Pregnant Women Face Special Issues in Treatment for Bipolar Disorder

If you’re a woman with bipolar disorder who is pregnant or who plans to have children, you’re probably concerned about the effects pharmaceutical treatment for bipolar disorder can have on your unborn baby. While recent research has shown that the risk of birth defects among pregnant women taking bipolar medication is much smaller than previously thought, you may nevertheless wonder if it’s best to discontinue pharmaceutical treatment for bipolar disorder during your pregnancy for the good of your child.

The symptoms of bipolar disorder vary in severity from one person to the next, and there’s no one answer for a woman wondering how to manage pregnancy and bipolar disorder. However, while discontinuing your medication may eliminate the risk of medication-related birth defects, it will significantly raise your risk of experiencing a bipolar relapse. Your mental illness could have developmental ramifications for your baby both before and after birth.

Bipolar Medication and Birth Defect Risk

In the past, medications like lithium, which are used for the treatment of bipolar disorder, were believed to cause life-threatening or disabling birth defects in a large percentage of babies born to bipolar mothers – in the 1970s, lithium was believed to cause birth defects in 1 in 50 babies born to mothers taking the medication. Newer research has discovered that the risk is more like 1 in 1,000 to 2,000. Other medications administered as treatment for bipolar disorder are considered even more dangerous for developing babies than lithium, like valproic acid, carbemazepine and lamotrigine, which can cause spina bifida, cleft palate and other birth defects. Because of the smaller risk of birth defects with lithium, doctors recommend women with bipolar disorder who want to get pregnant switch to lithium before conceiving.

Risks of Discontinuing Pharmaceutical Treatment for Bipolar Disorder

Though the risk of birth defects for pregnant women taking lithium is small, it’s still too much risk for many pregnant women managing bipolar disorder. However, a pregnant woman with bipolar disorder is almost certain to experience a relapse of bipolar symptoms if she discontinues her medication during pregnancy – relapse rates among bipolar women who stop taking their medication during pregnancy can be as high as 70 percent. Pregnancy is a high-stress time; the anxiety and sleep disruptions associated with carrying a child and giving birth can easily trigger a bipolar relapse.

The prospect of a bipolar relapse during pregnancy threatens the well-being and even the life of both mother and child. Women who discontinue pharmaceutical treatment for bipolar disorder during pregnancy spend an average of 40 percent of their pregnancies experiencing illness symptoms. A woman who is experiencing a depressive episode is less likely to practice the good self-care necessary for the unborn baby’s health and development. Such a mother-to-be is even vulnerable to suicide. Women who discontinue treatment for bipolar disorder during pregnancy are also 100 times more likely than women without bipolar disorder to experience postpartum psychosis, which can even lead to infanticide.

Managing Pregnancy and Bipolar Disorder

While many women with bipolar disorder choose to stop taking their medications before conception or after they discover they’re pregnant, psychiatrists don’t recommend this, especially for women with severe psychiatric symptoms. If you stop taking your bipolar medications during pregnancy and experience a severe recurrence of symptoms, you may need to take even higher doses of medication to bring your symptoms back under control. And the higher your dosages, the higher your risk of birth defects.

Lithium has the fewest risks for pregnant mothers and babies, though it’s important to make sure you drink plenty of water to avoid lithium toxicity. Your doctor will want to monitor your blood carefully for high lithium levels, especially during and right after your delivery. Your baby’s blood will also need to be tested for high lithium levels. If you choose to breastfeed, lithium is secreted in milk; your baby’s blood will need to be monitored for high lithium levels if you choose to breastfeed after birth. Your doctor may also recommend a first-generation or second-generation antipsychotic medication, which is not believed to cause birth defects, or receive ECT treatment for bipolar disorder during pregnancy.

If you are taking valproic acid or carbemazepine, you should switch to a safer medication before you conceive. If you find out you’re pregnant while still taking valproic acid, you may want to break down your single daily dose into several daily doses to reduce the risk of side effects. Your doctor may also recommend a vitamin K supplement.

Managing bipolar disorder and pregnancy is challenging, but not impossible. If you have questions about receiving bipolar disorder treatment while pregnant, call 888-415-0708 to set up an appointment with our psychiatrist.

The Two Most Common Anxiety Disorders

When you’re too anxious, it’s a problem. Anxiety disorders are the most common mental illnesses Americans suffer, and they can make it hard to get through day-to-day life. The constant stress can even cause physical problems over time. The two most common anxiety disorders are specific phobias and social anxiety disorder. Other common anxiety disorders include generalized anxiety disorder, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder.

To some extent, anxiety is normal. Everyone gets a little anxious in reaction to stress and difficult life events. Anxiety can even be helpful – it can help you recognize a dangerous situation and give you the adrenaline boost necessary to react accordingly. When you’re facing a stressful situation or a big decision, a little anxiety can give you the extra mental boost you need to make the best choices.

Prevalence of Anxiety Disorders

More than 18 percent of American adults have an anxiety disorder, and more than 22 percent of those cases – a total of 4.1 percent of the entire adult population – have symptoms that are classified as “severe.” Women are more likely than men to experience an anxiety disorder some time during their life; the average age of onset for anxiety disorders is 11 years old.

Most Common Anxiety Disorders

Specific phobias, like claustrophobia or arachnophobia, are the most common anxiety disorders. They affect 19 million Americans, or 8.7 percent of the population. Most people develop phobias during childhood; the average age of onset is seven. Women are twice as likely as men to suffer from a phobia.

Common phobias include fear of spiders, snakes, heights, closed spaces, storms, needles, public speaking, flying, germs and illness or death. Phobia treatment includes exposure therapy, relaxation techniques and changing negative thoughts or beliefs related to your fear.

Social anxiety disorder, which is also sometimes called social phobia, is another of the most common anxiety disorders. It affects 15 million Americans, or 6.8 percent of the population. The average age of onset of social anxiety disorder is 13, and it affects both women and men at equal rates. Thirty-six percent of people who suffer from social anxiety disorder struggle with their symptoms for more than 10 years before seeking help.

People with social anxiety disorder fear that others are watching or judging them. The disorder can make it hard to attend social events, go to work, attend school or otherwise live a normal life. People with this anxiety disorder have trouble making and keeping friends, forming romantic attachments, getting jobs, finishing school or even performing the tasks of daily living. Treatment for social phobia involves challenging negative thoughts in therapy, learning breathing exercises and confronting your fears.

Less Common Anxiety Disorders

Other anxiety disorders occur less frequently, but are no less debilitating for the people who suffer from them. Post-traumatic stress disorder, for example, affects 7.7 million Americans, or 3.5 percent of the population. It can involve flashbacks, nightmares, and intrusive memories of traumatic events – anyone who has experienced a natural disaster, terrorist attack, the sudden death of a loved one, sexual or violent assault, war, an accident, or any other life-threatening event is at risk of developing PTSD. Sixty-seven percent of people who have experienced mass violence develop PTSD; 45.9 percent of women and 65 percent of men who are raped develop PTSD.

Women develop PTSD twice as often as men, and children can develop it too. It can cause relationship problems, since it leaves sufferers unable to trust or share intimacy, communicate, or solve problems. The way that loved ones react to a trauma survivor’s PTSD symptoms can affect his or her condition, making the symptoms worse or helping to alleviate them.

Generalized anxiety disorder, or GAD, is another of the more common anxiety disorders. It affects 6.8 million adults or 3.1 percent of the U.S. population, with women more than twice as likely as men to develop symptoms. GAD is characterized by excessive worry about ordinary things, for no reason. They may worry about their health, money, work, family or other things, when there is no obvious cause for concern. Symptoms can be so severe that they affect a person’s ability to function normally.

Panic disorder affects 6 million Americans, or 2.7 percent of the population. It is characterized by panic attacks and is often accompanied by major depression or agoraphobia. The least common anxiety disorder, obsessive-compulsive disorder or OCD, affects 2.2 million Americans, or one percent of the population. It is characterized by intrusive, disturbing, unwanted thoughts, and compulsive behaviors, including counting, checking, and cleaning behaviors. These behaviors can take up so much of the sufferer’s time that he or she might have little to no time left for normal routines and functioning.

You don’t have to continue struggling with anxiety. Call our Delray Beach psychiatrist today at 888-415-0708 and learn how we can help you overcome anxiety.

Addiction Psychiatry Endorses Medications for Alcoholism

Alcoholism treatment usually consists of support group meetings and intensive psychotherapy, often under the aegis of an inpatient facility. But experts in the field of addiction psychiatry feel that psychiatric medications are underused in the treatment of alcoholism. Two drugs, in particular, have been found to be effective for the treatment of alcoholism – acamprosate and naltrexone. According to new research from the field of addiction psychiatry, these drugs are extremely effective in the treatment of alcoholism – more effective than some medications used to treat other conditions, like high cholesterol. Yet they will never be prescribed to most alcoholics.

Medication Promotes Alcohol Abstinence

According to a paper published last month in JAMA, the anti-alcoholism drugs acamprosate and naltrexone are effective at reducing cravings for alcohol in people suffering from alcoholism. Researchers from the University of North Carolina at Chapel Hill conducted a systematic review of all the evidence available for the use of these medications, including 122 randomized controlled trials and one cohort study involving a total of 23,000 people.

In order to evaluate the effectiveness of the medications, the researchers examined a measure of effectiveness known as the “number needed to treat,” which tells researchers how many people need to take a pill before one of them will be helped to reduce or refrain from drinking. The study found that, to keep one person from relapsing into full-blown alcoholism, 12 people need to take acamprosate; 20 people need to take naltrexone to help one.

Effectiveness studies of other widely used medications, like statins, which are used to treat high cholesterol, have found that acamprosate and naltrexone are astoundingly effective in treating alcoholism. By comparison, studies of the effectiveness of statins have found that anywhere from 25 to over 100 people need to take a pill in order to avoid one cardiac event.

Restoring Balance in the Brain

The medications work by interacting with neurotransmitters, the brain chemicals responsible for moods and feelings in general. Chronic, heavy alcohol abuse causes imbalances among the brain’s neurotransmitters, leading to alcohol cravings; acamprosate restores the normal balance.

Naltrexone works to reduce alcohol consumption in a different way. Many alcoholics experience a feeling of euphoria when they drink, brought on by the stimulation of the brain’s opioid receptors. Naltrexone blocks the opioid receptors, preventing the familiar feeling of euphoria that drives such alcoholics to take their next drink and their next. According to experts in addiction psychiatry, naltrexone removes the motivation to drink and can make alcoholics more receptive to treatment, including 12-Step meetings and psychotherapy.

Neither medication should be considered a magic bullet, but they can be very helpful in treatment even recalcitrant alcoholism.

Addiction psychiatry expert Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, says the study proves that these medications can help many. “This is an important paper,” Dr. Koob told the New York Times. “There are effective medications for the treatment of alcoholism, and it would be great if the world would use them.”

Medications Could Help Fill the Treatment Gap in Addiction Psychiatry

Addiction psychiatry experts agree that many alcoholics struggle to cross an enormous treatment gap. Less than one-third of alcoholics receive any treatment at all, while less than 10 percent are given medication. Alcoholism and alcohol abuse kill 88,000 Americans per year.

Prescribing medication like acamprosate and naltrexone could help many Americans struggling with alcoholism to resist cravings and maintain abstinence, or at the very least, to drink much less. Since many Americans still don’t have access to inpatient rehab services or even outpatient addiction psychiatry services, they must rely on support groups like Alcoholics Anonymous and may not receive any professional care at all. If more primary care doctors felt comfortable prescribing these medications to people who want to quit or cut down on their drinking, the lack of access to addiction psychiatry services may have less of an impact on Americans who drink alcoholically.

But, if they’re so effective, why aren’t these medications prescribed more often? Perhaps it’s because many people, including alcoholics themselves and many medical professionals, still believe that addiction is, at its root, a character flaw, and that overcoming it should be a matter of sheer willpower alone. It may also have something to do with the fact that, despite its effectiveness, researchers still don’t fully understand how at least one of these drugs, acamprosate, works.

If you’re struggling with alcoholism, there’s a way out. Call our addiction psychiatrist today at 888-415-0708 to learn more.