Bipolar disorder is a complex mental health condition that is characterized by episodes of mania, hypomania, and major depression. Thankfully, many people who have bipolar disorder are able to experience relief from these symptoms when they receive effective professional care. In most cases, treatment for this disorder involves a combination of therapy and prescription medication.
The challenges of treating people with bipolar disorder include identifying the right prescription medication, determining the optimal dosage level, and ensuring that the individual takes the medication as directed.
But what happens when a person who is taking prescription medication to manage the symptoms of bipolar disorder becomes pregnant? Is it safe for them and their fetus to continue taking the medication? If they stop taking the medication, what is the likelihood that their symptoms will return? Can the unmedicated symptoms of bipolar disorder jeopardize the child’s health?
Let’s start by reviewing some of the medications that are commonly used to treat people who have bipolar disorder.
Common Medications for Bipolar Disorder
Depending on what types of symptoms a person has been experiencing as a result of bipolar disorder, they may receive one or more of the following types of medications:
- Mood stabilizers: This category includes lithium (which is marketed under the brand name Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), and sodium valproate.
- Antipsychotics: Examples of antipsychotic medications that are used to treat bipolar disorder include risperidone (Risperdal), aripiprazole (Abilify), and lurasidone (Latuda).
- Antidepressants: If a person with bipolar disorder has symptoms of depression, their care may include medications such as paroxetine (Paxil), sertraline (Zoloft), or escitalopram (Lexipro).
Some doctors may prescribe Symbyax, which contains both an antidepressant (fluoxetine) and an antipsychotic (olanzapine). Benzodiazepines may also be used on a short-term basis to alleviate anxiety or help pregnant people with bipolar disorder who have been having trouble getting to sleep or staying asleep.
Is it Safe to Take Medication for Bipolar Disorder During Pregnancy?
There is no single, universal answer to the question, “Is it safe to take medication for bipolar disorder during pregnancy?” Healthcare professionals have determined that some medications are relatively safe for pregnant people to take, while others present a higher risk for birth defects and other problems.
If you are trying to decide if you should take medication for bipolar disorder while you are pregnant, the best approach is to consult with your doctor. You need to get an informed perspective from someone who is familiar with you and who can help you understand the potential risks and benefits of continuing to take certain medications during your pregnancy or ending your use of them until after you give birth.
With that understanding, here’s what various experts have to say about the safety of medications for bipolar disorder during pregnancy:
Mood stabilizers are often integral components of treatment for bipolar disorder. Unfortunately, using these medications while pregnant can be problematic. Many mood stabilizers are teratogenic, which means their use by pregnant people can cause a child to be born with a variety of congenital disorders.
A December 2016 study in the journal Australian Family Physician included the following findings about using mood stabilizers for bipolar disorder while pregnant:
- Sodium valproate – The rate of major congenital malformations among infants who were exposed to sodium valproate is 10%-11%. Also, people who use this drug while pregnant may be putting their children at risk for “significant intellectual impairment.”
- Carbamazepine – Prenatal exposure to this mood stabilizer has been linked to neural tube defects, which can lead to spina bifida, anencephaly, and other congenital conditions.
- Lamotrigine – Researchers estimate that using lamotrigine during pregnancy or while breastfeeding causes congenital abnormalities in about 2.7% of babies.
- Lithium – The use of this mood stabilizer while pregnant is associated with an increased but still relatively low risk of fetal heart abnormalities.
According to a July 2015 report in the Indian Journal of Psychiatry about the use of bipolar disorder medications during pregnancy, no psychotropic medications have earned approval by the U.S. Food and Drug Administration for use by pregnant people.
Instead, the FDA has established a five-tier rating system (A, B, C, D, and X) to indicate the potential for harm that various medications pose if used by a pregnant person. In this system, A indicates relative harmlessness and X signifies that the drugs pose considerable danger to the fetus. Most antipsychotics are classified as C substances, while one (clozapine) is in category B.
The July 2015 report included the following details about research into the use of antipsychotics while pregnant:
- Clozapine – Studies on animals suggest that clozapine does not harm the fetus, even when the animals receive as much as four times more medication that a human would use. Case reports of human births have not established a conclusive association between clozapine use and fetal harm.
- Risperidone – Animal studies have linked risperidone with an increased prevalence of stillbirth. Case reports of humans who used risperidone for bipolar disorder while pregnant show a 3.8% rate of fetal organ malformation and a 16.9% rate of spontaneous abortion. The researchers noted that these rates are comparable to the prevalence of fetal organ malformation and spontaneous abortion among all pregnancies.
- Olanzapine – A review of 610 pregnancies that involved prenatal exposure to olanzapine found a 67.5% rate of normal births and a 9.8% rate of premature birth. More than 4% of the children had congenital anomalies and 8% had perinatal complications. Spontaneous abortion occurred in 9.3% of the pregnancies.
- Ziprasidone – Studies involving animals indicate a link between prenatal exposure to ziprasidone and an increased prevalence of developmental delays; damage to the heart, kidneys, and skeletal system; and stillbirths. A single case report involving the use of ziprasidone by a human during pregnancy noted that the child was born with a cleft palate.
Most people who use prescription antidepressants for bipolar disorder take selective serotonin reuptake inhibitors (SSRIs). The U.S. Centers for Disease Control and Prevention (CDC) has reported the following about the safety of using SSRIs during pregnancy:
- Sertraline (Zoloft) – This is one of the most commonly prescribed SSRIs. It is not associated with an increased risk of birth defects.
- Paroxetine (Paxil) – This SSRI has been linked to several birth defects, including abnormalities in the brain, skull, heart, and abdominal wall.
- Fluoxetine (Prozac) – Taking fluoxetine while pregnant may increase the likelihood that the baby will be born with a heart defect or craniosynostosis, which occurs when the bones in the baby’s skull join together before their brain is fully formed.
The CDC report also notes that, even in cases of elevated risk of birth defects due to SSRI use during pregnancy, the actual likelihood that such defects will occur remains relatively low. For example, using paroxetine during early pregnancy may raise the prevalence of certain heart defects from 10 per 10,000 births to 24 per 10,000 births.
What Happens if I Stop Using My Bipolar Disorder Medication During Pregnancy?
As described in the previous section, taking some medications for bipolar disorder during pregnancy can expose the fetus to an array of dangers. However, this doesn’t mean that ceasing the use of all medications while pregnant is always the right choice.
For example, the Australian Family Physician study that we cited in the Mood Stabilizers section also reported the following:
- Childbirth can cause about 37% of women to experience a relapse of bipolar disorder symptoms.
- The risk of childbirth-related relapse rises to 66% if the woman is not taking medication for bipolar disorder.
When someone has active symptoms of bipolar disorder while pregnant, this can also be a source of potential harm to both them and their child. A report on bipolar disorder during pregnancy that was published in a 2015 edition of the journal Drug, Healthcare and Patient Safety included the following information:
- Placental abnormalities, antepartum hemorrhages, and toxicities due to the use of alcohol, tobacco, and other substances are significantly higher among mothers who have bipolar disorder.
- Children who are born to someone with bipolar disorder are more likely to have low birth weight and smallness for their gestational age delivery. They also have an increased likelihood of being born prior to the 37th week of pregnancy.
- People who have untreated bipolar disorder have an elevated risk of giving birth to children with small head circumference and neonatal hypoglycemia (low blood sugar).
Choosing whether or not to take medication for bipolar disorder during pregnancy can be a difficult decision that necessitates a thorough assessment of several risk factors and potential outcomes. As we suggested earlier in this article, this is a decision that should be made only after consulting with a qualified healthcare provider who is familiar with the individual’s treatment history and current health status.