Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood  Stabilizer Discontinuation

Viguera, Adele C.; Whitfield, Theodore H.; Baldessarini, Ross J.; Newport, D. Jeffrey; Stowe, Zachary N.; Reminick, Alison; Zurick, Amanda; Cohen, Lee S.

doi:10.1176/appi.ajp.2007.06101639

Cited by 468 publications

(301 citation statements)

References 48 publications

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“…Information regarding potential teratogenic effects of different psychotropic medications, as well as limitations of the scientific evidence, should be discussed and carefully considered. 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%

“…A longitudinal study conducted in a tertiary care centre found a high risk of recurrence during pregnancy: 85% of pregnant women with BD who discontinued a mood stabilizer and 37% of those who were maintained on one or more mood stabilizers experienced a mood episode—predominately depressive or mixed—during pregnancy. For nearly half of the patients, recurrence occurred in the first trimester, with the median time for recurrence for those abruptly discontinuing treatment being 2 weeks, compared to 22 weeks for those who were gradually tapered off 511. However, studies from primary care, as well as obstetric centres, found low rates of relapse or hospitalizations in pregnancy 526…”

Section: Specific Populationsmentioning

confidence: 99%

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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%

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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“…In particular, the reported reoccurrence rates for bipolar disorder are approaching 50% in the antenatal period and 70% in the postnatal period (Viguera et al, 2007). Women with a diagnosis of schizophrenia are at an increased risk of psychosis (Munk-Olsen et al, 2006, Munk-Olsen et al, 2009, whilst women with a history of depression are also at an increased risk of its recurrence, continuation, or exacerbation (Bennet, 2004).…”

Section: Introductionmentioning

confidence: 99%

Mothers with mental health problems: Contrasting experiences of support within maternity services in the Republic of Ireland

et al. 2016

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Objective: to explore the views and experiences of women with mental health difficulties, in the Republic of Ireland, accessing and receiving care from publicly-funded maternity care services during pregnancy, childbirth and immediate postnatal period in hospital.Participants: In total 20 women with a range of mental health problems were recruited. The women had given birth within maternity services with and without specialist perinatal mental health services.Design: A qualitative descriptive design using in-depth face to face interviews was used to explore women's experience. Data were analysed using an inductive thematic process.Findings: the study offers valuable insights into the maternity care experiences of women with mental health problems, and highlights the deficits and fragmentation of care in maternity units that do not have a specialist mental health service. Even when the women voluntarily disclosed their difficulties, midwives appeared to lack the knowledge and skills to respond sensitively and responsively.Key conclusions and implications for practice: there is a need to expand perinatal mental health services in the Republic of Ireland, so that quality service provision is not dependent on geography. In addition, there is a need for education to address the lack of knowledge and understanding of perinatal mental health problems amongst maternity care practitioners.

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“…Considerable clinical and research attention has been devoted to documenting both the prevalence of perinatal depression and risk factors for its emergence during the perinatal period. [1][2][3][4] However, much less is known about psychiatric comorbidity in women with perinatal depression. The current study addressed the prevalence of comorbid eating disorders (ED) in these women.…”

Section: Introductionmentioning

confidence: 99%

Eating Disorders and Trauma History in Women with Perinatal Depression

Meltzer‐Brody

Zerwas

Leserman

et al. 2011

Journal of Women's Health

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Objective: Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. Methods: A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n = 99) or postpartum (n = 59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. Results: In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p = 0.02; PHQ-severity 14.5, SD 7.4, p = 0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD = 6.1; PHQ 9.0, SD = 6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p < 0.05), and those with BN were more likely report physical (50.0%, p < 0.05) and sexual (66.7%, p < 0.05) trauma histories. Conclusions: ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

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Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood Stabilizer Discontinuation

Cited by 468 publications

References 48 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

Mothers with mental health problems: Contrasting experiences of support within maternity services in the Republic of Ireland

Eating Disorders and Trauma History in Women with Perinatal Depression

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