Treatment of Bipolar Disorder During the Postpartum Period

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Treatment of Bipolar Disorder During Pregnancy

CNS Spectrums ◽

10.1017/s1092852900025712 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 11-12

Author(s):

Lee S. Cohen

Keyword(s):

Bipolar Disorder ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

History Of ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Selection of Appropriate Therapy: Valproate and Reproductive Function

CNS Spectrums ◽

10.1017/s1092852900025694 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 7-9

Author(s):

Natalie Rasgon

Keyword(s):

Bipolar Disorder ◽

Reproductive Function ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Reproductive Health and Bipolar Disorder

CNS Spectrums ◽

10.1017/s1092852900025608 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 1-16 ◽

Cited By ~ 19

Author(s):

Trisha Suppes

Keyword(s):

Bipolar Disorder ◽

Reproductive Health ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Question-and-Answer Forum

CNS Spectrums ◽

10.1017/s1092852900025736 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 15-16

Author(s):

Terence A. Ketter ◽

Trisha Suppes ◽

Martha J. Morrell ◽

Natalie Rasgon ◽

Lee S. Cohen ◽

...

Keyword(s):

Bipolar Disorder ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

History Of ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Gender Differences in Bipolar Disorder

CNS Spectrums ◽

10.1017/s1092852900025670 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 2-4

Author(s):

Trisha Suppes

Keyword(s):

Bipolar Disorder ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

History Of ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Effects of the Female Reproductive System on Bipolar Disorder

CNS Spectrums ◽

10.1017/s1092852900025682 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 5-6

Author(s):

Terence A. Ketter

Keyword(s):

Bipolar Disorder ◽

Reproductive System ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

Female Reproductive System ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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Pola Penggunaan Obat Mood Stabilizer Pada Pasien Bipolar di Rumah Sakit Jiwa Daerah Atma Husada Mahakam

Proceeding of Mulawarman Pharmaceuticals Conferences ◽

10.25026/mpc.v10i1.368 ◽

2019 ◽

Vol 10 ◽

pp. 86-93

Author(s):

Annida Rifaya ◽

Risna Agustina ◽

Rolan Rusli

Keyword(s):

Bipolar Disorder ◽

Atypical Antipsychotics ◽

Early Adulthood ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

School Level ◽

Research Subjects ◽

High School Level ◽

Bipolar Patients ◽

Depressive Episodes

Bipolar disorder is a chronic mood disorder characterized by episodes of mania or hypomania that occur alternately or mixed with depressive episodes. This study aims to determine the characteristics of bipolar patients and patterns of drug use inpatient and outpatient bipolar patients at Atma Husada Mahakam Hospital. The type of this research is non experimental (descriptive) and done retrospectively. Data are collected from medical record. Research subjects were 84 inpatients and 137 outpatients with bipolar disorder diagnosis. Data are analyzed by describing research's objects. The results were obtained from inpatient and outpatient data showing 63% and 60% female sex, showing 26-35 years (early adulthood), not working, not married, and high school level education. The most usage pattern of drugs is a combination of 2 and 3 drugs, namely 74.99% for inpatient care and 73.71% for outpatient treatment. The drugs most commonly used are mood stabilizers (valproate acid) and atypical antipsychotics (risperidone).

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Drug Class Summaries and Dosing Guidelines

Clinical Psychopharmacology ◽

10.1093/med/9780199995486.003.0014 ◽

2018 ◽

pp. 158-165

Author(s):

S. Nassir Ghaemi

Keyword(s):

Bipolar Disorder ◽

Side Effects ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Bipolar Illness ◽

Drug Classes ◽

Second Generation Antipsychotics ◽

Reasonable Evidence ◽

Depressive Episodes ◽

Major Drug

A “mood stabilizer” is a drug that prevents mania and depressive episodes in bipolar disorder. The four drugs that have reasonable evidence that they can do this are lithium, Depakote, carbamazepine, and Lamictal. Second generation antipsychotics are not mood stabilizers, despite the FDA maintenance indications that many have received, because of the invalidity of the enriched, randomized, discontinuation maintenance design. Thus, all patients with bipolar illness should receive one of those four mood stabilizers, and dopamine blockers should be used as adjuncts, but not by themselves. In this chapter, a summary is given of the major drug classes, and the agents within those classes. Specific dosing guidelines are provided for most agents. Main clinical side effects and drug interactions are reviewed.

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Bipolar depression: trial-based insights to guide patient care

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2008.10.2/dekemp ◽

2008 ◽

Vol 10 (2) ◽

pp. 181-192 ◽

Cited By ~ 1

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Unmet Need ◽

Mood Stabilizers ◽

Number Needed To Treat ◽

Clinical Approach ◽

Clinical Trial Results ◽

Major Depressive Episodes ◽

Depressive Episodes ◽

Illness Phase

For the majority of patients with bipolar disorder, major depressive episodes represent the most debilitating and difficult-to-treat illness dimension. Patients spend significantly more time depressed than manic or hypomanic, and attempt suicide more frequently during this illness phase, yet the availability of treatments remains limited. The discovery of more effective therapeutics for managing depressive episodes is arguably the greatest unmet need in bipolar disorder. This article provides an evidence-based summary of pharmacological treatments for the acute and longitudinal management of bipolar depression. Clinical trial results are reviewed for a diverse array of compounds, inclusive of traditional mood stabilizers (eg, lithium and divalproex), atypical antipsychotics, unimodal antidepressants, and modafinil. Where applicable, differences in efficacy across compounds are examined through discussion of number needed to treat and effect size determinations. A pragmatic clinical approach is presented for management of the depressed phase of bipolar disorder.

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