Postpartum psychosis is a psychiatric emergency. Evidence supports early use of lithium plus antipsychotics—and, when needed, ECT—to achieve remission and prevent relapse.
Lithium orotate is a lithium salt marketed as a supplement, but we do not have evidence that it is an effective or safer mood stabilizer, and it should not be used as a substitute for standard lithium treatment in pregnancy.
Emerging data suggest that severe sleep loss around labor and delivery may mediate the link between bipolar disorder and postpartum psychosis, offering new targets for prevention.
Postpartum bipolar disorder appears to have a somewhat distinct clinical profile in terms of timing and symptom pattern, but current evidence suggests it is better conceptualized as a subtype of bipolar disorder rather than a fully separate diagnostic entity.
While zuranolone may show promise for the treatment of depressive episodes in patients with bipolar disorder, more research is needed.
This article explores the case of a woman with bipolar disorder who develops HG associated with severe anxiety and sleep disruption, and discusses various treatment options.
The MGHP3 study provides key insights into the onset, duration, treatment, and characteristics of postpartum psychosis in a large, diverse cohort.
Because women with bipolar disorder are at high risk for relapse during the postpartum period, we typically recommend that women continue treatment with lithium throughout the postpartum period. While this intervention clearly decreases risk for postpartum psychiatric illness, the use of lithium while breastfeeding presents certain challenges. Â
Loss of at least one night’s sleep at the time of labor and delivery is a potent risk factor for postpartum psychosis in women with bipolar disorder.
Vigilance is required in screening women who present with postpartum depression; a subset of women who screen positive for depression may actually have bipolar disorder.
