THE USE OF LITHIUM AND MANAGEMENT OF WOMEN WITH BIPOLAR DISORDER DURING PREGNANCY AND LACTATION

The introduction of lithium salts almost a century ago and the subsequ ent approval of lithium carbonate for the treatment of patients with b ipolar disorder represent one of the cornerstones of modern psychophar macology. The onset of bipolar disorder in women often occurs during t he childbearing years, which complicates the treatment decisions secon dary to the possibility of conception while taking medication. The est ablishment of the lithium registry for fetal teratogenesis in the late 1960s ushered in a heightened level of concern for the use of lithium during the reproductive years; although, in the years to come, it has become apparent that alternative pharmacologic treatments for bipolar disorder may exceed the teratogenic risk of lithium monotherapy. In t his paper, the available data on the use of antimanic medications duri ng pregnancy and lactation are reviewed with an emphasis on providing a realistic risk/benefit assessment for medication selection and manag ement of these patients. Treatment strategies are discussed for (1) wo men who are contemplating pregnancy (2) women who inadvertently concei ve while taking medications (3) women who choose to become pregnant wh ile taking medication, and (4) women who intend to breastfeed while ta king medications.