Antipsychotic Medications and Cognitive Behavior Therapy in Pregnant Women with Bipolar Disorder
Asian Journal of Biochemistry, Genetics and Molecular Biology, Volume 12, Issue 4,
Page 42-59
DOI:
10.9734/ajbgmb/2022/v12i4270
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.
- Bipolar disorder
- antipsychotic medication
- pregnant women
- cognitive behavior therapy
- defensive medicine
- medical ethics
- teratogenic
How to Cite
References
Altshuler L, Cohen L, Szuba M, Burt V, Gitlin M, Mintz J. Pharmacological management of psychiatric illness during pregnancy: Dilemmas and guidelines. The American Journal of Psychiatry. 1996;153: 592–606.
Andaroon N, Kordi M, Kimiaee S, Esmaily H. Effect of an individual counseling program by a midwife on anxiety during pregnancy in nulliparous women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;20:86–95.
Babu G, Desai G, Tippeswam H, Chandra P. Birth weight and use of olanzapine in pregnancy: A prospective comparative study. Journal of Clinical Psychophar-macology. 2010;30:331–332.
Bailey R, Adams J, Unger D. Atypical antipsychotics: A case study in era risk management. Journal of Psychiatric Practice. 2006;12(4):253-258.
Baldessarini R, Tondo L, Vázquez G. Pharmacological treatment of the adult bipolar disorder. Molecular Psychiatry. 2019;24(2):198-217.
Belmaker R. Bipolar disorder. The New England Journal of Medicine. 2004;351: 476–486.
Betcher H, Monitel C, Clark C. Use of antipsychotic drugs during pregnancy. Current Treatment Options in Psychiatry. 2019;6(1):17-31.
Bodén R, Lundgren M, Brandt L, Reutfors J, Kieler H. Antipsychotics during pregnancy: Relation to fetal and maternal metabolic effects. Archives of General Psychiatry. 2012;69:715–721.
Briggs G, Freeman R, Yaffe S. Drugs in pregnancy and lactation: Reference guide to fetal and neonatal risk: Lippincott Williams & Wilkins; 2012.
Carlborg A, Ferntoft L, Thuresson M, Bodegard J. A population study of disease burden, management and treatment of bipolar disorder in Sweden: a retrospective observational registry study. Bipolar Disorder. 2015;17(1):76-85.
Chand S, Kuckel D, Huecker M. Cognitive behavior therapy. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.
Chiang K, Tsai J, Liu D, Lin C, Chiu H, Chou K. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: a meta-analysis of randomized controlled trials. Plos One. 2017;12(5):e0176849.
Cohen M, Meador K, Browning N et al. Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6 years. Epilepsy Behavior. 2013;29: 308–315.
Connolly K, Thase M. The clinical management of bipolar disorder: A review of evidence-based guidelines. Prim Care Companion CNS Disorder. 2011;13 (4):26102.
Cooke S, Schwartz A, Kaslow N. Evidence-based psychotherapy: Advantages and challenges. Neuro-therapeutics. 2017;14(3):537-545.
Coppola D, Russo L, Kwarta R. Jr, Varughese R, Schmider J. Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes. Drug Safety. 2007;30: 247–264.
Crump C, Sundquist K, Winkleby M, Sundquist J. Comorbidities and mortality in bipolar disorder: A swedish national cohort study. JAMA Psychiatry. 2013;70:931– 939.
Culpepper L. The diagnosis and treatment of bipolar disorder: Decision-making in primary care. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01609.
Dickson R. Olanzapine and pregnancy The Canadian Journal of Psychiatry. 1998;43:196-197.
Dilsaver S. An estimate of the minimum economic burden of bipolar I and II disorders in the United States: 2009. Journal of Affective Disorders. 2011;129: 79–83. Available:10.1016/j.jad.2010.08.030
Drug.com. Amisulpride pregnancy and breastfeeding warnings; 2022.
Drug. Com. Asenapine pregnancy and breastfeeding warnings; 2022.
Available:https://www.drugs.com/pregnancy/asenapine.html
Drug.com. Paliperidone pregnancy and breastfeeding warnings; 2022.
Drug.com. Perphenazine pregnancy and breastfeeding warnings; 2022.
Drug.com. Pimozide pregnancy and breastfeeding warnings; 2022.
Available:https://www.drugs.com/pregnancy/pimozide.html
Drug.com. Quetiapine pregnancy and breastfeeding warnings; 2022. Available:https://www.drugs.com/pregnancy/quetiapine.html
Drug.com. 2022. Thioridazine pregnancy and breastfeeding warnings. Available:https://www.drugs.com/pregnancy/thioridazine.html
Drug.com. Trifluoperazine Pregnancy and Breastfeeding Warnings; 2022. Available:https://www.drugs.com/pregnancy/trifluoperazine.html
Drummond N, McCleary L, Freiheit E, Molnar F et al. Antidepressant and antipsychotic prescribing in primary care for people with dementia. Canadian Family Physician. 2018;64(11):e488-e497.
Einarson A. Abrupt discontinuation of psychotropic drugs following confirmation of pregnancy: A risky practice. Journal of Obstetrics and Gynaecology Canada. 2005;27:1019–1022.
Ekman M, Granström O, Omérov S, Jacob J, Landén M. The societal cost of bipolar disorder in Sweden. Epidemiology. 2018;48(10):1601-1610.
Epstein R, Moore K, Bobo W. Treatment of bipolar disorders during pregnancy: Maternal and fetal safety challenges. Drug, Healthcare and Patient Safety. 2014;7: 7-29.
Faden J, Citrome L. Resistance is not futile: Treatment-refractory schizophrenia - overview, evaluation and treatment. Expert Opinion on Pharmacotherapy. 2019;20(1): 11-24.
Franks S. Polycystic ovary syndrome. The New England Journal of Medicine. 1995;5(333):853 61.
Galbally M, Frayne J, Watson S, Nellen M. APriprazole and prgnancy: A retrospective. Multicenter Study. 2018;1(238):593-596.
Gentile S. Antipsychotic therapy during early and late pregnancy. A Systematic Review. Schizophrenia Bulletin. 2010;36: 518–544.
Global burden of disease study 2013 collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386,743–800.
Goldstein B, Strober M, Birmaher B et al. Substance use disorders among adolescents with bipolar spectrum disorders. Bipolar Disorder. 2008;10:469–478.
Gonzalez‐Pinto A, Gonzalez C, Enjuto S, Fernandez de Corres B, Lopez P et al. Psychoeducation and cognitive‐behavioral therapy in bipolar disorder: An update. The Acta Psychiatrica Scandinavica. 2004;109 (2):83-90.
Green M. Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. Journal of Clinical Psychiatry. 2006;67(9):3-8.
Gregory V Jr. Cognitive-behavioral therapy for depression in bipolar disorder: A meta-analysis. Journal of Evidence-Based Social work. 2010;7:269–279.
Hammond J, Toseland P. Placental transfer of chlorpromazine. Case report. Archives of Disease in Childhood. 1970; 45(239):139.
Hansen L, Megerian G, Donnenfeld A. Haloperidol overdose during pregnancy. Journal of Obstetrics & Gynecology. 1997; 90(4):659-661.
Harer W. Chlorpromazine in normal labor. Journal of Obstetrics, & Gynecology. 1956; 8(1):1-9.
Harvey G. Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation. American Journal of Psychiatry. 2008;165:820-829.
Harvard Medical School. National Comorbidity Survey (NSC); 2007.
Available:https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort
Harvard Medical School. National Comorbidity Survey (NSC); 2007.
Available:https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12- month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort
Hollon S, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depression & Anxiety. 2010;27:891–932.
Iqbal M, Aneja A, Rahman A, Megna J, Freemont W et al. The potential risks of commonly prescribed antipsychotics: During pregnancy and lactation. Psychiatry (Edgmont (Pa.: Township). 2005;2(8): 36–44.
Jennings A, Guerin N, Foley T. Development of a tool for monitoring the prescribing of antipsychotic medications to people with dementia in general practice: A modified eDelphi consensus study. Clinical Interventions in Aging. 2018;8(13):2107-2117.
Johnson K, LaPrairie J, Brennan P, Stowe Z, Newport D. Prenatal antipsychotic exposure and neuromotor performance during infancy. Archives of General Psychiatry. 2012;69:787–794
Jones I, Chandra P, Dazzan P, Howard L. Bipolar disorder, affective psychosis and schizophrenia in pregnancy and the postpartum period. Lancet. 2014;384 (9956):1789-1799.
Judd L, Akiskal H, Schettler P et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry. 2002;59: 530–537.
Kaaja E, Kaaja R, Hiilesmaa V. Major malformations in offspring of women with epilepsy. Neurology. 2003;60(4):575-579.
Kaneko S, Battino D, Andermann E et al. Congenital malformations due to antiepileptic drugs. Journal of Epilepsy Research. 1999;33:145–158.
Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Comparative Study. 2005;62(6):593-602.
Kessler R, Chiu W, Demler O, Merikangas K, Walters E. Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry. 2005;62:617–627.
Kohan M, Borhani F, Abbaszadeh A, Sultan Ahmadi J, Khajehpoor M. Experience of mothers with premature infants in neonatal. Journal of Qualitative Research in Health Sciences. 2020; 1(1):41-51.
Koren G, Cohn T, Chitayat D, Kapur B et al. Use of atypical antipsychotics during pregnancy and the risk of neural tube defects in infants. American Journal of Psychiatry. 2002;159(1):136-137.
Lam D, Bright J, Jones S, Hayward P, Schuck N, Chisholm D et al. Cognitive therapy for bipolar illness—a pilot study of relapse prevention. Cognitive Therapy and Research. 2000;24:503–520.
Lindahl V, Pearson J, Colpe L. Prevalence of suicidality during pregnancy and postpartum. Archives of Women's Mental Health. 2005;8:77–87.
Littrell K, Johnson C, Peabody C, Hilligoss N. Antipsychotics during pregnancy. 157(8), American Journal of Psychiatry. 2000;157(8):1342.
McCandless F, Sladen C. Sexual health and women with bipolar disorder. Journal of Advanced Nursing. 2003;44(1):42-48.
Mehta T, Van Lieshout R. A review of the safety of clozapine during pregnancy and lactation. Archives of Women's Mental Health. 2017;20(1):1-9.
Mei-Dan E, Ray J, Vidog S. Perinatal outcomes among women with bipolar disorder: A population-based cohort study. American Journal of Obstetrics and Gynecology. 2014;212(3):367: e1-367.e8.
Mendhekar D. Possible delayed speech acquisition with clozapine therapy during pregnancy and lactation. Journal of Neuropsychiatry and Clinical Neuro-sciences. 2007;19(2):196-197.
Merikangas K, Jin R, He J, Kessler R, Lee S, Sampson NA et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Comparative Study. 2011;68(3):241-251.
Miklowitz D. Adjunctive psychotherapy for bipolar disorder: State of the evidence. American Journal of Psychiatry. 2008;165: 1408–1419.
Miklowitz D, Otto M, Frank E, Reilly-Harrington N, Wisniewski S et al. Psychosocial treatments for bipolar depression: A 1-year randomized trial from the systematic treatment enhancement program. Archives of General Psychiatry. 2007;64(4):419-426.
Minick G, Atlas MC. What's the best strategy for bipolar disorder during pregnancy?. The Journal of Family Practice. 2007;56(8):665-8.
Morton-Cuthrell K. Stress, Emotions, Coping: The lived experiences of caregivers who raise adolescents with bipolar disorder. Asian Journal of Advances in Medical Science. 2022;4(4): 19-32.
Mother To Baby. Risperidone (Risperdal®); 2022.
Available:https://mothertobaby.org/fact-sheets/risperidone-pregnancy/
Newcomer J. Second-generation (atypical) antipsychotics and metabolic effects: A comprehensive literature review. CNS Drugs. 2005;19:1–93.
Newham J, Thomas S, MacRitchie K, McElhatton P, McAllister W. Birth weight of infants after maternal exposure to typical and atypical antipsychotics: Prospective comparison study. The British Journal of Psychiatry. 2008;192:333–337.
Nora J, Nora A, Toews W. Letter: Lithium, Ebstein’s anomaly, and other congenital heart defects. Lancet. 1974;2(7880): 594–5.
Parial S.Bipolar disorder in women. Indian Journal of Psychiatry. 2016;57(2):S 252-63.
Patel V, Kirkwood B, Pednekar S, Pereira B, Barros P, Fernandes J et al. Gender disadvantage and reproductive health risk factors for common mental disorders in women: A community survey in India. The European Journal of Clinical Pharmacology. 2006;63(4):404-413.
Pompili M, Gonda X, Serafini G, Innamorati M, Sher L, Amore M et al. Epidemiology of suicide in bipolar disorders: A systematic review of the literature. Bipolar Disorder. 2013;15(5): 457-490.
Reid H, Pratt D, Edge D, Wittkowski A. Maternal suicide ideation and behavior during pregnancy and the first postpartum year: A systematic review of psychological and psychosocial risk factors. Front Psychiatry. 2022;13:765118.
Rihmer Z, Angst J.Mood disorders: Epidemiology. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. (9th Ed.). Philadelphia: Lippincott Williams & Wilkins; 2009.
Rousseau D, Gunia B. Evidence-based practice: The psychology of EBP implementation. Annual Review of Psychology. 2016;67:667–692.
Rumeau‐Rouquette C, Goujard J, Huel G. Possible teratogenic effect of phenothiazines in human beings. Teratology. 1977;15(1):57-64.
Sachs G. Psychosocial interventions as adjunctive therapy for bipolar disorder. Journal of Psychiatric Practice. 2008;14 (2):39–44.
Sanchez-Moreno J, Martinez-Aran A, Tabares-Seisdedos R, Torrent C et al. Functioning and disability in bipolar disorder: An extensive review. Journal of Psychotherapy and Psychosomatics. 2009;78:285–297.
Schou M. Lithium treatment during pregnancy, delivery and lactation: an update. Journal of Clinical Psychiatry. 1990;51:410–413.
Sekhar M, Vyas N. Defensive medicine: A bane to healthcare. The Annals of Medical and Health Sciences Research. 2013;3 (2):295–296.
Sexson W, Barak Y. Withdrawal emergent syndrome in an infant associated with maternal haloperidol therapy. Journal of Perinatology. 1989;9(2):170-172.
Slone D, Siskind V, Heinonen O, Monson R, Kaufman D et al. Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality rate, birth weight and intelligence quotient score. American Journal of Obstetrics & Gynecology. 1977;128(5):486-488.
Sobel D. Fetal damage due to ECT, insulin coma, chlorpromazine, or reserpine. AMA Archives of General Psychiatry. 1960; 2(6):606-611.
Stingl J, Berghöfer A, Bolk-Weischedel D. Healthy outcome under olanzapine treatment in a pregnant woman. Pharmacopsychiatry. 2000;33(2):78-80.
Stoppler M. Geodon side effect center. RxList; 2022.
Available:https://www.rxlist.com/geodon-side-effects-drug-center.htm#overview
Suppes T, Leverich G, Keck P et al. The stanley foundation bipolar treatment outcome network. II. demographics and illness characteristics of the first 261 patients. Journal of Affective Disorders. 2001;67:45–59.
Szentagotai A, David D. The efficacy of cognitive-behavioral therapy in bipolar disorder: A quantitative meta-analysis. Journal of Clinical Psychiatry. 2010;71: 66–72.
Thase M, Kingdon D, Turkington D. The promise of cognitive behavior therapy for the treatment of severe mental disorders: A review of recent developments. World Psychiatry. 2014;13:244–250.
Tondo L, Isacsson G, Baldessarini R. Suicidal behavior in bipolar disorder: Risk and prevention. CNS Drugs. 2003;17:491–511.
U.S. Food and Drug Administration. FDA Drug Safety Communication: Antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns; 2011
Available:http://www.fda. gov/Drugs/DrugSafety/ucm243903.htm
Van Waes A, Edith Van de Velde. Safety evaluation of haloperidol in the treatment of hyperemesis gravidarum. The Journal of Clinical Pharmacology, & Drugs, The Journal of New. 1969;9(4):224-227.
Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant B, Hasin D. Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry. 2008;65(7):805-815.
Viguera A, Cohen L, Baldessarini R, Nonacs. Managing bipolar disorder in pregnancy: Weighing the risks and benefits. Can J Psychiatry. 2002;47P: 426–436.
Viguera A, Nonacs R, Cohen L, Tondo L, Murray A, Baldessarini R. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. American Journal of Psychiatry. 2000;157: 179–184.
Web MD. (2022). Iloperidone tablet, uses, side effects and more.
Ye B, Jiang Z, Li X, Cao B, Cao L, Lin Y et al. Effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta-analysis with randomized controlled trials. Psychiatry and Clinical Neurosciences. 2016;70351–361.
Yonkers K, Vigod S, Ross L. Diagnosis, pathophysiology and management of mood disorders in pregnant and postpartum women. Journal of Obstetrics & Gynecology. 2011;117:961–977.
Yonkers K, Wisner K, Stowe Z, Leibenluft E, Cohen L, Miller L et al.Management of bipolar disorder during pregnancy and the postpartum period. The American Journal of Psychiatry. 2004;161:608-620.
-
Abstract View: 373 times
PDF Download: 84 times
