Bipolar disorder

INFORMATION FOR WOMEN WHO HAVE BIPOLAR DISORDER DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is bipolar disorder?

Bipolar disorder (BD) is a mental illness that features episodes of depression and episodes of either mania (an elevated mood state in which the individual is happy, but out of control) or hypomania (a less extreme form of mania in which the person is happy, but in control). Mania and hypomania are both defined by having any of the following symptoms: euphoria (exaggerated sense of happiness and confidence), jumpiness or being wired, excessive talkativeness, racing thoughts, distractibility, agitation or restlessness, and impulsiveness characterized by poor, rapid decisions, such as going on spending sprees, or taking high sexual risks. The “controlled form” of mania includes happiness dominating over impulsiveness. Although hypomania sounds like a good trait, the problem is that it can easily convert to mania or simply deteriorate to a new episode of depression.

There are different categories of bipolar disorder: “Type I BD” is the most severe type, as it includes both mania and major depression. “Type II BD” is milder, consisting of hypomanic episodes and symptoms of depression without major depression.

How common is bipolar disorder during pregnancy?

BD is very common worldwide, afflicting an estimated 25 percent of the population, with Type I BD occurring in 12 percent and Type II BD in 34 percent of people. The condition is heritable, meaning that genetic factors present in your family can increase your risk of developing BD. Since pregnancy and childbirth overlap when most females with BD are diagnosed, BD is likely present in a high number of pregnancies, with estimates roughly similar to, if not somewhat higher, than the prevalence of the condition in the overall population (meaning a few cases per every 100). 

How is bipolar disorder diagnosed during pregnancy diagnosed?

Determination of whether you have BD, and the subtype of BD, depends on an assessment by your healthcare provider, or therapist, of whether you meet a set of diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders. Type I BD is diagnosed if there has been at least one episode of mania, preceded or followed by episodes of either hypomania or major depression. There also can be episodes of psychosis (the person has delusions and/or hallucinations) mixed in. Type II BD is diagnosed if there has been at least one major depression episode plus one or more episodes of hypomania, but not mania. In other words, what distinguishes Type I BD from Type II BD is how high into the mania realm the person goes, not how far she drops down towards depression. Switching from mania to hypomania is enough to qualify for Type I BD. As for the “cyclothymic disorder”, this is diagnosed based on a history of several bouts of hypomanic symptoms interspersed between periods of having symptoms of depression, but not enough to call it major depression. Furthermore, to qualify as cyclothymic disorder, the episodes must have been going on for a minimum of 2 years for an adult or 1 year in children and teens. There also are mixed types of BD that can be diagnosed based on the DSM-V criteria.

Does bipolar disorder cause problems during pregnancy?

Yes. Women with BD carry a 1020 percent risk of committing suicide at some point during life, which is about 20-30 times higher than the risk of those that do not have BD. Apart from the suicide risk, both depressive episodes and manic/hypomanic episodes can keep pregnant women from going for routine pregnancy check-ups as well as from eating a good diet. Furthermore, manic episodes can cause the woman to engage in risky behaviors. For example, while manic, you might decide to take up scuba diving, or skydiving, which is perfectly fine when youre not pregnant and when you go through proper training, but is not recommended during pregnancy.

Does bipolar disorder during pregnancy cause problems for the baby?

Depressive episodes can be harmful to the baby as they greatly increase the mother’s risk of going into labor prematurely. As noted above, manic episodes can lead a pregnant woman to engage in risky behaviors. Depending on what that behavior is, it can lead to a whole range of undesirable outcomes for the developing baby, including spontaneous abortion (miscarriage) resulting from maternal injury, infection from a sexually transmitted disease, and congenital malformations and other problems resulting from maternal drug abuse.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the BD
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat bipolar disorder during pregnancy?

The main treatment for BD consists of a mood-stabilizing medication such as lithium. In terms of effectiveness in stabilizing the mood to reduce manic, and therefore depressive episodes, lithium works fairly well, although certain people respond a lot better than others, and some do not respond at all. The problem with lithium is that it is thought to be potentially harmful for the developing baby. Other mood stabilizers, such as carbamazepine and valproic acid also carry risks to the baby. This potential risks due to the prenatal exposure to the medication, however, must be weighed against the very significant risks of harm to the baby resulting from the maternal BD. itself. Although this may be daunting, it is known that, during the first trimester, the use of lithium, carbamazepine, and valproic acid pose a very high risk of birth defects in the baby. Therefore, it is better to avoid them during this period. Lamotrigine is another mood stabilizer and for which the concern is slightly reduced compared with the others, but this may be partly because lamotrigine has not been studied as much as the other medications in pregnancy.

Who should NOT stop taking medication for bipolar disorder during pregnancy?

BD is often a very difficult condition to manage whether the person is pregnant or not. Thus, if you become stable on a particular treatment, its often more risky to end the treatment than to continue.

What should I know about choosing a medication for my bipolar disorder during pregnancy?

Concern about potential birth defects in babies of mothers who used mood stabilizers during pregnancy varies among the different medications. If you have just been diagnosed with BD and are not yet taking any medication for it, your doctor can recommend and prescribe a drug that is thought to carry the lowest risk of complications for the developing baby while still being effective to treat your BD.  

You may find Pregistrys expert reports about the individual medications to treat biploar disorder here. Additional information can also be found in the sources listed at the end of the report.

What should I know about taking a medication for my bipolar disorder when I am breastfeeding?

Carbamazapine and valproic acid are considered fairly safe in breastfeeding mothers, whereas lithium is thought to be potentially hazardous to the nursing infant.

What alternative therapies besides medications can I use to treat my bipolar disorder
during pregnancy?

Various psychotherapies are available and may be effective in combination with medications.

What can I do for myself and my baby when I have bipolar disorder during pregnancy?

It is important to manage mental health conditions with the same seriousness as we approach physical conditions. If you were given a diagnosis of BD, it means that you must balance realistically the risks of drug treatment versus the risks of not using any drug treatment.

Resources for bipolar disorder pregnancy:

For more information about bipolar disorder during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

 

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Last Updated: 27-01-2020
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for Bipolar disorder