Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis

Wesseloo, Richard; Kamperman, Astrid M.; Munk‐Olsen, Trine; Pop, Victor J.M.; Kushner, Steven A.; Bergink, Veerle

doi:10.1176/appi.ajp.2015.15010124

Cited by 365 publications

(270 citation statements)

References 52 publications

(79 reference statements)

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“…The postpartum period is a time of elevated risk for recurrence, with 66% of women who were medication free during pregnancy and 23% of those on treatment experiencing a mood episode following the delivery 534. The risk of postpartum relapse is highest in women who also experienced a mood episode during pregnancy and those who are not on prophylactic treatment 535.…”

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

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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.

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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

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“…A recent meta-analysis of studies reporting on postpartum recurrences found that the rates varied widely; for bipolar disorder between 9 and 75%; and for puerperal psychosis between 14 and 57% (Wesseloo et al, 2016). This may well reflect differences in definitions of recurrence, the range of phenotypes being included and, importantly, whether women were or were not on medication.…”

Section: Risks Related To Bipolar Disordermentioning

confidence: 99%

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

et al. 2017

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Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, due to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.

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“…Almost one in five (17%) new mothers with BD are admitted for psychiatric treatment in the early postpartum (Wesseloo et al, 2016), a period in which the risk of admission is significantly greater for these women than at any other time in their lives (Munk-Olsen et al, 2009). Relative to the general population, the risk of postpartum psychosis (PP) is dramatically elevated in women with BD, increasing from one in a thousand to approximately one in five deliveries (Di Florio et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Adverse childhood life events and postpartum psychosis in bipolar disorder

Perry

Gordon‐Smith

Florio

et al. 2016

Journal of Affective Disorders

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Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis

Cited by 365 publications

References 52 publications

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

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

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

Adverse childhood life events and postpartum psychosis in bipolar disorder

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