Bipolar moms-to-be who stop meds risk relapse

NEW YORK (Reuters Health) - Women with bipolar disorder who discontinue treatment with mood stabilizers during pregnancy are at increased risk of recurrent mood episodes, results of a study suggest.

Bipolar disorder is a mental illness marked by severe mood swings from depression to mania. In adults, the depression may manifest as persistent sadness, sleep problems or suicidal thoughts, while mania symptoms include unusual energy, euphoria and greatly inflated self-esteem.

Currently, it's common practice to stop ongoing mood stabilizing drug treatment during pregnancy in order to avoid potential harmful effects of these agents on the developing fetus, Dr. Adele C. Viguera and associates note in the American Journal of Psychiatry.

To examine the effect of this practice, Viguera, currently at the Cleveland Clinic in Ohio, and associates recruited 89 women with bipolar disorder, but without symptoms, at conception. Sixty-two discontinued drug therapy within the period between 6 months before conception and 12 weeks after conception.

There were 89 recurrences of mood episodes during pregnancy among 63 patients. At least one episode occurred in 85 percent of women who discontinued treatment versus only 37 percent of those who stayed on treatment.

"Among women who discontinued versus continued mood stabilizer treatment, recurrence risk was twofold greater, median time to first recurrence was more than fourfold shorter, and the proportion of weeks ill during pregnancy was five times greater," Viguera and her colleagues write.

They conclude: "For women with severe and frequent recurrences of bipolar disorder, maintenance treatment with a mood stabilizer during pregnancy may be the most prudent strategy, much as maintenance treatment is recommended for pregnant women with other serious and chronic medical conditions, such as epilepsy."

SOURCE: American Journal of Psychiatry, December 2007.