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Bipolar Medications and Pregnancy

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esq99 Posted: 02-02-2012 12:57 PM

Greetings to all,

I´m new to FAM and am quite enjoying charting my progress. I´m bipolar and currently under a strict medication regiment. I read a book about the subject but I wish to have more information. My OBGYN back home (I currently moved) said I had to be off my meds but my psyquiatrists say that I´m better off on my meds. I tried going off them but had a crisis and had to take them again. This proved that I have to be on medication and can only lower the dosage. I would like to know about success stories about Bipolar, Meds and Pregnancy. Is anyone out there a Biopolar patient? I´m on Zoloft, Lamictal and Abilify.

Take care,

Elizabeth...

Elizabeth... Baby Dust

 

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natalieL21 replied on 02-02-2012 1:15 PM

I am bipolar as well. I have not been on medication for a few years but my mother who is also bipolar was on medication  through out all her pregnancies. She was on lithium and zolof during her pregnancies i believe. We we all born health. He doctor told her the same thing as you psychiatrist  that she was better to stay on the medication. this was 23, 21, and 17 years ago. 

Sorry i couldn't be more helpful 

 

Natalie 25 Heart  Mat (DH) 25
Married July 16th 2011
BFP April 1st 2012Baby Girl
Rowynn Elizabeth Adria Nov 28th 2012
TTC#2 August 2013
BFP October 1st 2013Baby Boy
Audrick Richard Wayne June 3rd 2014
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dj rayne replied on 02-02-2012 1:35 PM

Depends on the meds and the dose.Some find lowering doses and finding alternates for some meds during specific developmental periods is best for them and their situation. What may effect me or my baby adversely may not effect you. Educate yourself on your meds. Find out what is rec if you become PG while on them. What are the risks and are you willing to take them or is finding an acceptable replacement or going without one or more something you feel you need to consider for a short time. Many women have taken meds because they can't cope without them and have had no problems others have.  What type of harm is possible on the chosen med? Are you OK with a chance of slow motor development but couldn't accept a child that would indefinately be in your care as a result? What is the chance of eiher? Replace those two with any of the s/e listed and ask the question over and over if need be. Ask for a referal and consult with a Dr that uses different meds during PG. Have him consult with your psychiatrist about what may be best for you. Have help and input from more than one source which it looks like you are doing.

David Jude

Click HERE for useful tips and information about this site including linking your chart and directions to allow others to view it Flowers  and HERE for Shrug abbreviations.

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CWags22 replied on 02-02-2012 3:00 PM

Just wanted to chime in quickly on this from a therapist's perspective.  I'd say that what you learned from the crisis off your meds is that you need a different way to manage them, not that you have to be on them.  Certain antidepressants and mood stabilizers carry lower risks during pregnancy, and as DJ Rayne said, you should speak with your psychiatrist about what the safest ones are.  It's possible that you could swap out one or two of your high risk meds for a lower risk one for the duration of your pregnancy.  The other thing to look at is how you came off your meds.  Did you do it abruptly or did you taper?  A gradual taper starting with your most risky for pregnancy med might be a better way to go.

There are psychiatrists out there (I don't know where you live) that specialize in medication management for women during pregnancy.  There are plenty of bipolar women in the world who have healthy babies and manage their symptoms, so there's definitely a way to do it.  It just might not be your ideal way or the way that you thought it would work, but there will be a way.

Lots of Luck and Baby Dust

Me-31 DH-31

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BrandyRelaxing replied on 02-02-2012 4:54 PM

Sounds like you've got some good advice already, but I'll toss in my two cents anyways.  I am on Lamictal (for epilepsy, not bipolar), but from what I've read on Mother Risk (from the Hospital for Sick Children in Canada), the risks are worth me not having a seizure.  I think the dosage is important, and I've also read that monotherapy (just taking 1 drug) is safer than taking multiple ones.

Brandy

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drjanine06 replied on 02-05-2012 7:08 PM

An open line of communication needs to happen between your OB and psychiatrist.  Ideally, yon don't want to be on them, but a healthy you is most important.  Can't quote me on this, but Lamictal is pretty safe and Zoloft.  Abilify, I am not familiar with.  If you can't ween, then it is better for you and your baby to stay on them.  Now, I would also have therapy with it.  That is my thought.  My GYN/OB is totally understanding about this.  Best of luck!

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dj rayne replied on 02-06-2012 9:48 AM

These are from the patient inserts on those meds and is intended as FYI. Again speak with your Drs about what may be helpful to you. Communication between your providers is a must in my opinion.

 It is not known whether Lamictal will harm an unborn baby. FDA pregnancy category C. Taking this medication during early pregnancy can increase the risk of the baby being born with cleft lip or cleft palate. Tell your doctor if you are pregnant or plan to become pregnant while taking Lamictal. Birth control pills can make Lamictal less effective, resulting in increased seizures. Tell your doctor if you start or stop using birth control pills while you are taking lamotrigine. Your Lamictal dose may need to be changed. Tell your doctor if you plan to stop taking birth control pills. Lamotrigine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

 

Sertraline (Zoloft) has been assigned to pregnancy category C by the FDA. Animal studies have failed to reveal evidence of teratogenicity, but have revealed decreased pup survival related to in utero sertraline exposure in doses up to 4 times the maximum human recommended dose. There are no controlled data in human pregnancy. Neonates exposed to sertraline late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These symptoms are consistent with either a direct toxic effect of SSRIs, a drug discontinuation syndrome, or possible serotonin syndrome. Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN). This condition has been associated with substantial neonatal morbidity and mortality. It has not been determined if all SSRIs pose a similar level of PPHN risk. Sertraline is only recommended for use during pregnancy when benefit outweighs risk.

Also, babies exposed to Zoloft late during pregnancy are at increased risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is associated with significant complications and even death. Women who take SSRIs, including Zoloft, after week 20 of pregnancy have a six-fold increase of delivering a baby with PPHN.

 

 

If you become pregnant while taking Abilify, do not stop taking it without your doctor's advice. FDA pregnancy category C. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Aripiprazole can pass into breast milk and may harm a nursing baby. Do not use Abilify without telling your doctor if you are breast-feeding a baby. Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy.

 

David Jude

Click HERE for useful tips and information about this site including linking your chart and directions to allow others to view it Flowers  and HERE for Shrug abbreviations.

To every thing there is a season and a time to every purpose under the heaven.  Eccl 3:1

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Wanderme replied on 04-15-2012 1:11 AM

Women who have bipolar disorder are at a very high risk for a major mood episode during pregnancy and/or the postpartum period (even with medication).  This kind of episode can be harmful to both mom and baby.  For that reason, most experts agree that going completlely off meds is not a good idea.

The good thing is that Lamictal is the best bipolar medication to be on during pregnancy.  The pregnancy and child development studies for lamictal look fantastic--basically no adverse effects as the dosage typically used for bipolar disorder.  You are very fortunate that this medication works for you.  Zoloft has pros and cons, which you should discuss with you med provider.  And there isn't much info available on the effects of Ability.   You should be taking folic acid BEFORE you get pregnant.  Also, be aware that you will probably need to take higher doses of some of your medicines during pregnancy to get the same effects.  

Having a baby when you are bipolar takes a lot of planning.  You would be very well served to find a Psychiatrist and a Therapist who specialize in perinatal mental health.  Another thing to think about is your support system: who do you have in your life who can support you if you do have a major mood episode during pregnancy or postpartum?

Pregnancy can be quite challenging when you are bipolar but it's not impossible.  The best thing you can do is to try to be really well-prepared.  

Good Luck!

Me (32) & DH (32)  

Baby Boy 03/07/13 -- Conceived using FAM.  Sucky pregnancy (severe NVP, SPD, & PIH).  Awesome baby!

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Amelia710 replied on 04-18-2012 7:49 PM

Hi there :)

I have been taking 200 mg. Lamictal throughout my pregnancy (after exhaustive research).  There was a Lamictal registry that followed the pregnancy of thousands of women over MANY years (I think 8-10) that showed that Lamictal did not cause a greater number of birth defects, unlike some of the other drugs like Depakote which can be quite dangerous.  However, your doctor may have to increase your Lamictal in order to maintain its effectiveness, since clearance during pregnancy increases pretty dramatically (I use double what I would normally need).  Your dose should be readjusted right after you deliver to avoid toxicity, though.

Zoloft is relatively safe, as well.  I have a friend who took the highest possible dose and her baby turned out fine.  Not to be alarmist, but she tried to go off of her medicine and ended up suicidal within a few weeks.  Mood relapse is not a given but quite possible. 

I don't know anything about Abilify.  I know it's usually used as a adjunct therapy to mood stabilizers/antidepressants.  You may want to research it before you make your decision.

All that being said, I did no medications through my first two pregnancies, and I survived, but my bipolar tends to be "softer" (no life-threatening manias or depressions, usually).  I decided to stay on my meds with this pregnancy, and so far the baby looks great.  I took LARGE doses of folic acid before I got pregnany, then for the first 3-4 months.  So far, so good.

Also, remember that having a major mood episode during pregnancy can be more harmful for your baby than using the medication, especially those with a relatively good safety profile.  Obviously, if self harm is an issue, that could put you and your little one in jeopardy.  Even so, with untreated mood disorders, there tends to be a higher rate of prematurity, preeclampsia, etc, than if the mood d/o is properly treated.

BEST OF LUCK.  I am living proof that someone who is careful about treatment can be a great mom . . . . especially if you have a good support system!

Mom to three beautiful girls, 7, 3, and 3 months :)

Four sweet angel babies:  ectopic pregnancy, 3/08; missed miscarriage at 10 weeks, 11/10; chemical pregnancy/early loss, 3/11; miscarriage at 5 weeks, 5/1; new baby -- yeah!!

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