Use of Mood Stabilizers and SGAs During Pregnancy Flavio Guzmán, MD

Considerations in Bipolar Disorder

Balancing risks vs benefits Before conception Discuss with the patient and partner risks and benefits of pharmacotherapy Bauer, M., & Gitlin, M. (2016). Lithium During Pregnancy and in the Postpartum Period. In The Essential Guide to Lithium Treatment (pp. 103-112). Springer International

Balancing risks vs benefits Before conception Discuss with the patient and partner risks and benefits of pharmacotherapy Up to 50% of pregnancies are unplanned Early discussion gives time to make informed decisions Grover, S., & Avasthi, A. (2015). Mood stabilizers in pregnancy and lactation. Indian journal of psychiatry, 57(Suppl 2), S308.

Non-pharmacological treatment No history of suicide attempts or frequent suicidal ideation Prolonged periods of euthymia Good social support Close monitoring Bauer, M., & Gitlin, M. (2016). Lithium During Pregnancy and in the Postpartum Period. In The Essential Guide to Lithium Treatment (pp. 103-112). Springer International

Maximize non-pharmacological treatments Good social support Regularity of sleep Psychotherapy Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.

Monotherapy vs Polypharmacy Recommended by guidelines Polypharmacy Increases overall teratogenic risk Some patients require polypharmacy Burt, V. K.,et al (2010). Bipolar disorder and pregnancy: maintaining psychiatric stability in the real world of obstetric and psychiatric complications. American Journal of Psychiatry.

General recommendations Whenever possible, avoid valproate Lithium and lamotrigine levels can fluctuate Monitor mood stabilizers during treatment “Half treatment” exposes the fetus to both the risks of treatment and maternal mental illness Use effective doses ECT is effective and relatively safe for severe or refractory symptoms Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.

General recommendations Whenever possible, avoid valproate Lithium and lamotrigine levels can fluctuate Monitor mood stabilizers during treatment “Half treatment” exposes the fetus to both the risks of treatment and maternal mental illness Use effective doses ECT is effective and relatively safe for severe or refractory symptoms Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.