BP Meds & Birth Control:Advisable to Have Children?
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Q's:  BP Meds & Birth Control : Advisable to Have Children?

Four years ago I was diagnosed with bipolar disorder. I am 20 now and soon to be married. I would like to use birth control pills or take a Deprovera shot. I am on the following medication:
(1) Lithium (Lithobid)
(2) Levoxyl for my hypothyroidism
(3) currently 250 mg Zyprexa - I've been off it before, might do so again, or, in
the worst case, take a higher dose
(4) I might have to take different medication in the future

Will oral contraceptives interact with my medication? Will I have to increase the  dosage of either? Is Deprovera safe for me?  I might want to have children in the future. Is it advisable? I probably won't be able to get off lithium for the length of the pregnancy. Will there be any side effects? Should I have children at all (given the heredity risks)?

Dear K' -- 
The subject of pregnancy in bipolar disorder is very complicated and must be individualized for each individual woman.  There is one opinion I hear consistently, though, and that is that discouraging women with bipolar disorder from having children is inappropriate.  In other words, to your question of "is it advisable?", the answer from most experts on this subject that I've heard is that you should not let bipolar disorder stand in the way of considering pregnancy.  Then the hard part begins. 

As you may have learned, the old thinking about how risky lithium is during pregancy changed a few years back when a group of researchers re-examined as much of the data on exactly how many cases of heart problems seemed to be caused by lithium, versus how many happen anyway without lithium.  After that re-examination, many experts I've heard such as Lee Cohen from Harvard emphasize that the risk one takes using lithium in the first trimester of pregnancy is very low (Dr. Cohen at Harvard, one of the world's experts, puts the risk on the basis of this new data at about 0.05% among babies exposed to lithium in the first trimester -- that's 5 in 10,000 cases or 1 per 2,000 pregnancies on lithium.  See the article from which this number comes at http://www.womensmentalhealth.org/topics/pregnancy_lib_bipolar_update_06.02.html .  

You can get more information like this from Dr. Cohen and colleagues website for the Harvard Women's Reproductive Psychiatry program at www.womensmentalhealth.org .  Look at "Psychiatric Disorders during Pregnancy" and check out the "pregnancy library" -- lots to read there.  

As for heredity risks, try a little essay from my site on Risk to your Kids. 

As for interactions:  not clearly enough to change the medications.  Is Depo-provera safe?  I am not aware of a problem but will let you proceed to search further on that one as I haven't looked lately.  Note that the Harvard site above has a link for asking questions.  You'll get better answers to all these questions from them, if they respond.  Good luck to you. 

Dr. Phelps

Published May, 2003


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