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Archive | bipolar disorder

Clinical Guidelines for Lithium Dosing During Pregnancy

  We have an abundance of articles which address the impact of psychotropic medications on pregnancy.  Much less research, however, has focused on how pregnancy may affect how these medications work. Physiologic changes take place during pregnancy which may affect the absorption, distribution, metabolism, and elimination of medications.  These pharmacokinetic changes may result in lower […]

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Oxcarbazepine (Trileptal) and Pregnancy: Do We Have Enough Information?

  Last week in clinical rounds we discussed a case of a woman with bipolar disorder who was planning a pregnancy.  She had a long history of illness, experiencing primarily depressive episodes since her early 20’s.  The only mood stabilizer that seems to have worked for her has been oxcarbazepine (Trileptal) and she is currently […]

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Lamotrigine Reduces Risk for Postpartum Relapse in Women with Bipolar Disorder

Numerous studies have demonstrated that women with histories of bipolar disorder are at high risk for postpartum illness.  Because of this increased risk for relapse during the postpartum period, we typically recommend that women with histories of bipolar disorder continue treatment with a mood stabilizer throughout the postpartum period.  Historically, lithium has been the most […]

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Lamotrigine and Pregnancy: Meta-Analysis Shows No Increase in Risk for Malformations

  Maintenance treatment with a mood stabilizer during pregnancy can significantly reduce the risk of relapse in women with bipolar disorder; however, many of the mood stabilizers commonly used in this setting, including lithium and valproic acid, carry some degree of teratogenic risk. In contrast, lamotrigine (Lamictal) appears to be a much safer option for […]

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Worse Pregnancy Outcomes in Women with Bipolar Disorder

When we meet women for consultations regarding the use of psychotropic medications during pregnancy, we focus primarily on the impact of medications on the developing fetus and the pregnancy.  However, we need also to address the impact of psychiatric illness in the mother on the pregnancy.  In studies of pregnant women with unipolar depression, it […]

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Clinical Case: Breastfeeding in a Woman with Bipolar Disorder

Ms. C is a woman with a long history of bipolar disorder, dating back to her teen years.  Because she experienced recurrent hypomania and mania every time she attempted to discontinue her treatment, she and her psychiatrist decided that she would remain on her regular regimen of medications during pregnancy and the postpartum period, which […]

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Adjunctive Treatment with Medroxyprogesterone in Women with Acute Mania

Women with bipolar disorder often experience fluctuating mood symptoms across the menstrual cycle, typically reporting an exacerbation of symptoms during the premenstrual phase of the cycle (Rasgon et al, 2003, 2005).  Other studies have indicated that women with bipolar disorder have more affective instability as they transition into the menopause, when there are pronounced fluctuations […]

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Screening for Depression During Pregnancy May Lead to Misdiagnosis for Women with Bipolar Disorder

The American College of Obstetrics and Gynecology now recommends that women be screened for depression during pregnancy.  Because depressive symptoms during pregnancy have been associated with worse outcomes and are a robust predictor of postpartum depression, the identification of women with depression during pregnancy would help us to identify women in need of treatment and […]

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