Bipolar Treatments and Pregnancy

by Georgianna
(Freeport, NY, U.S.A)

"Bipolar disorder is a serious medical illness that causes shifts in a person's mood, energy, and ability to function" (NIH, 2009).

Throughout pregnancy, mood levels change which can increase or decrease the levels of medication needed to avoid illness. Precautionary measures, such as discontinuing medications prior to conception, are recommended to prevent major mutations to the fetus. However, discontinuing medications can increase the risk of bipolar episodes during pregnancy. Suggested medications, such as Lamotrigine, together with support from medical experts, family and friends can reduce the reoccurrence of bipolar episodes throughout pregnancy.

Bipolar disorder is commonly diagnosed in teenagers and young adults during their prime years for sexual reproduction. "Is is estimated that 100,000 of the women who give birth each year have bipolar disorder" (NIMH, 2009). Thus, it is important for bipolar women to take proper precautions if planning on becoming pregnant or sexually active.

Prior to conception bipolar women are recommended to taper off their medication to reduce the risk of birth defects to the fetus. "If the patient's previous course of illness has been good with low severity and frequency of episodes, a planned pregnancy without mood stabilizers may be considered" (www.mentalhealth.com).

Women need to gradually decrease their level of medication and be completely off their medication four-week prior to conception to prevent mutations to the fetus.

Unfortunately, women who make the decision to stop medications prior to conception increase their risk of bipolar episodes during their pregnancy. "Those thinking of going off their medication need to consider that maternal depression can result in higher rates of drug, alcohol, and substance use, poor self-care, nutrition, and sleep" (McManamy, 2008). This is why it is important that women consult with medical professionals for evaluation prior to conception. Women should remain in contact with their psychiatrists to ensure the recurrence of illness is managed properly during their pregnancy.

After the first trimester, the fetus has completed its most venerable stage of development. Bipolar women are advised by their psychiatrists to reconsider starting their medications since the risk-to-benefit ratio of birth defects in the second and third trimester, are minimal compared to the reoccurrence of bipolar episodes. By choosing to resume medication, the risk of bipolar episodes is lowered throughout the duration of the pregnancy. However, women who refuse to continue their medication after the first trimester, due to the possibility of birth defects in the second and third trimester, increase their chances of bipolar episodes during the pregnancy.

After consulting with a medical professional, being reintroduced to any medication has the potential for side effects. The FDA reports that the drug Lamotrigine (lamictal) when used during pregnancy is recommended only if benefits outweigh potential risk (Medic8.com).

Lamotrigine is an anticonvulsant and has been available in Europe since 1996. It is the recommended medication for bipolar women to take after the first trimester.

Side effects of Lamotrigine treatment to the fetus included cleft pallet. In the North American Antiepileptic Drug (NAAED) Pregnancy Registry, 564 pregnant women were treated with Lamotrigine monotherapy, and 5 oral cleft cases occurred (total prevalence of 8.9 per 1000) (Holmes, 2006).

Lamotrigine is considered a "new and improved" medication so the long term side effects need further research. Women taking Lamotrigine during pregnancy should be closely monitored. "Symptoms of Lamotrigine toxicity include dizziness, lack of coordination and/or blurred or double vision" (Wood, 2009). The level of medication necessary varies according to the body's changing chemistry, so tests are taken to determine necessary dosage.

A key factor for pregnant women with bipolar disorder is maintaining emotional well-being. When pregnant women are unmediated, trying to maintain the body?s changing chemistry balance can be extremely challenging. Stress is a trigger that causes bipolar episodes, so reducing stress levels during pregnancy is beneficial and has no health effects to the fetus.

According to Our Bodies Ourselves, "during difficult times, doing positive things for ourselves-such as eating well, exercising, and enjoying simple pleasure (hot baths, time alone, or special time with friends) can bring relief and comfort" IBWHBC, 2005). Medications prescribed to bipolar women are designed to assist in mood stabilization. It is crucial that pregnant bipolar women receive constant support while they are unmediated prior to conception and throughout their pregnancy to reduce the occurrence of illness.

For example, some support groups include, talking with a specialist who understands the implications of being bipolar and pregnant. Health care professionals can provide tips to reduce illness occurrence during the four months while discontinuing medications. Family and friends are the major every-day sources of support. They provide comfort and help create an environment to reduce triggers that cause bipolar episodes.

For women with bipolar disorder, the treatment of being unmediated for approximately four months can be stressful. To assist in a healthy pregnancy outcome, bipolar women need to plan head. By seeking medical expertise and understanding the risk-to-benefit ratios of medications and birth defects, the proper treatment plan can be administered. Having constant support from family and friends can reduce the risk of bipolar episodes during pregnancy without harming the fetus.