Pregnancy mood stabilizers

Amisulpride may be preferable to anticonvulsant mood stabilizers if treatment is required during pregnancy... 

For bipolar patients, given the risk ot relapse in the postpartum period, mood stabilizer treatment, especially with agents with better evidence of efficacy than gabapentin, should generally be restarted immediately after delivery if patient is unmedicated during pregnancy... 

Antianxiety Agents Mood-Stabilizing Drugs Psychotherapeutic Drugs and Pregnancy Summary... 

Approaches for treating bipolar disorder in special populations (e.g., comorbid medical or psychiatric disorders, pregnancy, or breastfeeding) are found in Table 68-9. Patients with comorbid medical conditions or concomitant substance abuse, those over 65 years of age, and pregnant patients may require different treatment approaches. Approximately 20% to 50% of women with bipolar disorder relapse postpartum therefore prophylaxis with mood stabilizers is recommended immediately postpartum to decrease the risk of relapse. ... 

Bipolar disorder has a lifetime prevalence of approximately 1%. During pregnancy, untreated bipolar disorder may result in hospitalization, suicidal ideation, violence, loss of employment, malnutrition, and an increased risk of postpartum psychosis. It does not appear that pregnancy provides protection for the risk of recurrence of symptoms. Women who discontinue the use of mood stabilizing drugs abruptly before conception or who have had four or more episodes of recurrence of symptoms have a substantial risk for recurrence during pregnancy. Risk for recurrence in the first 3 to 6 months postpartum has been estimated at 20% up to 80%. Postpartum psychosis may occur in 10% to 20% of women with bipolar disorder. 

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