Mood Stabilizers and Pregnancy
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Q:  Mood Stabilizers and Pregnancy

I was diagnosed with bipolar disorder about 18 years ago.  During my first pregnancy my doctor had me on Prozac to control the depression, I was a complete MANIC MESS but it beat feeling depressed.

I am now trying to get off of a combination of 600 milligrams of Lithium and 30 milligrams of Celexa because I want to have another baby.

Is there a somewhat safe mood stableizer that can be taken during a pregnancy?

I really need your advise.  I am more on the hyper-manic side and have very rearly felt normally stable.

Thank you so much I hope you respond.

Dear Ms. M'
In my view the first step is to get mood symptoms completely stable, using whatever agents are required to do so.  This will be good for your relationship with your existing child, and mate too if he/she's around.  That will be a good step toward preparing your household for another child.  In my view you must think quite seriously about whether you can get stable enough to put yourself and everyone else in the household through more mood instability for the sake bringing another child into the world.  The pregnancy itself has a pretty high likelihood of being quite seriously destabilizing, at least at delivery. 

Once you have good symptom control, and can view your choices from there, things get really tricky making the transition to a regimen on which you can become and be pregnant.  Most doctors, from what I can see, have people taper off lithium (slowly, over at least several months, hoping mood will stay stable), get pregnant as quickly as possible, then resume lithium in the second trimester.  Depakote is handled similarly, and can be continued during breastfeeding, unlike lithium (at least according to the American Academy of Pediatrics, although some think this "okay" for Depakote for breastfeeding is not based on enough information).   As you've learned, Depakote and lithium and most other recognized mood stabilizers must not be taken at the time of conception because the first trimester of pregnancy is risky for the fetus if you're still on one of those medications (although some doctors think the risk of lithium has been overestimated and will consider continuing it for some women, particularly if she is willing to have an ultrasound and abortion if the test shows an abnormality of the type that lithium causes, which can be detected with that test).  

You can ask your doctor about verapamil and thyroid hormone as other alternatives believed safe in pregnancy (each must be managed carefully as the dosing changes during pregancy and after).  

Good luck with your search for alternatives and this difficult decision. 

Dr. Phelps  

Published August, 2001


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