How do you counsel patients about the risks and benefits of mood stabilizers (e.g., lithium, lamotrigine) during pregnancy?

Great question! The risk of relapse for bipolar disorder mood episodes in women is at least as common during pregnancy as in the non-pregnant state, and discontinuation of medications increases the risk of relapse during pregnancy and postpartum. The majority of women who stop mood stabilizers for pregnancy do experience relapses in mood episodes. Among women who discontinue versus continue mood stabilizer treatment, recurrence risk has been noted to be twofold greater, with recurrence occurring sooner, and more time overall ill.

As such, I strongly recommend that patients continue treatment during pregnancy. It is important to ensure that the patient is on a regimen that targets bipolar depression and mania. Potential regimens could includ...