Pregnancy in women with bipolar disorder
Q: I have been diagnosed for BP for 10 years and have been taking lithium during that time period. I have also been taking zyprexa and paxil. I have been hospitalized three times for manic episodes. I would like to have a baby and my doctor says I will have to be off lithium and that a long hospital stay is likely if I go off the meds and get pregnant. What is your experiece with patients who are off meds and pregnant? Are there alternative meds to take. Is there a way to minimize the chances of a manic episode happening. I decided to take a lower stress job and am trying to keep my home stress minimal as well. Thanks
Q: Hello Dr. Phelps, I was diagnosed with bpI in April 2000. I have been on many different meds since then. The ones I am taking now are: Lithium 600mg/day, Depakote 500mg/day, Zoloft 50mg-bid, Wellbutrin 150mg-bid, and Ativan .5mg-qid. I have two little boys ages three and one. I have probably had bp since I was quite young, only it was very mild. However after the birth of my second child I developed a more serious case of bpI and was finally diagnosed. I went through a horrible depression with suicidal ideation and the irritability was unspeakable. I also have had pregnancy induced hypertension with both of my pregnancies and with my second child it was so serious that I had to be on complete bedrest, laying on my left side for three weeks before they were able to induce me at 37 weeks. During labor my blood pressure rose so high due to the pain that they had to give me an epidural to control it. I am also at risk for an incompetant cervix due to the fact that my mother took DES in order to avoid miscarriage when she was pregnant with me. I have a lot to worry about when it comes to pregnancy. My question is this: Do you think it is possible to try and have another baby in a few years? Also, what are the chances I could pass this on to the baby? I have 2 sons but I do not believe the bp will affect them as only women in my family seem to have it. I am struggling with my desire to try and have a daughter and all of the health issues at hand, not to mention the ethical issue of possibly handing down bp to a baby. Anything you can help me with I would greatly appreciate. Thank you so much for your time! Sincerely, Tamye
Dear Rachael and Tamye --
You've learned enough to know this is a very tricky issue. There are no clear guidelines. You both have somewhat similar risks. What's new nowadays is that we aren't quite as afraid of lithium's inducing birth defects as we were a few years back. It's clearly less risky than Depakote, but still also clearly presents some risk. Lots of doctors recommend using ultrasound to screen during early pregnancy (end of 1st trimester, beginning of 2nd) for the heart and spine defects caused by lithium and Depakote, respectively -- since even with Depakote the large majority of kids will be ok. Of course that approach only helps if you're willing and able to have an abortion.
HOWEVER, you must recognize that this is one of the trickiest projects you can undertake -- as Tamye already knows from her experience. You can search for and read the works of Lee Cohen at Harvard who is recognized as one of the main experts on this topic, and then make sure that your psychiatrist is familiar with Dr. Cohen's guidelines. Use the PUB MED tool, and my guidelines to help you use it: search "pregnancy bipolar Cohen", and you'll get his recent stuff. Here's one review I pulled from that large list, that's recent and probably an excellent introduction; have a librarian help you get the whole thing.
Make sure you have proper contraception until you've prepared yourself!
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