A profile of psychotropic medication in bipolar patients of reproductive age

Abstract

Background: Bipolar disorder (BD) is associated with unfavourable reproductive health outcomes. Evidence-based treatment guidelines advocate for reproductive safe prescribing, including family planning, avoidance of teratogenic medication and documentation of risk acknowledgement. However, there is poor adherence to the prescribed guidelines in clinical practice.
Aim: To describe the range of psychotropic medications prescribed to women of reproductive age (WRA) with BD at a tertiary psychiatric unit.
Setting: Helen Joseph Hospital, Johannesburg, South Africa.
Methods: A retrospective record review of females aged 18–49 years treated for BD between January 2016 and December 2023 was conducted. A convenience sample of 141 files was reviewed. Data were collected from the latest clinical notes and prescription charts.
Results: A combination of mood stabilisers (MS) and atypical antipsychotics was predominantly prescribed (81.6%). Of the MS, valproate use was most common (50.6%), followed by lithium (29.3%). Risperidone was the most prescribed antipsychotic (39.0%), followed by olanzapine (24.7%) and quetiapine (20.5%). Antidepressants were combined with MS or antipsychotics in 10.6% of cases. Documented contraception counselling (5%) and contraception use (9.2%) were low. None of the records had documented risk acknowledgement for valproate use (100%).
Conclusion: Prescribing guidelines for teratogenic MS were not consistently followed. Therefore, WRA diagnosed with BD may be at an increased risk of teratogenic drug exposure in pregnancy.
Contribution: This study highlights the need for improved documentation of medication risk discussions, family planning and informed consent at every visit.