Pregnancy: Starting Epilim & Concerns
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Q:  Pregnancy: Starting Epilim & Concerns


I HAVE ONLY JUST BEEN DIAGNOSED WITH BIPOLAR AND AM 6 AND A HALF MONTHS PREGNANT. IM ALREADY TAKING ZOLOFT FOR DEPRESSION BUT IT'S NO LONGER ENOUGH FOR ME TO REMAIN STABLE. I AM STARTING EPILUM BUT DON'T REALLY FEEL SAFE DOING SO. WILL THIS HARM MY UNBORN CHILD? AND IF SO, WHAT WOULD YOU RECOMMEND FOR ME TO TAKE SO I DON'T "GO OVER THE RAILS" SO TO SPEAK. EITHER WAY, MEDICATION OR NOT I FEAR OF HARMING MY BABY.

PLEASE GIVE ME ANY ADVICE YOU HAVE. I'M JUST NOW LEARNING OF THIS DISORDER AND KNOW FAR TO LITTLE ABOUT IT.

THANK YOU.
 

Dear Ms. N' -- 
This must be a very scary position to be in.  The answer here is going to sound mostly like "you need a good doc' to guide you and work closely with you", as this is one of the trickiest areas of psychiatry.  There is lots of balancing of risk and possible benefit to do. 

For example, it sounds like you've already decided that going for a no-medication approach is unrealistic?  We should start by wondering about the Zoloft, I suppose after wondering how sure we are about this bipolar diagnosis (as things are much more complicated if that diagnosis is really correct, and much simpler if it's a simpler depression-kind-of-thing going on).  But assuming bipolar is basically correct, then there's some reason to think that without Zoloft you might actually be in a better position and might not need other medications -- BUT, note all the "maybe" language in there.  It's crucial to have someone work through your options with you, not some e-note like this to go by.  

The point was, antidepressants can make bipolar disorder worse, and given the medication approaches you'll be considering for bipolar disorder, the first thing is to make absolutely sure you need any of them; and to do that, given the antidepressant's possible effects, you need to see where you'd be without the antidepressant.  However, that includes possibly worse:  if you weren't pregnant, we'd usually add a mood stabilizer to your Zoloft and then start wondering if the Zoloft needs to stay in the picture after that (that's an area of considerable controversy, as you may have read).  The main reason to think about tapering the Zoloft first is to be absolutely sure you need to add that mood stabilizer; but if your symptoms were pretty bad before the Epilim (U.S. Depakote, valproate) you may not have had much choice there. 

Then, you have to decide which mood stabilizer; and you've already started on the valproate approach, which is very reasonable at this stage of pregnancy (in the first trimester, it's much riskier).  The American Academy of Pediatrics has approved valproate for use during breast feeding, and this may be why your doc' picked it, since you can continue after delivery (not so for lithium, which cannot be used while breast feeding).  

All that probably gives you some idea of the complexity and the issues involved.  I hope you have or are able to find a good psychiatrist with some experience in this area, as that I think is the key (even a "consultation" once with an expert would almost surely be worth it, if your current doc' does not feel that she/he is sufficiently expert). 

Dr. Phelps


Published April, 2003
 

 

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