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Am J Psychiatry 1995; 152:1641-1645
Copyright © 1995 by American Psychiatric Association
Postpartum prophylaxis for women with bipolar disorder
LS Cohen, DA Sichel, LM Robertson, E Heckscher and JF Rosenbaum
Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA.
OBJECTIVE: The postpartum period has typically been considered a time of
heightened vulnerability for development of affective disorders, and women
with bipolar disorder have consistently demonstrated vulnerability to
puerperal worsening of mood. This retrospective study examined the extent
to which mood-stabilizing agents provide prophylactic benefit to bipolar
women during the postpartum period. METHOD: The clinical course of 27 women
meeting the DSM-III-R criteria for bipolar disorder was followed during
pregnancy and the postpartum period. Information regarding severity of
illness (as measured by number of episodes of mania, depression, or both)
was obtained, in addition to data on pharmacotherapy (if any) received
before, during, and after pregnancy. The extent to which the prophylactic
use of antimanic agents minimized the risk of relapse was explored.
RESULTS: Only one of the 14 patients taking prophylactic agents during the
acute puerperium relapsed within the first 3 months postpartum, while eight
of the 13 who did not receive antimanic drugs showed evidence of recurrent
affective instability during those 3 months. A survival analysis indicated
that the women receiving prophylactic treatment with mood stabilizers
maintained well-being significantly longer than the women who did not
receive such treatment. CONCLUSIONS: Women with bipolar disorder appear to
benefit from puerperal prophylaxis with mood stabilizers. Consistent with
results of earlier studies, postpartum prophylaxis was associated with
lower rates of relapse into affective disorders. The findings have
implications for the early identification and treatment of subgroups of
women at particular risk for puerperal illness.
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