bipolar disorder, Dr. Paul Markovitz  Q. I am 23 and have been diagnosed with rapid-cycling Bi-polar disorder for nearly 8 years and am taking Depakote (1250 mg/day). My partner and I have begun to think about having children and I was wondering whether it would be possible for me to carry the child. My doctor has told me that I would have to stop taking the Depakote, but was not sure if there was an alternative medication (she is researching). I am also wondering about the possibility of passing this on to a child.

  A. There is an increased risk of congenital anomalies in the fetus if you are taking Depakote, so your doctor is correct about stopping it. An alternative may be to use an antidepressant for the cycling. Some folks with Bipolar II are also borderline, and the treatments for borderline can be used. These are antidepressants like Prozac (80 mg), Zoloft (300-400 mg), Effexor XR (300 or 450) or Serzone (500-600). These have a very low probability of harming the fetus.

While bipolar illness is not entirely genetic, there is a genetic component. Not all parents with bipolar illness have bipolar kids. Actually, it is more likely your child will be depressed only according to the statistics than bipolar. More importantly, well under half the kids ever have either depression or mania. That said, they will probably have a cure for many of the psychiatric illnesses in the near future (10-20 years), so I would lead your life exactly like you want. If you want a child, have it.