My wife has been diagnosed with Schizzo-Affective disorder/bi-polar disorder. She is taking paxil currently and tapered off the zyprexa and cylert that she was taking so that we could try to have a child. She had an episode recently and is in the hospital. She may have to go back on the zyprexa. Can she get pregnant on the zyprexa, and if so, what are the chances of the child developing birth defects? What about cylert as well? Are there any pregnancy problems with cylert? What are some of the preventative measures to be taken, if any, for a pregnant woman taking zyprexa and cylert?

Hi Aaron -- 
Management of bipolar or schizoaffective disorder during pregnancy is one of the toughest, trickiest challenges we face.  We don't really have enough information to really tell you what's safe, except for the oldest antipsychotics (Stelazine, Thorazine, Haldol) which we would use if symptoms were clearly severe.  There's some, though less, information that suggests antidepressants like Paxil are safe (most of it is an extension of our experience with Prozac). 

After that, there's not much to go on, including for Zyprexa and Cylert.  Her doctor should meet with her (and you) and review all your options.  Generally an antidepressant without a mood stabilizer or antipsychotic would not be the way schizoaffective or bipolar disorder would be managed, pregancy or not; but in her case, her doctor may have specific reason for doing that, or be balancing the risk of symptoms against the risk of the medication for your unborn child.  It's a very difficult decision-making process, this risk balancing.  

Dr. Phelps

Published April, 2001