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The Buzz: Access to Pharmacotherapy Amongst Women With Bipolar Disorder During Pregnancy

Written by Michael Guerrero-Calderon


Access to Psychopharmacology (w/ a Focus on Women Facing Bipolar Disorder)


What is Bipolar Disorder?

Bipolar Disorder is a mental disorder that causes unusual changes in mood, energy, activity levels, concentration, and the ability to carry out daily activities.


What are the types of Bipolar Disorder?

Type 1:

Can last at least 7 days and symptoms can become so severe emergency medical care may be required. Depressive episodes can last for 2 weeks or more

Type 2:

Similar to type 1 but are not as severe, and depression episodes come in short patterns of time.

Unspecified:

Symptoms do not match either type 1 or type 2, but it can also mean the person is at-risk of developing Bipolar Disorder.




Types of Medications for Bipolar Disorder & Their Risks During and After Pregnancy:

Antipsychotics:

Can cause withdrawal symptoms in neonates, abnormal muscle movement, gestational diabetes


Mood Stabilizers:

Negative neurodevelopmental effects, neonatal toxicity and adaptation syndromes


Anticonvulsants:

Brain and spinal cord abnormalities, oral cleft malformation, stillbirth


Barriers for Pregnant Women Receiving These Medications:

Some psychiatric providers stop providing these medications for pregnant women with bipolar disorder because they believe these risks outweighed the mother’s mental health. Other psychiatric providers did not have the needed training to know how to manage a pregnant woman’s mental health while she was pregnant. And pregnant women in need of psychiatric services had difficulty in being able to schedule such services due to delays in getting an appointment.



The Problem?

Stopping bipolar medications for pregnant women has been shown to cause an increase in psychiatric vulnerabilities, which increases the risk of complications during birth or infancy. Many have called this a “double vulnerability” because not only does the mother now have to worry about having a severe bipolar episode, but also must worry about ensuring the safety of her baby before and after birth. This problem becomes more significant since bipolar disorder has been shown amongst 23% of perinatal women, meaning this vulnerability can become common if psychiatric providers do not reconsider their stance so that pregnant women can manage their psychiatric conditions.


"My psychiatrist told me he doesn't give medications to pregnant women and I have to stop the medication. He just told me that once I got pregnant I need to stop immediately and not realizing that I've been with my medication for over three years... he just said there is a line you can call to see what medications are safe during pregnancy (Byatt, 2018)."


The Solution?

Since many regions of the US and around the world have lacked in perinatal-psychiatric training for these specialized doctors, major reform is needed in this area of care. Offering advanced courses for psychiatrists during their education programs or creating a residency program for psychiatrists are some of the many ways such training can be implemented for them to be able to manage a pregnant woman’s bipolar disorder and their needed medications to avoid any risks. Emphasizing the fact that the risks of stopping medications outweigh the risks of bipolar medications during pregnancy is also needed for current practicing psychiatrists.This will then lead to less women possibly suffering from a severe bipolar episode and lessen their risk of complications during birth and infancy.


"I don't like being what I'm on, but I think the outcome of being happy and not depressed and being able to take care of my 3-year old overpowers the downfall, the slight chance of risk of something being wrong with the baby (Byatt, 2018)."



Considerations: Women who are pregnant and also receiving psychopharmacological treatment should speak with their doctors about the best plan for them and their child. Before making any changes to your treatment plan check in with your OBGYN and Psychiatrist.

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