Q. I'm 29 years old and have been suffering from bipolar disorder for about 4 years. I'm taking lithium since then and it's working fine. I'm in good health and would like to get pregnant. What would be your advice?

  A. My last reading of the literature is that lithium is associated with an increased incidence of heart defects in the fetus. Its a low incidence, but a bad side effect. I would go to a specialist at a university that deals with pregnancy in psychiatric patients. There are lots of options available, and you should have a local doctor helping out. The old stand in was to use neuroleptics, but many doctors are using other agents during pregnancy.