Expert: Ivan Goldberg, M.D. - 10/23/2007

Question
Hi. My husband and I adopted a baby 18 months ago and would now like to try to get pregnant. I have bipolar type 2 and wanted to know a mood stabalizer and an anti-depressant, if any, that are safe for attempting pregnancy. Also, have you ever heard of PMDD being diagnosed as bipolar type 2? I seem to have a lot of hormone issues, but I cannot find a doctor that will listen to me. Thanks!

Answer
Hi Amber . . .

Women with bipolar disorder who wish to become pregnant have some hard decisions to make. It is well known that women with bipolar disorder are very much at risk to have an episode if they stop their medication during pregnancy. It is also known that it is not good for the developing fetus for a woman to have a mood episode while pregnant. Finally it is well known that women with bipolar disorder are at high risk for a post-partum mood episode.

So, what do women do about this. Some avoid getting pregnant ever. Others stop their medications, according to a schedule provided by their physician, for the first trimester of the pregnancy, and then resume them, and still other women, including some women taking lithium, continue their medications throughout the pregnancy. Each of these choices avoid some risk while carrying others.

The following is from a book that a collaborator and I am in the process of writing This is the section on mood disorders during pregnancy rather than post-partum episodes.:

B3. Mood Disorders and Pregnancy

B3a. Diagnosis

Q: How are mood disorders associated with pregnancy diagnosed?

A:  The full range of depression1 2A and mania3 4 can be seen during pregnancy. The presentation is generally the same as with nonpregnant women. A common rating scale for depression5 6A (TABLE EPDS) used during and following pregnancy does not ask about poor energy, low sex drive, weight or appetite change since they are often seen in a normal pregnancy as well as depression.


1. I have been able to laugh and see the funny side of things   As much as I always could   Not quite so much now   Definitely not so much now   Not at all
2. I have looked forward with enjoyment to things   As much as I ever did   Rather less than I used to   Definitely less than I used to   Hardly at all
3. *I have blamed myself unnecessarily when things went wrong   Yes, most of the time   Yes, some of the time   Not very often   No, never
4. I have been anxious or worried for no good reason   No, not at all   Hardly ever   Yes, sometimes   Yes, very often
5. *I have felt scared or panicky for not very good reason   Yes, quite a lot   Yes, sometimes   No, not much   No, not at all
6. *Things have been getting on top of me   Yes, most of the time I haven't been able to cope at all   Yes, sometimes I haven't been coping as well as usual   No, most of the time I have coped quite well   No, I have been coping as well as ever
7. *I have been so unhappy that I have had difficulty sleeping   Yes, most of the time   Yes, sometimes   Not very often   No, not at all
8. *I have felt sad or miserable   Yes, most of the time   Yes, quite often   Not very often   No, not at all
9. *I have been so unhappy that I have been crying   Yes, most of the time   Yes, quite often   Only occasionally   No, never
10. *The thought of harming myself has occurred to me   Yes, quite often   Sometimes   Hardly ever   Never

TABLE EPDS. Edinburgh Postnatal Depression Scale (EPDS)6B


Q: Why is the recognition of pregnancy-related mood disorders particularly important?

A: It is always important to identify depressive illness but there are additional compelling reasons for obstetric, primary care and psychiatric professionals to be vigilant to the possibility of mood disorders in pregnant women:
•   Depression during pregnancy can cause complications including preeclampsia,7 preterm delivery8 and low birth weight.9 It has also been found to result in delayed language and intellectual development of toddlers.10
•   Depression during pregnancy also increases the risk of depression following pregnancy.2B

B3b. Facts