While no drug-drug interactions with OC have been reported to date with valproate,

lithium, or the atypical antipsychotics, further study is required in women with bipolar disorder. In summary, there is no systematic controlled data to demonstrate that certain treatments or more effective for men and women. Instead, providers should carefully weigh potential side effects and interactions associated with treatments, and the importance of those risks for individual women. Treatment of bipolar disorder during pregnancy and postpartum Medication use during pregnancy We strongly recommend that clinicians Inhibitors,research,lifescience,medical discuss plans for conception with all women with bipolar disorders who arc of childbearing potential. Recent work suggests that when women with bipolar disorder are provided accurate and balanced information about the potential risks and benefits they face, 37% choose not to pursue pregnancy.50 Prenatal counseling should include discussion of possible risks Inhibitors,research,lifescience,medical of taking medications during pregnancy, risks to the patient, and child of escalating or uncontrolled symptoms of bipolar disorder, and the risk of genetic transmission of bipolar disorder to the child.14 In bipolar women who are pregnant,

the use of medications must, be assessed in terms of adverse fetal or neonatal effects, in addition to the usual concerns for effectiveness, tolcrability, and safety Inhibitors,research,lifescience,medical for the mother. Before pregnancy begins, the patient, family, and clinician should detailed a plan of potential JNJ-26481585 mw interventions in case of recurrences or exacerbations of mood episodes. For example, deciding if electroconvulsive Inhibitors,research,lifescience,medical therapy, which is relatively safe in pregnancy, would be the first choice if a severe depressive episode occurred. One of the most difficult problems for women with bipolar disorder is the lack of effective nontcratogenic treatments. First-trimester exposure to the traditional Inhibitors,research,lifescience,medical mood stabilizers (lithium, valproate, and carbamazepine) is

associated with an increased risk of fetal malformations.51-53 Given this risk, many women with bipolar disorder choose to discontinue medications during pregnancy and sometimes, while trying to conceive. When this is done abruptly, women are at increased risk for relapse. Viguera et al21 reported recurrence rates following lithium discontinuation in a cohort, of 101 through pregnant and nonpregnant women. Over the 64-week period following lithium discontinuation, recurrences occurred in 85.7% of the prcgnant/postpartum women and 67.8% of the nonpregnant women. Recurrence rates were less when lithium was discontinued via a gradual taper (15 to 30 days). In some cases, it is preferable to continue the medication while carefully monitoring fetal development with high-resolution ultrasound. Once the high risk associated with first-trimester exposure to certain medications has passed, many women who had discontinued medication then consider restarting pharmacotherapy.