Bipolar Disorder in Pregnancy and Postpartum: Principles of Management

Current Psychiatry Reports
Sabrina J KhanShari I Lusskin

Abstract

Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.

References

Jan 12, 1994·JAMA : the Journal of the American Medical Association·L S CohenM L Weiner
Feb 15, 2000·The American Journal of Psychiatry·A C VigueraR J Baldessarini
Oct 24, 2001·Epilepsy Research·A SabersE L Hansen
May 15, 2002·The Journal of Clinical Psychiatry·Marlene P FreemanPaul E Keck
Aug 27, 2003·Neurology·Anne SabersTorbjörn Tomson
Apr 2, 2004·The American Journal of Psychiatry·Kimberly A YonkersLori Altshuler
Apr 9, 2005·The Journal of Clinical Psychiatry·Kate McKennaAdrienne Einarson
Nov 3, 2005·The American Journal of Psychiatry·D Jeffrey NewportZachary N Stowe
Jul 27, 2006·The Annals of Pharmacotherapy·Madhu Page-SharpKenneth F Ilett
Aug 9, 2006·Neurology·K J MeadorUNKNOWN NEAD Study Group
Feb 3, 2007·The American Journal of Psychiatry·Adele C VigueraLee S Cohen
Aug 3, 2007·The American Journal of Psychiatry·D Jeffrey NewportZachary N Stowe
Apr 12, 2008·Bipolar Disorders·D Jeffrey NewportRoss J Baldessarini
May 16, 2008·Journal of Clinical Psychopharmacology·Margareta Reis, Bengt Källén
Jul 25, 2008·Neurology·H DolkUNKNOWN EUROCAT Antiepileptic Drug Working Group
Dec 17, 2008·Psychosomatic Medicine·Eric L Anderson, Irving M Reti
Nov 4, 2009·The American Journal of Psychiatry·Verinder SharmaHendrica L Ritchie
Mar 4, 2010·Archives of Women's Mental Health·Cheryl Ann Chessick, Sona Dimidjian
Aug 10, 2010·Epilepsy Research·Ivana KacirovaHana Brozmanova
Nov 26, 2010·Neurology·K J MeadorUNKNOWN NEAD Study Group
Dec 28, 2010·Journal of Affective Disorders·Verinder Sharma, Bin Xie
Feb 5, 2011·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Hilal OzkanSenay Yapici
Mar 23, 2011·Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)·M A Marín GabrielN Gutiérrez Cruz
May 19, 2011·JAMA : the Journal of the American Medical Association·Ditte Mølgaard-Nielsen, Anders Hviid
Sep 2, 2011·Handbook of Experimental Pharmacology·Torbjörn Tomson, Dina Battino
Oct 11, 2011·Annals of Epidemiology·Martha M WerlerUNKNOWN National Birth Defects Prevention Study
Oct 18, 2011·Early Human Development·N Margreth van der LugtFrans J Walther
Jan 27, 2012·Archives of Women's Mental Health·Debra L BogenKatherine L Wisner
Mar 1, 2012·Seizure : the Journal of the British Epilepsy Association·E MawhinneyJ Morrow
Apr 5, 2012·Archives of General Psychiatry·Katrina C JohnsonD Jeffrey Newport
May 4, 2012·Neurology·S Hernández-DíazUNKNOWN North American AED Pregnancy Registry
Jul 4, 2012·Archives of General Psychiatry·Robert BodénHelle Kieler
Sep 4, 2012·The Journal of Clinical Psychiatry·Verinder Sharma, Carley J Pope
Apr 25, 2013·JAMA : the Journal of the American Medical Association·Jakob ChristensenMogens Vestergaard

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Citations

Nov 5, 2016·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Faruk Uguz
Dec 10, 2016·Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine·Philip O Anderson
Apr 14, 2017·The Australian and New Zealand Journal of Psychiatry·Olga Zivanovic
May 10, 2017·Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine·Caroline Morin, Isabelle Chevalier
Aug 22, 2017·The Australian and New Zealand Journal of Psychiatry·Carolyn Haskey, Megan Galbally
Mar 22, 2018·Clinical Obstetrics and Gynecology·Shari I LusskinElizabeth S Albertini
Jun 12, 2020·Bipolar Disorders·Nina M MolenaarVeerle Bergink
Sep 26, 2019·Frontiers in Pharmacology·Maria Luisa ImazRocio Martin-Santos
Nov 9, 2019·Current Psychiatry Reports·Alison HermannAbigail Benudis
Feb 13, 2020·Focus : Journal of Life Long Learning in Psychiatry·Elizabeth AlbertiniRachel S Tamaroff
Nov 10, 2020·Perspectives in Psychiatric Care·Brayden N Kameg
Dec 4, 2020·General Hospital Psychiatry·Amelia C WendtAmritha Bhat
Apr 8, 2021·Revista brasileira de psiquiatria : orgão oficial da Associação Brasileira de Psiquiatria, Asociación Psiquiátrica de la América Latina·Faruk Uguz, Aysegul Kirkas
Dec 24, 2020·The Australian and New Zealand Journal of Psychiatry·Gin S MalhiGreg Murray

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