicide, et al). Clinical reality is vastly different from step 2.
