How do you titrate lithium for patients with bipolar affective disorder during pregnancy and immediately after delivery in the context of fluid shifts and changing levels?

Great question!

Lithium clearance increases during pregnancy, and some women may require a dose increase to maintain therapeutic benefits. It is not my practice to prophylactically increase the dose during pregnancy, but I do recommend monitoring labs (lithium level, BUN and creatinine, and TSH) ea...

I agree with the above. Usually, at therapeutic doses, patients will have a slight tremor. When patients are destabilized and entering a cycle the tremor disappears due to lithium being transported to the intracellular space and there is a drop in level. Some old-school mood disorder specialists “ti...