Bipolar Disorder

Last Update: 06 Aug 2025

Condition

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on bipolar disorder during pregnancy and breastfeeding or chestfeeding. The information is based on current research and may be updated as new scientific knowledge emerges. This content does not replace personalized advice from your healthcare team.

1. What is bipolar disorder?

Bipolar disorder (also called bipolar affective disorder) affects about 1 to 2 out of every 100 people in Canada. It can affect anyone, no matter their age, backgrounds, or where they live.

Bipolar disorder is a long-term mental health condition that causes strong changes in mood, energy, and behaviour. People with bipolar disorder go through periods of feeling very low (depression) and periods feeling overly high (called mania or hypomania). These mood swings can affect sleep, thinking, relationships, and daily life.

Bipolar disorder includes different kinds of mood episodes. The table below shows what they look like and how long they usually last.

Table 1. Types of mood episodes in bipolar disorder.

Episode type	What it looks like	How long it lasts
Mania	– Very high or irritable mood -Lots of energy and activity -Talking more than usual or having racing thoughts. -May have risky behaviours (like overspending, substance use) -May see or believe things that are not real (psychosis) -May need hospitalization	At least 1 week, most of the day
Hypomania	– Like mania but milder – Talking more than usual or having racing thoughts. – Less impact on daily life -No hallucinations or unusual beliefs (psychosis)	At least 4 days, most of the day
Depression	– Persistent sadness or tiredness – Feeling hopeless or losing interest – Changes in sleep or appetite – Trouble concentrating – Thoughts of death may happen	At least 2 weeks, most of the day
Mixed episode	– Feel “high” (mania/hypomania symptoms) and “low” (depression symptoms) at the same time – Mood, energy, and thoughts can shift quickly	Duration depends on the type: 1 week (mania) or 4 days (hypomania) or 2 weeks (depression)

Bipolar disorder is not your fault. The exact causes are not fully understood. Research shows that everyone has some genetic vulnerability to bipolar disorder, but some people are more at risk than others. Having a genetic vulnerability does not mean you will develop bipolar disorder. Stressful life experiences, combined with this genetic vulnerability and brain chemistry, can trigger the episodes of mania, hypomania, or depression. With support and treatment, bipolar disorder can be managed, even during pregnancy.

Pregnancy can change the way bipolar disorder behaves. Hormone changes, stress, and lack of sleep can sometimes trigger mood episodes or make symptoms stronger. Your medication may need to be adjusted to keep you and your baby safe.

That’s why it’s important to understand your symptoms and get support early. Working with your doctor, midwife, or mental health provider can:

Help you recognize early signs of mood changes
Protect your wellbeing and your baby’s health
Plan for support after delivery, when relapse risk can increase

If you are pregnant or planning a pregnancy and have bipolar disorder (or think you might) talk to your doctor, midwife, nurse practitioner, pharmacist, or mental health provider. Bipolar disorder can be complex to manage, but with the right treatment and support, many people have healthy pregnancies and babies.

2. Why is it important to manage bipolar disorder during pregnancy?

Managing your bipolar disorder during pregnancy helps protect your health, your baby’s health, and your family’s well-being.

Without treatment, mood episodes like depression or mania can make it harder to take care of yourself. You may:

Miss medical appointments
Have trouble sleeping, eating, or keeping a routine
Feel overwhelmed
Turn to substances like drugs or alcohol to cope.

Severe symptoms can lead to thoughts of self-harm or the need for hospital care. After delivery, untreated bipolar disorder can increase the risk of postpartum depression or psychosis, which can affect bonding and caregiving.

For your baby, unmanaged bipolar disorder can increase the chance of low birth weight (less than 5 pounds and 8 ounces [2,500 grammes]), and preterm birth (before 37 weeks).

Planning your pregnancy and talking with your doctor about your treatment plan gives you the best chance for a healthy pregnancy and baby.

Understanding Risks in Pregnancy

Every pregnancy has some risks of complications like miscarriages (loss of the baby), preterm birth (baby comes before 37 weeks), congenital malformations (birth defects), and other complications. These risks can happen in any pregnancy for many reasons, unrelated to medical conditions or their treatments. This is called the background risk. Research helps us estimate these risks and compared them with the risks when bipolar disorder is not treated or supported.

The table below shows possible risks of untreated bipolar disorders during pregnancy compared to these background risks:

Some are well documented
Others need more research
Your personal risk depends on age, genetics, lifestyle, other medical conditions, and ethnicity

Table 2: Possible risks of untreated bipolar disorder during pregnancy.

For who?	What?	What does research say?
Pregnant person	Fertility (ability to get pregnant)	People with bipolar disorder may have menstrual cycle or hormone changes (estrogen, progesterone, testosterone) that might affect fertility. The impact on fertility is unclear. More research is needed.
	Miscarriages	Some studies found a slightly higher risk of miscarriage, while others did not. More research is still needed.
	Risky behaviour	Mood episodes can lead to missed prenatal visits, poor sleep or nutrition, substance use, and/or self-harm.
	Other pregnancy complications	Some studies found a slightly higher risk of placenta previa, gestational diabetes, preeclampsia, hemorrhage, or cesarean delivery. Not all studies agree. More research is needed.
	Postpartum mental illness	Significantly higher risk of severe mental health problems after birth, like postpartum depression or psychosis. If medication was stopped during pregnancy: 66% relapsed postpartum compared to 23% relapsed when medication was continued tooltip.
Unborn baby	Congenital malformations	Some studies found a small increased risk of microcephaly (smaller head size), while others did not confirm this. More research is still needed.
	Growth	Many studies found a small chance of low birth weight (5 pounds and 8 ounces or 2,500 g).
	Preterm birth	Many studies found an increased chance of preterm birth (before 37 weeks).
Future child	Brain development	Some studies found a small increased chance of attentionrelated or other developmental problems (like ADHD) later in life. Children of parents with bipolar disorder have a higher genetic vulnerability to ADHD and other psychiatric conditions whether or not treatment is used.
Future child	Long-term health	Children may face more emotional challenges (anxiety, difficulty managing feelings, mental health issues) later in life. This is also linked to genetic vulnerability, with or without treatment.
Family	Family Dynamics	Mood episodes can cause stress, worry, and emotional burden for partners and relatives. Common family concern, but little research exists.

3. What can I do to manage my bipolar disorder besides medications?

If you are pregnant or planning to become pregnant, it can help to make a “mental health plan”, just like you would prepare for childbirth. Talk with your partner or support person and your healthcare team. Learn to recognize your early signs of depression or mania, so you can take action quickly if symptoms return.

Bipolar disorder is a serious condition, and most people need medication to manage symptoms. Some non-medication strategies complement medication to support your mood and overall wellbeing.

Keep a regular sleep schedule: Going to bed and waking up at the same time every day helps stabilize your mood. Poor sleep is a common trigger for mood episodes.
Manage stress: Activities like mindfulness, deep breathing, and gentle yoga can lower stress and reduce the risk of mood swings.
Eat well and stay active: Regular physical activity and a healthy diet support better mood, energy, and resilience against mood episodes.
Psychotherapy: Research on therapy for bipolar disorder during pregnancy is limited, but cognitive behavioral therapy (CBT) and other types of psychotherapy may help manage stress and mild symptoms.
Get emotional and practical support: Support from family, friends, or a support group during and after pregnancy can lower stress, improve sleep, and help with daily routines.
Working closely with your healthcare team before and during pregnancy is one of the best ways to protect your mental health, promote your baby’s well-being, and reduce the risk of severe episodes before and after birth.

4. Medications prescribed for managing bipolar disorder

Medication is often the most effective way to manage bipolar disorder. It helps stabilize mood and reduce or prevent mood swings.

There are different types of mood-stabilizing medications. The best medication for you depends on your symptoms, how you responded to past treatments, and personal factors like age, lifestyle, and overall health.

If you are pregnant or planning to become pregnant, it is important to talk with your doctor about your treatment plan. Both the medications and untreated mood episodes can affect the baby early in pregnancy, sometimes before you even know you are pregnant.

It is important to never stop, adjust, or change your medication on your own. Always talk to your healthcare team first. Stopping suddenly can increase the risk of relapse. If you and your team decide to stop medication, your dose will be reduced gradually and they will aim for at least 4 to 6 months of stability before pregnancy.

What does research say?

If treatment is needed during pregnancy, your healthcare team may recommend:

Using one medication or the fewest number needed to stay stable
Considering options like lithium or certain atypical antipsychotics (e.g. olanzapine, quetiapine, risperidone)
Avoiding valproic acid (divalproex, Epival®, Depakene®) because it has a higher risk of birth malformations and other complications for the baby

The table 3 below lists some medications available in Canada used to manage bipolar disorder. Not all of these are recommended as first line medications during pregnancy. For details on a specific medication, consult its dedicated factsheet.

Table 3. Medications available in Canada for managing bipolar disorder.

Medication Types	Medication Names	Brand names
Mood stabilizer	Lithium	e.g. Carbolith®, Lithane®
Antiseizure /Mood Stabilizer	Carbamazepine	e.g. Tegretol^®
	Valproic acid	e.g. Epival®, Depakene®
	Lamotrigine	e.g. Lamictal^®
Atypical antipsychotic	Aripiprazole	e.g. Abilify^®
	Clozapine	e.g. Clozaril^®
	Olanzapine	e.g. Zyprexa®
	Quetiapine	e.g. Seroquel®
	Risperidone	e.g. Risperdal®
	Loxapine	e.g. Loxapac®
	Haloperidol	e.g. Haldol®
	Asenapine	e.g. Saphris®
	Ziprasidone	e.g. Zeldox®

How do I know which one to take?

There is no such thing as a “zero-risk” choice for managing bipolar disorder in pregnancy. There are risks with medications, but there are also risks with experiencing mood episodes during pregnancy. Your healthcare team (pharmacist, nurse, doctor, midwife) is best equipped to guide you toward an informed decision that works for you and your baby.

If you are already taking bipolar disorder medication, don’t stop taking it suddenly. This could make your symptoms come back or get worse. Instead, talk to your healthcare team to review your treatment plan.

If you’re unsure about your treatment or have questions, it’s best to discuss them your healthcare team. They can help you look at the benefits of your medications and any possible risks. Whether you talk to a pharmacist, nurse, physician, or midwife, they are there to support you and help you make an informed decision for your health and your baby’s health.

5. Will I be able to breastfeed or chestfeed?

Most people with bipolar disorder can breastfeed/ chestfeed if they choose to. When deciding whether to breastfeed or chestfeed, it is important to consider the benefits of breastfeeding/ chestfeeding, the risk of relapse due to stress or sleep loss, and the possible effects of your medication on the baby. The risk of relapse is highest right after birth, so having a plan and strong support is key

If you wish to breastfeed or chestfeed, know that some medications for bipolar disorders can pass into human milk. For example, lamotrigine and lithium can affect the baby. In these cases, careful monitoring of the baby is often recommended. Your healthcare team can help you weigh the benefits and possible risks. This will help you make an informed decision for you and your baby.

If you have any concerns or questions related to breastfeeding or chestfeeding, speak with your doctor, pharmacist, midwife, nurse, or a lactation consultant in your region.

Key Takeaways

Bipolar disorder is a long-term mental health condition that causes extreme mood changes. Episodes vary from very low (depression) to very high (mania or hypomania).
Pregnancy can increase the risk of mood changes, so your treatment plan may need small adjustments to keep you stable
Untreated bipolar disorder can increase the risk of preterm birth (before 37 weeks), risky behaviors (like missing appointments, substance use, selfharm), and serious postpartum mental health concerns like relapse and postpartum psychosis, which may need hospitalization
Medication is one of the most effective ways to manage symptoms and prevent mood swings.
It’s important to never stop or change your medication without talking to your healthcare team first. They will help you choose what is safest for you and your baby.

Research Is Great, But It Is Not Perfect

Making informed health decisions also involves considering the current state of scientific knowledge. Here are some limits noted by our committee of experts about the quantity and quality of studies on bipolar disorder during pregnancy:

Not enough long-term studies: There aren’t many studies that look at the long-term effects of bipolar disorder or its treatments on the pregnant person and babies after birth.
Different treatments: Pregnant people may take different medications or doses, which makes it difficult to compare results or know what works best.
Other factors: Things like having other health conditions, stress, income, or lifestyle may influence the results, making it hard to study bipolar disorder on its own.
Not everyone reports symptoms: Because of stigma around mental illness , some people may hide their symptoms. This can lead to missing or incomplete information in studies.
Lack of diversity: Many studies don’t include people from different backgrounds, ethnicities, sexual and gender identities, or income levels. This means we don’t fully understand how bipolar disorder affects all pregnant people.

These gaps show that we still need more research to better understand how bipolar disorder and its treatments affect pregnancy and postpartum health.

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