for better mental health

Lithium and other mood stabilisers

Explains how lithium and other mood stabilising drugs work, how they might help you, whether to take them if you’re pregnant or breastfeeding, and what alternative treatments are available.

Valproate pregnancy warning

Valproate carries the highest risk of danger to your baby out of all mood stabilisers.

The regulators of this medicine say that you should not take valproate if you are pregnant.

They also say you should not be prescribed valproate if you are able to become pregnant, unless you have a pregnancy prevention programme in place.

See our information on anticonvulsants during pregnancy and breastfeeding to find out more. 

What are my choices?

Mood stabilising drugs may carry risks of harm to your baby. You might need to think about your options if you take mood stabilisers and:

  • you become pregnant
  • you're planning to become pregnant
  • you're breastfeeding. 

If you become pregnant, you will probably be asked to consider one of these options:

  • Switch to an alternative drug which carries fewer risks, such as a low dose of an antipsychotic.
  • Come off your medication. This should be done gradually, ideally with your doctor's guidance.
  • If you are taking lithium, you might decide that you really need to continue with your lithium treatment. In this case your doctor should help you take careful steps to manage the risks of lithium to you and your baby.

You will need to think about any possible risks to your baby from continuing with your medication. But also consider any possible harm from changing or coming off your medication.

What can I do to feel more in control?

Being pregnant can sometimes feel like you’re giving up control of your own body. This can be stressful, but there are lots of positive steps you can take:

  • Planning your pregnancy gives you more options early on. But it is also a common experience to find out you’re pregnant without planning it. Whatever your situation is, it’s important to remember that you have the same rights as everyone else. This includes the right to choose whether or not to take medication, and to have your say in decisions about your treatment.
  • Talk to a healthcare professional as early as you can. This could be with your doctor or midwife, or a mental health specialist. The earlier you start talking to someone about your options, the more in control you're likely to feel. For planned pregnancies, you should do this as soon as you decide you want to start trying to get pregnant. For unplanned pregnancies, you should speak to them as soon as you think you might be pregnant.
  • Make sure you know the risks with each drug, so you can make an informed decision. Information on the risks with different types of mood stabiliser is included below.
  • Seek extra support, to talk through your options and decide what's right for you.
  • If you decide to come off your medication, make sure you do it safely. See our pages on coming off medication for more information.

Lithium during pregnancy and breastfeeding

The risks to your baby with taking lithium during pregnancy are:

  • Heart defects. Taking lithium in early pregnancy can increase the risk that your baby's heart might not develop properly. Your doctor or midwife should monitor your baby's heart using ultrasound scans.
  • Increased risk of serious side effects and overdose. Being pregnant causes changes in your hormone levels, fluid levels and kidney function. All of these can affect the amount of lithium in your blood. You might not always realise when these changes happen. You may also have less control over your body as it changes during pregnancy. This can mean it’s harder to make sure your lithium level stays within safe limits.
  • When you go into labour, both your lithium levels and your baby's lithium levels could become dangerously high. This is because the way your body clears lithium changes very suddenly during childbirth.
  • If you breastfeed, there is a very high risk of passing on lithium to your baby through your breast milk. This could be dangerous to your baby’s health.

The Royal College of Psychiatrists has more information about taking lithium while pregnant or breastfeeding.

Managing the risks with lithium

If you decide it's best to continue with your lithium treatment, you and your doctor should take these steps to manage the risks:

  • Regular lithium level monitoring. Your doctor will need to monitor your blood lithium level very carefully throughout your pregnancy to make sure it stays within a safe range. As a guideline, they should check your levels at least every 4 weeks, then weekly from the 36th week of pregnancy.
  • Your doctor may need to adjust your dose. This is because your kidneys clear lithium from your body differently when you're pregnant.
  • You should give birth in hospital. This is because your obstetric team will need to monitor your lithium levels. Your obstetric team is the medical team who help to deliver you baby.
  • The doctor who prescribes you lithium should speak regularly with your obstetrician about your treatment. Your obstetrician is the doctor responsible for delivering your baby.
  • You should stop taking lithium as soon as you go into labour. Your obstetrician will need to carefully check your fluid and salt balance and the level of lithium in your blood throughout your labour.

Your risk of postpartum psychosis

If you've ever had a bipolar episode in the past, you have a much higher risk of developing postpartum psychosis in the weeks after you give birth.

Because of this, your doctor might make these suggestions:

  • You could continue taking lithium as long as possible during your pregnancy. This is to lower your risk of postpartum psychosis.
  • If you've decided to stop lithium treatment during your pregnancy, you could start taking lithium again a few days after giving birth.

You should discuss what feels right for you with your doctor.

Anticonvulsants during pregnancy and breastfeeding

Anticonvulsant mood stabilisers carry the following risks to your baby:

  • Anticonvulsant drugs may cause your baby to develop foetal anticonvulsant syndrome, if you take them while you are pregnant. Children who develop this syndrome can have physical defects and delayed development. They may need special educational support. The Organisation for Anticonvulsant Syndrome (OACS) has more information about foetal anticonvulsant syndrome on its website. 
  • If you breastfeed, anticonvulsant drugs could be passed to your baby through your breast milk. It's possible that your baby could experience some side effects from the medication. You should talk to your doctor about what feels right for you, before you decide to breastfeed.

Each individual anticonvulsant drug also has its own risks. These risks are outlined below:

Valproate

Valproate carries the highest risk of danger to your baby out of all mood stabilisers. It can cause a number of different defects and symptoms in your baby. Together, these are known as 'foetal valproate syndrome'. They include:

  • heart defects
  • spinal defects, such as spina bifida
  • face and skull malformation, including cleft lip
  • malformed sexual organs
  • extra, or deformed, fingers or toes
  • bleeding and liver disease
  • a higher likelihood that your child might be diagnosed with autism and learning difficulties. There is also some evidence that children may have a higher risk of developing symptoms of attention deficit hyperactivity disorder (ADHD).

The regulators of this medicine say that you should not take valproate if you are pregnant.

They also say you should not be prescribed valproate if you are able to become pregnant, unless you have a pregnancy prevention programme in place. See our page on valproate for more information about this.

If you are prescribed valproate, you should receive a patient booklet and patient alert card with your prescription. These will give you more information about the risks of taking valproate.

Carbamazepine

There is evidence that taking carbamazepine during the first three months of pregnancy increases the risk of your baby developing:

  • heart defects
  • a cleft lip
  • a malformed penis
  • spinal defects, such as spina bifida.

Lamotrigine

Evidence on the safety of taking lamotrigine while pregnant is mixed. The NHS has information on taking lamotrigine while pregnant or breastfeeding.

"[While] I was on Epilim (sodium valproate)… I had a child born with various defects and she also has learning difficulties and GDD [global developmental delay] due to this drug. I was not told of the severe effects it can cause."

Antipsychotics during pregnancy and breastfeeding

See our page on the risks of taking antipsychotics during pregnancy. This includes information on the antipsychotics that you may be offered as mood stabilisers.

Further support during pregnancy and breastfeeding

Coming to a decision you feel comfortable with about what's right for you and your baby can be difficult. It's understandable if you feel conflicted or unsure about what to do.

As well as talking to your doctor or a psychiatrist, you might find these support options helpful:

  • Talk to someone you trust. If you feel able, it can help to talk through your feelings with someone you trust, such as a partner or close friend.
  • Midwife appointments. You can talk to your midwife about how you're feeling throughout your pregnancy. They can also help make sure you receive plenty of support from your health visitor after you give birth.
  • Perinatal mental health services. These services offer support to help you stay well during your pregnancy. You can be referred to these services by other professionals involved in your care, such as your doctor.
  • Online peer support. It can be helpful to talk to other people who've had similar experiences to yours. Netmums has a supportive online network for all parents and parents-to-be. Bipolar UK has an online community for people with experience of bipolar disorder. See our pages on online mental health for information on using the internet if you’re feeling vulnerable.
  • Specialist websites. Websites such as Action on Postpartum PsychosisNCT and the Breastfeeding Network provide information and support on pregnancy, breastfeeding and mental health. The Independent Fetal Anti-Convulsant Trust (In-FACT) and the Organisation for Anti-Convulsant Syndrome (OACS) offer support if you've been affected by taking anticonvulsant medication during pregnancy.

You might also find it helpful to read our pages on parenting with a mental health problem. These pages include information on taking care of yourself, looking after your children, and other kinds of support available to parents.

This information was published in June 2020. We will revise it in 2023.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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