Management of Bipolar Disorder During Pregnancy and the Postpartum Period

Yonkers, Kimberly A.; Wisner, Katherine L.; Stowe, Zachary N.; Leibenluft, Ellen; Cohen, Lee S.; Miller, Laura J.; Manber, Rachel; Viguera, Adele C.; Suppes, Trisha; Altshuler, Lori L.

doi:10.1176/appi.ajp.161.4.608

Cited by 336 publications

(248 citation statements)

References 103 publications

Supporting

Mentioning

199

Contrasting

Unclassified

Order By: Relevance

“…The decision to stop medications pre‐conceptually should ideally occur only after careful individualized risk‐benefit analysis for a given patient 511, 512, 513. If pharmacotherapy is required, monotherapy at minimum effective dose is recommended whenever possible 514, 515…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

Self Cite

View full text Add to dashboard Cite

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

show abstract

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…de desenvolver, ao longo do curso da doença e geralmente de forma transitória, fases de ciclagem rápida (Leibenluft, 1996a;Yonkers et al, 2004). A ciclagem rápida está presente em 15% a 20% dos pacientes com TAB que se apresentam para tratamento e as mulheres respondem por 58% a 92% dos cicladores rápidos, com média de 71% (Arnold, 2003).…”

Section: Características Especiais Ciclagem Rápidaunclassified

“…Anomalias craniofaciais também podem ocorrer após o primeiro trimestre, assim como alterações neurocomportamentais (Yonkers et al, 2004).…”

Section: Tratamento Na Gravidezunclassified

“…Em casos mais leves (um episódio manía-co prévio ou períodos longos de estabilidade) pode ser feita a tentativa de descontinuação da medicação, sempre lentamente (Yonkers et al, 2004), antes da concepção. Para quadros moderados, a retirada gradual também poderá ser feita, porém após confirmação precoce da gravidez (duas primeiras semanas, antes do estabelecimento da circulação materno-fetal).…”

Section: Tratamento Na Gravidezunclassified

“…Doses insuficientes exporiam a criança tanto ao risco de recaída materna quanto ao medicamento (Burt e Rasgon, 2004). Como, muitas vezes, a gravidez ocorre inesperadamente, seria preciso discutir essa possibilidade e suas implicações para o tratamento com toda paciente com TAB em idade reprodutiva (Yonkers et al, 2004).…”

Section: Tratamento Na Gravidezunclassified

See 2 more Smart Citations

O transtorno bipolar na mulher

Guerra¹,

Calil

2005

Rev. psiquiatr. clín.

View full text Add to dashboard Cite

ResumoDiferenças sexuais, descritas em vários transtornos psiquiátricos, também parecem estar presentes no transtorno afetivo bipolar (TAB). A prevalência do TAB tipo I se distribui igualmente entre mulheres e homens. Mulheres parecem estar sujeitas a um risco maior de ciclagem rápida e mania mista, condições que fariam do TAB um transtorno com curso mais prejudicial no sexo feminino. Uma diátese depressiva mais marcante, uso excessivo de antidepressivos e diferenças hormonais surgem como hipóteses para explicar essas diferenças fenomenológicas, apesar das quais, mulheres e homens parecem responder igualmente ao tratamento medicamentoso. A indicação de anticonvulsivantes como primeira escolha em mulheres é controversa, a não ser para o tratamento da mania mista e, talvez, da ciclagem rápida. O tratamento do TAB na gravidez deve levar em conta tanto os riscos de exposição aos medicamentos quanto à doença materna. A profilaxia do TAB no puerpério está fortemente indicada em decorrência do grande risco de recorrência da doença nesse período. Embora, de modo geral, as medicações psicotrópicas estejam contra-indicadas durante a amamentação, entre os estabilizadores do humor, a carbamazepina e o valproato são mais seguros do que o lítio. Mais estudos são necessários para a confirmação das diferenças de curso do TAB entre mulheres e homens e a investigação de possíveis diferenças na efetividade dos tratamentos.Palavras-chave: Transtorno bipolar, diferenças sexuais, gravidez, puerpério, amamentação. AbstractGender differences, described in several psychiatric disorders, seem to be also present in bipolar disorder (BD). The prevalence of bipolar I disorder is equally distributed between women and men. Women seem to be at higher risk for rapid cycling and mixed mania, conditions that could make BD a disorder with a more severe course in the female sex. A marked depressive diathesis among women, greatest use of antidepressants and hormonal differences have been mentioned as hypotheses to explain these phenomenological differences. However, women and men seem to respond equally to medication. The indication of anticonvulsivants as first-line treatment in women is controversial, except

show abstract