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What does it involve?
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No change to medication or dose
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Over a period of weeks to months, decreasing the amount of valproate
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Over a period of weeks to months, gradually stopping valproate
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Switching to a different medication (e.g. lamotrigine or an antipsychotic)
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What are the risks to me?
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Usual side effects of valproate
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Usual side effects of valproate, potential for relapse
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Higher risk of relapse (depends on a variety of factors – discuss with your clinician), increased risk of puerperal psychosis
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Risk of relapse if the other medication is not as effective as valproate; risk of new side effects
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What are the risks to my baby?
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Congenital malformations (see Table 4) long-term developmental disorders (estimated one in 3)
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Reduced risk of congenital malformations and developmental disorders (risk depends on the dose, discuss with your clinician)
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Indirect risks, e.g. disinhibition from poorly controlled bipolar disorder (discuss with your clinician)
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Some medications are much safer for your unborn baby (specifically lamotrigine, some antipsychotics)
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What are the benefits?
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You are less likely to relapse or suffer from puerperal psychosis
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Your unborn baby will have a lower risk of malformations than if you continue the full dose
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Your unborn baby will have the same risk of malformations as the general population
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If you can tolerate the new drug, you are less likely to relapse or suffer from puerperal psychosis; the other medication could have adverse effects
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Who would benefit most from this?
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People with unstable bipolar disorder and frequent relapses who are not controlled on other medication or lower doses of valproate
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People with bipolar disorder who are not controlled on other medication
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People who have been stable off valproate and do not wish to take other medications during pregnancy
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People who are stable on alternatives to valproate
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