Treatment of Peripartum Bipolar Disorder

Abstract

Bipolar disorder affects women throughout their childbearing years. During the perinatal period, women with bipolar disorder are vulnerable to depressive episode recurrences and have an increased risk for postpartum psychosis. Perinatal screening is critical to identify women at risk. Although medications are the mainstay of treatment, the choice of pharmacotherapy must be made by the patient based on a risk-benefit discussion with her physician. For optimal dosing in pregnancy, therapeutic drug monitoring may be required to maintain effective drug concentrations. Residual symptoms of bipolar depression are treatable with bright light therapy as an alternative to medication augmentation.

Keywords: Antipsychotics; Bipolar disorder; Carbamazepine; Lamotrigine; Light therapy; Lithium; MDQ; Pregnancy.

Fig. 1.

Treatment algorithm. ^a Additional risk–benefit information and patient Fact Sheetsavailable at Mother to Baby (mothertobaby.org). ^b Patients with a family history of bipolardisorder (item 4 of the Mood Disorder Questionnaire [MDQ]) require monitoring for antide pressant induced activation. EPDS, Edinburgh Postnatal Depression Scale.