Selena Gomez says she probably won't carry her own children because of her bipolar medication

• Selena Gomez offered a raw look at her mental health in an interview with Rolling Stone.
• She said she is unlikely to carry children while taking medication for bipolar disorder.

Selena Gomez has put "a lot of hard work" into accepting and managing her bipolar disorder, but parts of that reality still sting years after her diagnosis, she said in a recent interview with Rolling Stone.

In the interview, the 30-year-old singer and actress reflected on her wish to have children and how that might look different than she imagined, given her need for psychiatric medication.

She described visiting a friend who was trying to get pregnant and crying in her car afterward, because she's unlikely to go through that experience herself.

Gomez said she's on two medications to manage her bipolar symptoms, and she doesn't plan to stop taking them to conceive a child. Still, she said she hopes to be a parent someday.

"However I'm meant to have them, I will," she told Rolling Stone.

Although it's possible to get pregnant and breastfeed safely while taking psychiatric medication, some drugs used to treat bipolar disorder have been associated with an increased risk of birth defects, psychiatrist Fabiano Gomes told Insider.

He's treated many women with bipolar disorder, some of whom stopped taking their medication immediately upon learning they were pregnant — which he said is "the last thing you should do," especially for bipolar disorder.

It's possible to manage bipolar disorder while pregnant

In the Rolling Stone interview, Gomez talked about coming to terms with the fact that she may not be able to carry children while taking her medications.

Bipolar disorder is typically treated with mood stabilizers, antipsychotics, or a combination of the two, said Gomes, an assistant professor in the mood disorders program at McMaster University.

With the guidance of healthcare professionals, it is possible to treat bipolar disorder with medication during pregnancy, he said.

Newer antipsychotic medications may be used to treat both the highs and lows of bipolar I, a disorder characterized by severe episodes of mania and depression. But Gomes said documentation of side effects is somewhat limited for newer drugs.

"If the person is already on the medication that we don't have a lot of information about, and they're responding quite well, most patients would continue on that medication and then we would monitor with ultrasounds of the baby," he said.

However, if someone is open to switching to a different medication or tapering off for the duration of pregnancy, Gomes recommends doing so under the supervision of a psychiatrist or physician.

Pregnancy may also increase the risk of a manic or depressive episode for people with bipolar disorder, especially if they choose to stop taking their medication, according to the MGH Center for Women's Mental Health. Closely monitoring mental health during pregnancy is vital for these patients.

Some mood stabilizers increase the risks of birth defects

The most risky bipolar treatment for pregnant patients is Divalproex, also known as valproate, Gomes said.

The mood stabilizer is approved to treat mania associated with bipolar disorder, as well as migraine headaches and seizures. When people take it while pregnant, it's been associated with a significantly increased risk of birth defects, according to the National Organization for Rare Disorders.

Lithium, another mood stabilizer commonly prescribed to treat bipolar disorder, has also been linked to increased risk of heart defects. However, the increase in risk is much smaller — about a 4-fold increase of an already rare defect, Gomes said.

If a pregnant patient is taking lithium and thriving, some providers would consider that an acceptable risk with close monitoring, Gomes said. But whenever possible, he said a transition to solely antipsychotics, at least for the duration of pregnancy and breastfeeding, is a lower-risk option.