The pharmacology of bipolar disorder during pregnancy and breastfeeding.
Treating bipolar disorder in women during reproduction presents a significant challenge to the physician. The pharmaceutical agents most commonly used for treating bipolar disorder have been associated with adverse effects when used during pregnancy and breastfeeding. Of particular concern has been the association of lithium with cardiac malformations, and the association of carbamazepine and valproate with neural tube defects including spina bifida. Toxicity in neonates has also been reported for the most commonly used mood-stabilising agents. Treatment options for mood stabilisation are either associated with risks of adverse events, have been used less frequently and their associated risks are unknown, or may not provide effective prophylaxis against recurrences of bipolar episodes. However, strategies are available that minimise the risk to the fetus and infant whilst still providing effective prophylaxis against bipolar disorder in the mother. Ideally, a treatment regimen tailored to suit the individual should consider both mother and baby and should be planned prior to conception.
Dodd
Seetal
S
Department of Clinical and Biomedical Sciences, University of Melbourne, Community and Mental Health, Barwon Health, Swanston Centre, Geelong, Victoria, Australia. seetald@barwonhealth.org.au
Berk
Michael
M
D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000927:Anticonvulsants / Q000009:adverse effects* / Q000378:metabolism; D000928:Antidepressive Agents / Q000009:adverse effects / Q000378:metabolism; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000378:metabolism; D001714:Bipolar Disorder / Q000188:drug therapy*; D001942:Breast Feeding; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects / Q000378:metabolism; D008895:Milk, Human / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000378:metabolism
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D011619:Psychotropic Drugs