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Mental Health (Expert Forum)
Medication and Pregnancy
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
Medication and Pregnancy
by Debi, Jun 17, 2000 12:00AM
I am 35 years old and have bipolar I disorder. I am planning on trying to become pregnant in August. I was hoping to get some information on medications and how they effect the fetus. I do have an appointment at a Womens mental health center where they do research and treat women who have an affective disorder and are pregnant but I like to get as much information as possible. I currently take Tegretol, Neurontin, Seroquel, and BuSpar. I recently stopped taking Wellbutrin SR. I know that Tegretol causes neural tube deficits and heard that Calan is sometimes used as a mood stabilizer. I do not know much about Calan other than it's a calcium channel blocker and also used for high blood pressure. I've been on Tegretol for about 10 years, even if I stop taking it will it still be in my system and effect the baby? I'm already taking folic acid 800mcg/day. I wanted to totally go off meds to be safe for the baby but I've recently tried reducing the Seroquel and the symptoms of paranoia started returning so I don't really see no meds as an option anymore but I'll do whatever is best for the baby. I'm currently in graduate school for counseling and am taking a psychopharmacology class, I learned that the older, typical antipsychotics are safer in pregnancy but I know that they have more side effects and am confused on why they would be safer. I also have a hard time tolerating them, I've tried stelazine and navane in the past. Mellaril wasn't bad but serouquel works better. Any information on meds you could give me would be appreciated. Like I said I am trying to get as much info as possible so when I see the doctor on Friday I'll already have some background and can ask more questions. Thanks again ---Debi
Doctor's Answer
by HFHS MD-JM, Jun 18, 2000 12:00AM
Debi,
When deciding whether one should or should not take medications during pregnancy a risk benefit analysis needs to be done. Each medication has its on risks and the known efficious mood-stabilizers all have significant risks. Tegretol and Depakote have been associated with neural tube defects such as Spina bifida. Lithium has been associated with a cardiac anomaly known as Ebsteins' anomaly. Lamictal and Neurontin which are also thought to have some mood stabilizing properties have not been studied in pregnancy. The calcium channel blockers were thought at one time to have a potential to be helpful as mood stabilizers but really have not panned out and are generally not used at this time. The course of your Bipolar disorder may also dictate whether or not you could be off of medications for a short time especially during the first trimester when the majority of the fetus' organs are developing. You also need to know the risk of transmittng bipolar disorder to your child. These are just some of the questions that should be addressed prior to getting pregnant. Please discuss this issue in depth with your treating psychiatrist. By the way, the longer a medication is out , the more information about its safety in pregnancy we have.
Sincerely,
HFHS MD-JM
When deciding whether one should or should not take medications during pregnancy a risk benefit analysis needs to be done. Each medication has its on risks and the known efficious mood-stabilizers all have significant risks. Tegretol and Depakote have been associated with neural tube defects such as Spina bifida. Lithium has been associated with a cardiac anomaly known as Ebsteins' anomaly. Lamictal and Neurontin which are also thought to have some mood stabilizing properties have not been studied in pregnancy. The calcium channel blockers were thought at one time to have a potential to be helpful as mood stabilizers but really have not panned out and are generally not used at this time. The course of your Bipolar disorder may also dictate whether or not you could be off of medications for a short time especially during the first trimester when the majority of the fetus' organs are developing. You also need to know the risk of transmittng bipolar disorder to your child. These are just some of the questions that should be addressed prior to getting pregnant. Please discuss this issue in depth with your treating psychiatrist. By the way, the longer a medication is out , the more information about its safety in pregnancy we have.
Sincerely,
HFHS MD-JM
Member Comments (1)
by Silent all these years, Jun 19, 2000 12:00AM
Pregnancy is stressful, and raising kids is even more stressful. Raising a child with a disability is extremely stressful even when you weren't doing anything (like taking medication) that could have caused the disabling condition. A child with any of the conditions listed by the MD above would require a lot of extra medical care. Have you considered the effect that giving birth to a child with an iatrogenic (caused by the medical profession) birth defect may have on you and your illness? I think that you should postpone childbearing until you can be stable without taking any medication. Or consider adoption.
