Quetiapine in Postpartum Psychosis

Gobbi, Gabriella

doi:10.1097/jcp.0000000000000162

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…The effectiveness of lithium and ECT is supported by case reports 205 . Successful treatment with antipsychotics has been described in case reports 206,207 , but antipsychotic monotherapy did not show efficacy in a cohort study 203 . Together, lithium monotherapy might be the preferred initial intervention for postpartum psychosis but adjunctive treatment with benzodiazepines or antipsychotics is useful for the acute treatment of agitation, mania and psychotic symptoms, given the well documented effectiveness in non-perinatal populations.…”

Section: [H2] Postpartum Psychosismentioning

confidence: 98%

Postpartum psychiatric disorders

Meltzer‐Brody

Howard

Bergink

et al. 2018

Nat Rev Dis Primers

221

173

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Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.

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Section: [H2] Postpartum Psychosismentioning

confidence: 98%

Postpartum psychiatric disorders

Meltzer‐Brody

Howard

Bergink

et al. 2018

Nat Rev Dis Primers

221

173

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“…Antipsychotic treatment has been shown to be highly effective in preventing postpartum relapse of women with a prior history of postpartum disorder or ongoing psychotic illness. 29,59,60…”

Section: Postpartum Psychotic Disordersmentioning

confidence: 99%

“…Antipsychotic treatment has been shown to be highly effective in preventing postpartum relapse of women with a prior history of postpartum disorder or ongoing psychotic illness. 29,59,60 Because postpartum mothers may also be breastfeeding mothers, several authors have systematically reviewed the topic of safety of antipsychotic use during lactation, [61][62][63][64] but criticism has been leveled at some aspects of the reviewed studies. 65 The issues are the short-and long-term effects of antipsychotics in breastfeeding mothers on children's physical, cognitive, and psychosocial health, and also the antipsychotic side effects on mothers' abilities to care for their neonates.…”

Section: Antipsychotics In the Postpartum Periodmentioning

confidence: 99%

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

González-Rodríguez

Seeman

2019

Therapeutic Advances in Psychopharmacology

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During the postpartum and menopausal periods of women’s lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogens and selective estrogen-receptor modulators, mainly raloxifene, in addition to antipsychotics. Some symptoms appear to respond better than others. No oxytocin study has specifically targeted postmenopausal women. Because of feedback mechanisms, there is a theoretical danger of therapy with exogenous hormones interfering with endogenous secretion and disturbing the balance among inter-related hormones. When used with antipsychotics, hormones may also affect the metabolism and, hence, the brain level of specific antipsychotics. This makes treatment with antipsychotics plus hormones complicated. Dose, timing and route of intervention may all prove critical to efficacy. While much remains unknown, this literature review indicates that, within standard dose ranges, the combination of hormones and antipsychotics for postnatal and menopausal women suffering severe mental distress can be beneficial, and is safe.

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“…In our opinion, lithium monotherapy is the preferred initial intervention for postpartum psychosis (see Figure 2). Antipsychotic treatment has been described in case reports on chlorpromazine, clozapine, pimozide, and quetiapine (82,87). The study described above (86) demonstrated that antipsychotic monotherapy was efficacious in 20% of women within 2 weeks, after which nonremitted women were treated with lithium (86).…”

Section: Treatmentmentioning

confidence: 99%