Mood Stabilizers in Pregnancy: Are They Safe?

The safety of mood stabilizers in pregnancy is something many women with bipolar disorder will have to contemplate at some stage. When it comes to psychiatric drugs in pregnancy, however, the FDA has little information about pregnant women because they are not typically included in medical trials and research. If you are being treated for bipolar disorder and you are pregnant, trying to conceive or breastfeeding, you will need to work with your doctor to consider the risks and benefits of your particular medication. But when it comes to mood stabilizers in pregnancy, what do we know?

Considerations for Mood Stabilizers in Pregnancy

Are mood stabilizers safe in pregnancy? Unfortunately, the answer to this question is not as clear-cut as medical professionals would like it to be.

Mood stabilizers are commonly prescribed for patients with bipolar disorder to treat acute manic or depressive episodes and prevent future recurrence of symptoms. In pregnancy, however, doctors and psychiatrists must evaluate the benefits of mood stabilizers for the expecting mother, while also minimizing risks to the unborn child.

The issue is further complicated by the fact that women with bipolar disorder have a 50% chance of relapse during the pregnancy and the early postpartum period, and this recurrence risk is reported to be two or three times higher if they discontinue a prescribed mood stabilizer. One study found that women who stopped taking mood stabilizers in pregnancy spent around 40% of the gestation period in episodes (manic or depressive), compared to 8.8% of women who continued taking their medication.

If you’re concerned about taking mood stabilizers during pregnancy, you should discuss your options with your doctor. Never stop taking bipolar medication without medical guidance.

Mood Stabilizers During Pregnancy: Facts You Should Know

Although there are many things we don’t know about the safety of mood stabilizers during pregnancy, there are certain facts to consider.

Lithium (Lithobid) is considered the safest bipolar drug during the second and third trimester: According to the U.S. National Library of Medicine, lithium (Lithobid) “appears to be safe” during the latter stages of pregnancy.

Valproate (Depakene) and carbamazepine (Carbatrol, Equetro) carry risks when taken in the first trimester: The National Library of Medicine also concluded in 2015 that use of valproate during the first trimester is associated with major malformation and development decay, with a higher risk of autism spectrum disorder in the unborn child. Carbamazepine is also associated with a higher risk of major congenital malformation, which is why it is not recommended for use in the first trimester.

Valproate is considered safe while breastfeeding: Although it is contravened during pregnancy, valproate is deemed to be safe for breastfeeding women.

Lamotrigine (Lamictal) could be safer than other anti-seizure drugs: The same study printed in the National Library of Medicine references lamotrigine as "more favorable than other antiepileptics” during pregnancy and lactation.

Typical and atypical antipsychotics are considered safe: Again, the data on antipsychotic medications such as Olanzapine (Zyprexa) in pregnancy is non-conclusive, but these drugs are considered “a good option” during pregnancy for women with bipolar disorder.

Management of bipolar disorder when pregnant or breastfeeding is different for everyone: Your doctor may decide that stopping your medication and triggering mania or depression is riskier than taking mood stabilizers in pregnancy to control your symptoms. Your doctors will need to consider your current mental state, any previous relapses while off medication, your age, the nature of the pregnancy and other unique factors to determine the best course of treatment going forward.

If you are being treated for bipolar disorder and are pregnant, trying to conceive or breastfeeding, you should check with your doctor about the risks and benefits of taking mood stabilizers in pregnancy.

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