Q:  Pregnancy: Help with Sleep & Calming Anxieties

Dear Doctor,
I have been dignosed for 18 years with bipolar disorder. Have been pretty successful in treating my symptoms. I recently however, went off all my medications as I'm trying to get pregnant. I still am suffering from withdrawl symptoms, mostly from XANAX which I had been using for sleep for several years. I am desperate in an attempt to manage my symptoms.  Not doing very well since I am not sleeping at all, and am on the verge of slipping into a manic episode. What can I safely take during my pregnancy to 1) help sleep, and 2)calm my anxieties ? Please help, I am desperate,
Julee


Dear Julee -- 

Sorry to say that at this point bipolar disorder during pregnancy is generally managed without any medications at all, if at all possible. That is because, as you probably have discovered, nearly all the medications that can be used have some potential risk to a developing fetus. For some, the risk is greatest during the first trimester, and sometimes these are restarted later in pregnancy. Then comes another complex phase at delivery, and then another shortly after, trying to prevent postpartum depression.

Management of symptoms through all these stages requires quite direct involvement with a psychiatrist who knows her or his stuff. If you are not confident that your current doctor meets this description, you might want to look for a second opinion (either quickly, or perhaps even better, after putting your plans for pregnancy on hold until you have a management plan for bipolar disorder through the pregnancy, and beyond, worked out with the doctor whom you trust).

Your comment that you are "desperate" is very concerning. Make sure your current doctor knows about this. I hope that she or he can help you formulate a plan. Good luck with that--

Dr. Phelps



Published March, 2007