This months American Journal of Psychiatry (a.k.a the “green journal”) which is our fields top rated journal in terms of quality of research studies and it is used to guide practice decisions of psychiatrists. Although the topic of bipolar disorder and pregnancy has been researched and discussed many times in the past, there still exists no clinical guidelines for psychiatrists and their patients in terms of whether or not to stay on medication during pregnancy if you do have bipolar disorder.
This months article looked at two groups of people and tried to answer the question whether or not being on medications during pregnancy was recommended or not.
First group-Women diagnosed with bipolar disorder who have had prior post-partum psychotic episodes (included mixed and manic episodes)
Second group-Women with no history of bipolar disorder but who have had at least one prior episode of post-partum psychosis. However have never had any bipolar symptoms at any other time.
The study ultimately showed that women with a solid diagnosis of bipolar disorder have a high rate of becoming manic, mixed or depressed both during their pregnancy and in the post-partum time-frame.
Women who have had psychosis only during a past post-partum episode with no inter-episode bipolar diagnosis or symptoms had no relapse during pregnancy but a significant chance of having repeat psychosis during the post-partum period.
Thus the recommendation from the research team which I concur with, is as follows:
1.If you have a diagnosis of bipolar disorder you should remain on a mood stabilizer during pregnancy and of course after birth. In short, you should not stop your medication.(in this study they looked at lithium given it has the most evidence available as well as is the most efficacious mood stabilizer based on studies in the context of this topic and was also very effective in this particular study at preventing episodes both during pregnancy and in the post-partum time-frame.)
2.If you do not have bipolar disorder but have had a prior episode of post-partum psychosis with no inter-pregnancy symptoms, you should not start taking mood stabilizing medication during pregnancy, however immediatly following birth it is recommended starting a mood stabilizer (again lithium has the most evidence) otherwise you are at a high rate of again having post-partum psychotic symptoms.
This is the first straightforward recommendation in terms of what to do in this case and I think it is clinically beneficial to both us psychiatrists and our patients. As always discuss further with your psychiatrist. Post any questions or email me for further info!
Michael Yasinski M.D