Q. I have been on lithium for roughly ten years. I was hospitalized for manic episodes in 1991, 1996 and 1998. Since 1998 I have been taking Depakote and Zyprexa in addition to the lithium and have also been taking Paxil for 6 mo. or so. I am 35 years old and my clock is ticking. I would like to have a baby but know I would be taking risks to my health by going off lithium and Depakote and would be risking the baby's health by staying on it.

My doctor does not have much experience with this situation and is sending me to a specialist (part of the Women's Mental Health Clinic or something part of University Hosp. of Cleveland). My appointment is not for a month and this uncertainty is keeping me up nights. I guess I am look for answers if I can't get guarantees. Is there ANYTHING I can do to minimize my risk of another manic episode? Is this condition genetic? If I can't take lithium or Depakote, is there anything safe I can take to get me through conception and the first trimester?


  A. There are a number of medications you can take that will probably be safe for the fetus. Sleep at night, wait for the appointment, and then get on the one your doctor will suggest. Risperdal and Zyprexa are probably both safe in pregnancy, and can help. There are even reports out of Boston that Depakote is actually okay to use during pregnancy. See what the doctor suggests, since they will be the person monitoring you. There are safe options out there.