Bipolar Disorder And Pregnancy: Is Lithium Safe While Pregnant

Congratulations on your pregnancy or on making the decision to become pregnant! Pregnancy is one of the most magical times during a woman’s life, the happiness at feeling your child grow inside of you can't be matched by anything else in this world! Of course, there are many concerns that come with expecting a new arrival. There is so much to do and so many things to buy, how will you find the time? Then there are the health concerns, will my baby be healthy? Will I need a C-section? These are just some of the thoughts that may be floating around your head, but if you have bipolar disorder than your list of worries is longer than the average expecting mom's.

As exciting as a positive pregnancy test is, for the bipolar patient, pregnancy causes some big concerns and serious decisions. An individual suffering from bipolar must decide whether or not to stop their medications and they need to understand the risks that stress due to manic and depressive episodes may cause their child. They also need to be prepared for a higher risk of developing postpartum depression, which bipolar mother’s are more susceptible to.

No, Lithium cannot be labeled as safe during pregnancy. There are many risks to the fetus associated with continuing Lithium during pregnancy, although many doctors are deciding it's not as dangerous as they once believed it to be. But, for as many doctors who continue to prescribe it to pregnant patients there are just as many who refuse to do so.

The FDA has a system of classifying medications for use during pregnancy. The systems ranges from Category A, considered to be generally safe, to Category D, classified as unsafe during pregnancy. Lithium is listed under Category D. However, this does not mean that you can’t continue taking Lithium during your pregnancy. If you and your doctor decide that the benefits of the drug outweigh the risks to the fetus, a physician will normally continue prescribing it to you.

Because of the difference of opinion in the medical world regarding pregnancy and Lithium, your decision of remaining on Lithium or not may be based on your doctors attitude towards it. For instance, my psychiatrist has been practicing since I was in diapers, and she was very opposed to my taking Lithium during pregnancy. Since she has years upon years of experience working with bipolar women, many who were pregnant, I decided to trust her judgment. On the other hand, if your doctor isn't as opposed to you taking Lithium while pregnant, as mine was, you may be more inclined to continue taking the drug. This is why it’s very important to do some of our own research, we don’t want to be swayed simply by someone else‘s, even a doctors, personal opinion. You need to make the decision that is best for you and your child’s safety. That may be continuing the drug and it may be discontinuing it until after pregnancy, either way make sure the decision is yours.

• Increased risk of birth defects especially heart defects
• Lithium toxicity in mother and baby
• Goiters
• Increased risk of prenatal death
• Increased risk of still - births

If you are planning to continue taking Lithium after the birth of your child, it is highly recommended that you do not breastfeed. 

The risks are pretty high if you continue to take Lithium during pregnancy, but since nothing can be easy in this life, the risks to stopping Lithium can be just as bad. Mood swings were awful before you got on your medication, right? Well, with pregnancy your hormones are all over the place and without medicine to help you out, you will likely experience some of the most extreme highs and lows of your life. This can be very dangerous. During periods of mania you may do things that put your child's safety and your own at risk. During very depressive moods you may hurt yourself, your unborn child, or commit suicide. Think of all the reasons that caused you to seek help for bipolar in the first place, these will all come back and they will probably be more severe.

There is really no one size fits all answer to whether or not a woman should remain on Lithium while she's pregnant. There are risks involved no matter what decision you make. The best thing that you can do for yourself is to look into the risks and benefits of both options, talk to your doctor, and decide what decision is best for you. Only you know whether or not you can manage without Lithium until after delivery.

If you do decide to stop taking Lithium until after your pregnancy... be warned, it will not be easy. You should continue seeing your psychiatrist regularly and if you are not already, you should look into seeing a good therapist. I see my psychiatrist once a month and my therapist once a week, they both work at the same practice so this allows them to stay on top of my condition and make any changes necessary to ensure my safety and my child's.

You will need a good support system. This can include family, friends, or the father of your child. Being off your medication is rough and you will need people who are understanding, and supportive of what you are going through. The main goal at this point is to get through it, your not looking to get any medals or awards right now. You do not need to place pressure on yourself to be the perfect expecting mother or to get everything done, like I said the goal is to just get through it with your health intact and as safely as you can. I would not be able to do it without my son's father. He works very hard and will come home and do what needs to be done around the house, if I wasn't able to get to it that day. There are many days that I can't get off the couch, let alone do dishes or cook dinner. He doesn't judge me or get upset with me, he allows me to do, or not to do, what I need to cope with my illness. His support allows me to refrain from becoming overwhelmed, so I can focus on my health and how I am feeling. I used him as an example but as I said, family and friends can be just as great for emotional support as well.

Another great tool to have is the number of a local crisis center. Crisis is a number you can call when you need to talk to someone who understands what you are going through. They are trained in mental health situations and are able to offer you advice and tips to help you get through the moods you are experiencing.

No matter what decision you come to, the best advice I can give you is to take it easy. Don't get caught up in all the little things. The most important thing is to give yourself as much time as you need to relax and to enjoy your pregnancy.