Bipolar Disorder

Bipolar disorder is a condition that affects mood, energy, and thinking. It involves episodes of mania or hypomania (periods of elevated, intense energy and mood) and depression. There are different types — Bipolar I, Bipolar II, and Cyclothymia — and everyone’s experience is unique.

Bipolar disorder is a serious condition that deserves proper medical management at any point in life — but pregnancy brings some specific considerations that are worth understanding in advance.

The hormonal shifts of pregnancy and the postnatal period can affect mood significantly. For people with bipolar disorder, the postpartum period in particular carries a higher risk of relapse — including postpartum psychosis, which is more common in people with a bipolar diagnosis than in the general population.

This isn’t meant to frighten you. It’s important information that allows you and your care team to plan ahead and reduce those risks as much as possible.

Do’s

• Talk about your feelings to a friend, family member, doctor or midwife
• Make sure your bipolar diagnosis is clearly documented in your maternity notes
• Attend all antenatal appointments and be honest with your care team about how you are feeling
• Ask your GP or midwife for a referral to Perinatal Mental Health Services — you are entitled to specialist support
• Work with your care team to create a written perinatal relapse prevention plan before your baby arrives
• Tell a trusted person close to you what early warning signs of relapse look like for you, so they can help spot changes
• Prioritise sleep wherever possible — sleep deprivation is a known trigger for bipolar episodes
• Try calming breathing exercises if you feel overwhelmed
• Eat regularly and stay as active as you can — both support mood stability

Don’ts

• Do not stop or change your medication without speaking to your doctor or psychiatrist first — this can trigger serious episodes
• Do not compare yourself to others — every pregnancy and every experience of bipolar disorder is different
• Do not be afraid to tell healthcare professionals how you are really feeling — they are there to support you
• Do not use alcohol or recreational drugs to manage your mood — these can destabilise your condition and affect your baby
• Do not dismiss early warning signs of a mood episode — act quickly and contact your care team

Speak to your midwife or doctor if:

• You are feeling very low, very high, or noticing significant mood changes
• You are having thoughts of harming yourself or your baby
• You are sleeping very little but feel unusually energised
• You are experiencing racing thoughts, feeling confused, or behaving out of character
• Things you are trying yourself are not helping

For most people with bipolar disorder, medication plays an important role in staying well. Pregnancy naturally raises questions about what’s safe, and this is one of the areas where specialist advice is absolutely essential.

Here is a brief overview of commonly used medications in pregnancy. Every case is individual — these are not decisions to make alone, but with a specialist who knows your history.

Lithium

Lithium is considered a gold-standard treatment for bipolar disorder. It can be used in pregnancy, but requires careful monitoring as lithium levels fluctuate significantly during pregnancy and regular blood tests are needed. There is a small increased risk of heart defects, though the absolute risk remains low, and many people continue lithium safely throughout pregnancy with close supervision.

Lamotrigine

Another option considered by some specialists during pregnancy. Its levels in the blood also change significantly in pregnancy and will need close monitoring with dose adjustments.

Sodium Valproate

Quetiapine and other antipsychotics

These may sometimes be used in pregnancy and carry their own specific risk profiles that your psychiatrist will discuss with you individually.

One of the most empowering things you can do is ensure the right people are involved in your care before and during pregnancy. Ideally, your team should include:

• Your GP — a first point of contact and coordinator
• A psychiatrist or perinatal psychiatrist — specialist mental health support during pregnancy and postnatally
• Your midwife — your pregnancy wellbeing should be fully documented in your maternity notes, including your bipolar diagnosis
• A community mental health team (CMHT) or perinatal mental health team — depending on what is available in your area

Perinatal Mental Health Services are specialist NHS services staffed by psychologists, therapists, midwives, and peer support workers, specifically designed to support people whose mental health is affected by pregnancy. If you haven’t been referred, ask your GP or midwife. Make sure your bipolar diagnosis is clearly documented in your maternity notes and that there is an alert on your records so the right support is in place.

One of the most useful tools you can have is a written relapse prevention plan — developed with your care team and the people who support you. A good plan covers:

• What medication you will take throughout pregnancy and any changes around delivery
• How you will manage sleep in the early postnatal period
• Who will support you in the first weeks after birth
• The early warning signs that your mood is shifting — and what to do
• Who to contact in a crisis, day or night
• Your feeding preferences, and how these interact with your medication

Having this written down and shared with your partner, a trusted family member, and your care team means everyone knows what to look for and what to do. It removes the guesswork at a time when you may find it harder to advocate for yourself.

The weeks after birth are when the risk of relapse is highest for people with bipolar disorder. Postpartum psychosis, while relatively rare in the general population, affects a significantly higher proportion of people with bipolar disorder, and it can develop very quickly.

Symptoms to watch for include: little need for sleep but feeling energised, racing thoughts, behaving unusually or out of character, confusion, paranoia, or hearing or seeing things that others don’t. If you or those around you notice these signs, seek urgent help immediately. This is a medical emergency and responds well to prompt treatment.

Many people with bipolar disorder breastfeed successfully, but it does require careful thought about medication. Some mood stabilisers pass into breast milk in varying amounts, and the decision about whether to breastfeed needs to weigh up your mental health needs, the baby’s safety, and your own wishes.

This is not a simple yes or no — it is a nuanced conversation with your specialist. There is no single right answer, and whatever decision you and your care team reach together is valid.

NHS Therapy and Counselling Services

If you are feeling low and it is not improving, a talking therapy might help. Therapies such as Cognitive Behavioural Therapy (CBT) and counselling are available on the NHS. A GP can refer you, or you can self-refer directly to an NHS talking therapies service.

Medicines

You may be offered medicine to treat your symptoms. If you decide to take medicine while you’re pregnant or breastfeeding, speak to your doctor. They will help you weigh up the risks and benefits so you can decide on the best treatment for you and your baby. They will offer you the safest medicine at the lowest amount that will still work.

The Bipolar Lift CIC — Peer support and resources for people living with bipolar disorder.