Perinatal Bipolar Disorder Management: Lithium in the Setting of Obstetric Complications

Managing bipolar disorder in the perinatal period relies on psychopharmacologic treatment due to high rates of postpartum recurrence in the absence of mood-stabilizing medications. Lithium is classically recommended for postpartum bipolar episodes, yet lithium management during pregnancy, labor, and postpartum is complex and clinical practice varies even among reproductive psychiatrists. This case report details a 37-year-old woman with bipolar I disorder whose unexpectedly elevated lithium levels during pregnancy heralded preeclampsia. This case highlights the treatment challenges that arise when complicated psychiatric histories interact with complicated obstetric histories. We address conceptual questions about balancing psychiatric and obstetric risk when developing a medication regimen and illustrate continued dialogue regarding optimal lithium monitoring in the peripartum period.