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The following article was written by Dr. Richard Dopp, a Consulting Psychiatrist for MC3. It was published by the bphope magazine.

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Balancing the benefits and risks of taking psychotropic medications during pregnancy is a hard but necessary task.  You should always discuss treatment decisions thoroughly with your psychiatrist or other prescribing practitioner, as well as your obstetrician, to make the best personal choice.

Should I continue my bipolar meds if I’m pregnant?

First and foremost, any changes to your medication regimen must be worked through with your practitioners for the safest outcome. Raising the topic early on—preferably when still considering getting pregnant—is the best plan. And it helps to be proactive: Read up on your medications and bring any concerns to your care providers.

Recent research suggests that risks associated with continuing your pharmacotherapy during pregnancy have been overstated. Several studies over the past five years have found no significant differences in newborn health between mothers with bipolar who remain on meds and mothers without a psychiatric disorder.

Lithium, a mood stabilizer that is among the “first line” of medications prescribed to treat bipolar disorder, has a reputation for affecting fetal development. Findings from large-scale studies in the U.S. and Europe now indicate that negative outcomes are lower than previously thought.

However, treatment guidelines suggest lowering doses of lithium during the first trimester, when risk of miscarriage is generally higher and much of fetal heart development occurs.

With second-generation antipsychotic medications, also commonly used to treat bipolar disorder, recommendations call for lowering dosage in the third trimester. Nursing mothers should also consult with their prescribing practitioner about the likelihood of medication passing into breast milk.

What are the risks of not taking my meds?

Going off your prescribed medications increases the likelihood of having a depressive or manic episode. Depression and mania impose their own consequences for self-care during and after pregnancy, as well as for providing the attentive, 24/7 care required by a newborn.

An extensive review of previous studies, published in 2019, reported that 70 percent of women who discontinued treatment with lithium during their pregnancy experienced recurrence of mood episodes. Among women who continued on lithium while pregnant, that figure dropped to 23 percent.

Higher risk of depression, mania and psychosis continues after the baby is born, often complicated by hormonal changes and sleep deprivation.  Postpartum mood episodes may affect the process of mother-child bonding, which is important to long-term child development.

Dutch researchers found that nearly 60 percent of new mothers admitted to the hospital for postpartum depression reported impaired bonding. Over the course of treatment, however, decreases in both depressive and manic symptoms correlated with improved bonding.

What else should I consider?

Create a treatment team.
You should strongly encourage your obstetrician, prescribing practitioner, and psychotherapist to connect. A team approach, known as “collaborative care,” is the best way to get all your questions answered and your concerns addressed while keeping everyone on the same page regarding medications, supports, and reasonable monitoring.

Seek counsel(ing).
If you are not already in psychotherapy, give some thought to recruiting that extra support while you’re pregnant or considering pregnancy. Talk therapy gives you a dedicated opportunity to parse all the practical or emotional issues that come up along the way.

Respect your changing body.
The usual interventions and self-care strategies for bipolar management apply during pregnancy. However, you may want to adapt your activities over the months as your ligaments soften, lung volume decreases, and center of gravity shifts.

If you do yoga, for example, be aware that some poses should be modified during pregnancy. It’s a good idea to find a yoga instructor with training in prenatal yoga, or at least research this topic online.

Whether you are continuing or starting an exercise regimen—a vital contribution to both physical and emotional health—it’s wise to check in with your care providers over the months to assess personal safety levels for aerobic exercise and weight training.

If you don’t get the go-ahead for vigorous types of physical activity, walking can be an excellent substitute. If you have access to a pool, water walking or swimming at a gentle pace provides a lower-gravity alternative as your belly grows.