What is the best treatment option for a patient with bipolar disorder, who stopped her medication at the start of pregnancy and is now at the end of 2nd trimester?

This is a great question. Restarting medication would be a top priority, as we know that 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 that discontinuation of medications increases the risk of relapse during p...

The goal is to obtain a stable mood condition. The choices will depend on her clinical condition. Stable bipolar disorder can continue counseling/psychotherapy as only therapy. If her mood disorder is deteriorating to the point of functioning impairment despite psychotherapy, then psychopharmacother...

This is important and requires educating the patient, family, and yourself continuously. Lithium was dangerous in the 20th Century. The mood-stabilizing anticonvulsants are still dangerous. The second generation antipsychotics can be helpful, particularly lamotrigine with depressive symptoms.

I’ve m...

Depakote if she plans to breastfeed. It is safe in the third trimester.