A 30-year old pregnant woman comes to your clinic with decreased sleep, increased appetite and hyperactivity for 2 weeks. A diagnosis of mania is made. Fuher probing reveals four episodes of major depression in the past two years. What drug will you prescribe to this patient?

**Core Concept**
During pregnancy, the choice of medication for treating bipolar disorder is crucial due to the risk of teratogenic effects. Lithium, an effective mood stabilizer, is often avoided in the first trimester, so an alternative is needed.

**Why the Correct Answer is Right**
The patient's history of major depression and mania suggests a diagnosis of bipolar II disorder. Lamotrigine, an anticonvulsant, is a suitable choice for maintaining mood stability in bipolar II disorder, particularly for preventing depressive episodes. It is considered relatively safe during pregnancy, although its use should be closely monitored. Lamotrigine works by inhibiting the reuptake of glutamate and modulating the activity of GABA, which leads to a decrease in neuronal excitability.

**Why Each Wrong Option is Incorrect**
**Option A:** **Lithium** - Although effective for bipolar disorder, lithium is often avoided in the first trimester of pregnancy due to the risk of cardiac malformations.
**Option B:** **Haloperidol** - A typical antipsychotic, haloperidol is not a first-line treatment for bipolar disorder, particularly in pregnancy, due to its potential for extrapyramidal side effects and tardive dyskinesia.
**Option C:** **Valproate** - Another anticonvulsant, valproate is associated with a higher risk of neural tube defects and other congenital malformations, making it a less desirable choice during pregnancy.

**Clinical Pearl / High-Yield Fact**
When treating bipolar disorder in pregnancy, it's essential to weigh the risks and benefits of different medications. A thorough discussion with the patient about the potential risks and benefits of each medication is crucial in making an informed decision.

**Correct Answer:** C. Valproate

✓ Correct Answer: A. Haloperidol