Antipsychotic Medications and Cognitive Behavior Therapy in Pregnant Women with Bipolar Disorder

Abstract

One of the most difficult clinical tasks is treating pregnant women with bipolar disorder. Decisions that patients and physicians make are challenging, and no strategy is without risks nor prevents potential malpractice litigation. There is debate about whether to continue or discontinue antipsychotic medications during pregnancy. While discontinuation of antipsychotics may increase the risk of relapse, continued use of these medications may lead to fetal and maternal adverse outcomes. Some antipsychotics effectively treat symptoms related to bipolar disorder, including manic episodes and mood swings between mania and depression. Though antipsychotics may be useful for the treatment and management of bipolar disorder, the medications are not always favorable and are associated with adverse effects which have influenced some medical professionals to practice defensive medicine for decades that, in some cases, may coincide or conflict with medical ethics. While antipsychotics have a less safe yet effective impact on bipolar disorder in pregnant women, an alternative therapeutic approach such as Cognitive Behavior Therapy (CBT) should be considered. CBT psychotherapy is an evidence-based practice approach that can be beneficial in the treatment of bipolar disorder in pregnant women while bypassing the associated adverse reactions of antipsychotics. Attention is needed to explore the use and associated risks and benefits of antipsychotic medications during prenatal and postnatal, the debate of whether to continue or discontinue antipsychotic medication during pregnancy, and the role of CBT in the treatment of pregnant women with bipolar disorder. While antipsychotics may have beneficial effects that should not be underscored, the risks associated with the usage of antipsychotics during pregnancy cannot be minimized.