Treating bipolar disorder during pregnancy can be a tricky path to undergo. While the doctor does not want to prescribe a medication that could potentially result in a malformed fetus, neither does he want to allow the pregnant bipolar patient to suffer a relapse due to lack of proper medication.
Most psychotropic medications that are used in the treatment of bipolar disorder contain teratogens. Teratogens are harmful pathogens that could negatively affect a child’s development. On the hand, untreated depression or mania during pregnancy has been scientifically linked to low birth weight, early pre term delivery, and dangerous, high risk activities on the part of the bipolar mother that could endanger her or the baby.
There are three primary mood stabilizers that the FDA recommends for bipolar women who are experiencing pregnancy: lithium, valproate, and carbamazepine. All three of these drugs are classified “D”, which means that there is some risk of exposure to teratogens for the fetus; however, the benefits outweigh the risks.
These drugs are primarily thought to increase the fetus’s chances of incurring heart valve damage; however, it is thought this class of drugs will not affect a fetus’s mental development. Another option that a doctor has for treating bipolar disorder during pregnancy is to employ the use of antipsychotics. These Class “C” drugs are often used to treat mania of women because of their sedative properties.
Although they are considered milder than Class D drugs, fetal risk of exposure to teratogens cannot be ruled out. Antidepressants are often used for those with bipolar disorder who lapse into depression during pregnancy. However, because antidepressants do not contain teratogens, they are thought to be significantly safer for a fetus than Class C or D drugs.
A pregnant bipolar patient should consult her doctor for an individualized treatment plan for treating bipolar disorder during pregnancy.
One book that will be helpful for bipolar expectant mothers is Bipolar and Pregnant: How to Manage and Succeed in Planning and Parenting While Living with Manic Depression.