Bipolar disorder and pregnancy

Q: I've been trying to find information about bipolar and pregnancy. My Husband and I would like to start a family, but we are concerned about what effects could happen while being pregnant and not taking any meds. I don't plan on taking any since it could harm the baby, but I've had suicide attempts in the past while not being on medication. I take both Lithobid and Celexa. Thanks for your help!

Dear Ms. G' --
Unfortunately, this is one of the most complicated aspects of bipolar treatment.  You should ask your psychiatrist first; if you are not satisfied with the answer, this would be an excellent time to get a "consultation" from a psychiatrist with expertise in this area.  You might have to travel to a town with a university medical center to find a psychiatrist who really knows enough to counsel you about your options.  Basically, as you probably already know, there are risks with all the conventional mood stabilizers, risks of causing abnormalities in your developing child while she/he is still in your body. 

This risk is probably the greatest in the first 12 weeks of your pregnancy, including the first four when many women will not have realized they are pregnant yet.  So it really takes some advance planning.  Recently there has been some thinking that lithium poses less risk than it used to be thought.  And since the risk is primarily in the first trimester, psychiatrists are also now thinking it may be relatively safe to restart lithium in the second trimester (but no breast feeding -- it crosses into milk and into kiddo).  Of course that means that you have to try to taper the lithium, then get pregnant quick: and that's where you really need to work with your doc', as you need instruction on the taper process (it appears to increase the risk of relapse if you just stop lithium, even over as much as two weeks; it should take at least 1 month).   Then you need a close monitoring for symptoms, and a restart plan -- and that's just the lithium option.  There's a Depakote option, where breast feeding may be allowable, but that's worse on 1st trimester risk. 

So, the bottom line is that you really need to hear about multiple options and timing and discuss your past history of symptoms (frequency, as well as the severity; what else has worked a little as far as med's go, etc.)  to assess how much risk you're looking at if you go untreated for a while (during which time there are a few options, with fairly low risk, for symptoms without having to turn to mood stabilizers again).  Try the Harvard listing of bipolar specialists as you look for your "consultant".  Best of luck.

Dr. Phelps

Published January, 2001