Treatment of Bipolar Disorder During Pregnancy

The treatment of bipolar disorder during pregnancy or in those women who wish to conceive posesa unique set of dilemmas with which clinicians should be familiar. Given the teratogenicity of somepsychotropic medications used to treat bipolar disorder and incomplete reproductive safety data foragents frequently employed to manage the illness, patients and clinicians should collaborate as theyweigh options regarding appropriate pharmacologic therapy during pregnancy. Ultimately, risk-benefitdecisions are made that must factor in the risk of relapse of psychiatric illness during pregnancy and itsattendant morbidity versus the risk of fetal exposure to these agents. No clinical decision is risk-free,and patients with comparable information about risks and benefits of treatment options may make differentdecisions. However, awareness of the latest reproductive safety data across the family of compoundsused to treat bipolar disorder, including antipsychotics, antidepressants, mood stabilizers, andanticonvulsants, allows for the most informed decisions. This article (1) describes the treatment dilemmasfaced by bipolar women who are either pregnant or who wish to conceive, (2) reviews the teratogenicrisks associated with commonly used psychotropic medications used to treat the illness, and(3) provides some clinical guidelines for treating this population during pregnancy.