Bipolar Treatment During and after Pregnancy
Zachary Stowe, MD from Emory University, is an authority on the treatment of mental illness in women. He recently gave an update on these issues in our department’s Grand Rounds here at Washington University.
In general, there is a lot of concern about how (or whether) to treat serious mental illnesses like bipolar disorder during and after pregnancy due to concerns about the effects on developing fetuses and nursing babies. While the FDA attempts to describe the potential risk of medications on fetal development, the available data are incomplete. In many cases, there is very little information to help doctors and patients make intelligent treatment decisions.
Dr. Stowe makes a point of reminding patients and clinicians that children are being exposed to a potentially adverse condition even if their mothers opt not to take a medication. This is based on the clear and growing body of literature describing the detrimental effects on children that have a mother with untreated, or unsuccessfully treated, mental illness.
From this point of view, it is easier to consider treatment options by realizing that no course of action is completely “safe.” The focus then shifts to choosing a course of action associated with the greatest chance of benefit and the least chance of harm.
Dr. Stowe also points out that by the time a woman on medication becomes aware of the fact that she is pregnant, the fetus has already experienced a sizable exposure to that medication during crucial phases of development.
Breastfeeding is another potential concern for women taking medications. In general, essentially all medications the mother takes are found in her milk. However, the exposure that the child receives tends to be much lower than a developing fetus receives. Moreover, there are clear advantages to breastfeeding with regards to mother-child interactions and bonding that may override any potential risk from the medication.
Other options that are available depending on the state of one’s illness include various forms of psychotherapy. For women that are severely ill during pregnancy, electroconvulsive therapy has years of clinical experience demonstrating its safety for the fetus.
Here are some questions for all women of childbearing potential to consider with their physicians:
What method of birth control will I be using?
Do any changes to my birth control method have the potential to interact with my bipolar medications? Do changes in my bipolar treatment have the potential to interact with my birth control method?
Is it OK to breastfeed while taking this medication?
For more information compiled by Dr. Stowe and his colleagues, go to www.emorywomensprogram.org
Published On: February 02, 2007
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