Bipolar disorders, brain disorders associated with mood swings that can be severe, are common in women of childbearing age. Medications are required to keep symptoms of bipolar disorders at bay, but many bipolar medications have side effects potentially harmful to the fetus. No psychotropic drugs are FDA approved for use in pregnancy; choosing the drug that has the least potential for damage at the lowest possible dose may be necessary. The National Alliance on Mental illness (NAMI) states use of a single drug is less harmful than combining drugs.
Antidepressants
Most tricyclic and SSRI antidepressants are generally considered to be safe for use during pregnancy, with the exception of the SSRI paroxetine, the University of Maryland Medical Center states. Paroxetine (brand name Paxil) may significantly increase the risk of fetal heart defects. Bipolar I patients should not be given antidepressants alone without also taking a mood stabilizer, according to Lori Altschuler, M.D., lead author of "Treating Bipolar Disorder in Pregnancy" published on HealthyPlace.
Atypical Antipsychotics
Drugs such as Haldol, Risperdal, Thorazine and Zyprex are used to treat mania in bipolar disorders. These medications are classified as category C drugs in pregnancy, meaning that fetal risk cannot be ruled out. First trimester exposure to atypical antipsychotics may slightly increase the risk of fetal harm, Altschuler states.
Lithium
Lithium is used extensively to treat bipolar disorders. Use of lithium in pregnancy increases the risk of fetal heart defects to 1 in 1,000, a risk 20 times higher than the general population, Altschuler states, but still low. Babies exposed to lithium during pregnancy may also have "floppy baby syndrome," turning blue and having poor muscle tone. Because the risk of relapse in bipolar disorders is seven times higher than that of women not pregnant with bipolar disorder, medical personnel may decide to continue lithium in pregnancy despite the small fetal risk, NAMI states.
Antiseizure Medications
Antiseizure medications such as Depakote and Tegretol are sometimes used to treat bipolar disorders. They are not often used in pregnancy because they pose more risk for fetal defects than other medications. Neural tube defects, where the tube around the spine doesn't close properly, facial malformations, heart defects, small head size and growth retardation are all associated with use of these medications in pregnancy. If Depakote must be used, it should be taken in doses of less than 1,000 milligrams per day in divided doses rather than in a single dose, NAMI states. Women taking antiseizure medications should also take vitamin K to decrease the risk of facial malformations and folic acid to decrease neural tube defects.
References
- National Alliance on Mental Illness:Managing Pregnancy and Bipolar Disorder
- University of Maryland Medical Center: Bipolar Disorder
- Psychiatric News: Should Bipolar Medication be Halted During Pregnancy?"; Jun Yan; Jan. 18, 2008
- HealthyPlace.com: Treating Bipolar Disorder During Pregnancy; Lori Altschuler, M.D. et al
