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.
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
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
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).
Published April, 2003