Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: Focus on emerging mood stabilizers

Department of Mental Health ASL Salerno 1, Operative Unit District n 4, Salerno, Italy.
Bipolar Disorders (Impact Factor: 4.97). 07/2006; 8(3):207-20. DOI: 10.1111/j.1399-5618.2006.00295.x
Source: PubMed


Bipolar disorders are reported to have a high incidence during childbearing years and the need may arise to start or continue a pharmacological treatment during pregnancy and the postpartum period. In the last few years several investigations have evaluated the efficacy of emerging mood-stabilizing agents in the treatment of bipolar disorders, such as lamotrigine, olanzapine, risperidone, quetiapine, aripiprazole and ziprasidone. A number of studies, which examined the use of oxcarbazepine, point to its potential usefulness in prophylactic treatment. The aim of this review is to compare information from the literature on the safety of lamotrigine, oxcarbazepine, risperidone, olanzapine, and quetiapine to the safety data on classic mood stabilizers during pregnancy and the postpartum period.
A computerized search carried out from 1980 to April 5, 2006 led to the summarization of the results. (References were updated after acceptance and prior to publication.)
Emerging mood stabilizers show uncertain safety parameters in pregnancy and lactation. Limited information on lamotrigine and oxcarbazepine does not suggest a clear increase in teratogenicity, while olanzapine appears to be associated with a higher risk of metabolic complications in pregnant women. Data about risperidone and quetiapine are still inconclusive. Finally, the literature on the safety of these compounds in breastfeeding is anecdotal.
Untreated pregnant bipolar women are at an increased risk of poor obstetrical outcomes and relapse of affective symptoms. On the other hand, classic antiepileptic drugs are well-known human teratogens, whereas data on lithium are partially ambiguous. The safety of emerging mood stabilizers in pregnancy and breastfeeding has not been examined extensively. Therefore, when approaching bipolar disorder, if possible, each episode must be considered separately.

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Available from: Salvatore Gentile, Mar 19, 2014
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    • "Early studies reported that the administration of Li causes cardiovascular anomalies, such as Ebstein's anomaly , which is characterized by dislocation of the tricuspid valve to the right ventricle and various degrees of right ventricle hypoplasia at a rate 400-fold higher than in the general population (Schou et al. 1973). In particular , the development of Ebstein's anomaly increases with the administration of Li during the 2nd and 6th weeks of gestation (Gentile 2006a). Recent studies report that following the use of Li prevalence rates are 0.05%-0.1% and the risk for Ebstein's anomaly is 20-40-fold higher than in the general population: these rates are relatively low compared to earlier studies (Jacobson et al. 1992, Cohenet et al. 1994). "
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    • "Medications such as those taken for depression, anxiety or mood stabilization can interact with antipsychotics, as can treatments for medical disorders such as asthma and hypertension (Seeman 2004). Gentile (2006a) identifies a variety of prescribed medications and illicit drugs which are commonly taken by pregnant women. The use of analgesics and contraceptives are also common in women and must be considered, along with the possible side effects and interactions that could occur. "
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