%0 Journal Article
%T Treatment Choices in Women with Bipolar Disorder Seeking Pregnancy: A Clinical Case Illustration
%A Corrado Barbui
%A Andrea Bertolazzi
%A Batul Hanife
%A Andrea Cipriani
%J Case Reports in Psychiatry
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/630732
%X After ten years of successful maintenance treatment with lithium and olanzapine, a 40-year-old woman with bipolar disorder expressed concerns about continuing the use of medicines, as she was planning a pregnancy. In the past, she had suffered from five severe manic episodes with hospital admissions. After consultations with the treating psychiatrist, gynaecologist, and family doctor, olanzapine was stopped and lithium was gradually withdrawn. After few months, the patient, still in treatment with lithium 300£¿mg/die, experienced a new manic episode with hospital admission. Treatment with lithium and olanzapine was restored, and she progressively recovered. This case suggests that the risk of manic recurrence after ten years of maintenance treatment may be as high as the well-known risk of recurrence after few years of maintenance treatment, a consideration that doctors may find useful in the light of a complete absence of evidence on treatment choices after five years of successful maintenance treatment. 1. Introduction This case highlights concerns around treatment choices in women with bipolar disorder seeking pregnancy [1]. While there is evidence that maintenance pharmacological treatment decreases the risk of recurrence, continuing treatment in women actively seeking a pregnancy bears a potential teratogenic risk for the foetus and is also associated with adverse effects. These concerns are particularly challenging in women who have been stable on maintenance treatment without manic or depressive episodes for several years, as after five years it becomes less clear if treatment continues to exert a protective effect [2]. Another challenge is that maintenance treatment with lithium may be particularly problematic to discontinue, with high rates of recurrence upon discontinuation [3]. 2. Case Presentation In March 2012, a 40-year-old woman with a long history of bipolar disorder discussed with the treating psychiatrist the possibility of planning a pregnancy. The patient had been free of manic episodes for ten years. She was on maintenance treatment with lithium 1,200£¿mg/die and olanzapine 2.5£¿mg/die and was worried about the potential teratogenic effects of lithium as well as the potential adverse effects of olanzapine during pregnancy. In the past, she had suffered from five severe manic episodes that had always led to hospital admission (Figure 1). Each episode was characterised by persistent elevation of mood, increased energy and activity, psychomotor agitation, aggressiveness, a decreased need for sleep, marked distractibility, and flight of
%U http://www.hindawi.com/journals/crips/2013/630732/