Lithium Exposure During Pregnancy And The Postpartum Period Essay

Response to Discussion

Hello,

I greatly appreciate the work you did in your discussion on treating bipolar disorder in pregnant women. Going through it, I was able to learn about three options that can be safely used to manage bipolar disorder in pregnant women. This includes either using an FDA-approved drug (Lithium), off-label medication (Lamotrigine), or a nonpharmacological intervention (CBT and Interpersonal and Social Rhythm Therapy). Throughout the discussion, my attention was caught by the use of lithium. Lithium Exposure During Pregnancy And The Postpartum Period Essay

Among the most challenging clinical tasks is treating bipolar disorder in pregnant women. Every step of the way challenges patients and physicians, and no strategy is risk-free. Restarting efficacious medication throughout pregnancy exposes the patient and fetus to possible risks associated with bipolar relapses and dysfunction related to lingering mood symptoms (Sharma et al., 2020). For many, these events can be avoided by continuing effective medication during pregnancy; nonetheless, congenital abnormalities or other unfavorable neonatal outcomes have been linked to some of the most successful medications (such as valproate) (Sharma et al., 2020). Thus, the choice of lithium as the safest medication was excellent. Lithium Exposure During Pregnancy And The Postpartum Period Essay

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Considerably, when taken as directed, lithium has been demonstrated to be the most effective preventive option for the treatment of bipolar disorder (and other psychiatric disorders such as schizoaffective disorder and recurrent major depression), even in the perinatal period. Its side effect profile is also more favorable than is commonly believed. Additionally, the FDA in the United States issued a warning regarding the use of antipsychotics during the peripartum period. The risk of carbamazepine syndrome and fetal valproate (as well as the drug’s proven neurodevelopmental teratogenicity) makes it inappropriate to use these medications during this stage of the female reproductive cycle (Fornaro et al., 2020).

The majority of the information about drugs other than lithium is anecdotal or out-of-date, which further complicates the clinical decision. Although some guidelines, like the National Institute for Health and Care Excellence guidelines, specify that taking lithium is not advised, particularly in the first trimester of pregnancy, it is important to note that “evidence-based” guidelines may not align with “consensus-based” guidelines, which must consider the evidence regarding safety and efficacy (Fornaro wet al., 2020). Lithium Exposure During Pregnancy And The Postpartum Period Essay

References

Fornaro, M., Maritan, E., Ferranti, R., Zaninotto, L., Miola, A., Anastasia, A., … & Solmi, M. (2020). Lithium exposure during pregnancy and the postpartum period: a systematic review and meta-analysis of safety and efficacy outcomes. American Journal of Psychiatry, 177(1), 76-92. https://doi.org/10.1176/appi.ajp.2019.19030228

Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert review of neurotherapeutics, 20(4), 373-383. https://doi.org/10.1080/14737175.2020.1743684 Lithium Exposure During Pregnancy And The Postpartum Period Essay