Section - Video Lectures

11. Prevention of Postpartum Bipolar Disorder and Psychosis

Published on December 5, 2019 Expired on April 1, 2023

Marlene P. Freeman, M.D.

Associate Professor of Psychiatry - Harvard Medical School

Key Points

Postpartum psychosis is a serious and recurrent condition; women who have had it previously are at high risk of recurrence.
Women who have had no other psychiatric history of psychosis or mood episodes other than postpartum psychosis may be able to get through pregnancy without psychotropic medication.
The risk of postpartum psychosis recurrence is high, and women should be started on lithium or an antipsychotic immediately after delivery, if not earlier. Careful monitoring is required.
Women with bipolar disorder are at risk for recurrence when medications are discontinued or changed; pregnancy is not protective.

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Slides and Transcript

Slide 1 of 7

Okay. Next, we’ll talk about the prevention of postpartum bipolar mood episodes and postpartum psychosis. So women who have diagnosis of bipolar disorder or who have previously experienced postpartum psychosis are at very high risk of relapse to serious psychiatric illness in the postpartum. And what we do know is that pharmacotherapy can play an extremely important role in the prevention of severe psychiatric illness in these women. Specifically, in bipolar disorder, we know that there’s a high risk of relapse whenever women stop medication that’s been maintaining their wellness. So that’s true during pregnancy. And it’s especially true in the postpartum that if women have stopped medication for pregnancy, they’re at risk for relapse during the pregnancy but especially for relapse postpartum.

Prevention of Postpartum Bipolar Disorder and Psychosis Slide 1 of 7

Slide 2 of 7

So if a woman has stopped the mood stabilizer during pregnancy, we recommend that she restart the medication immediately after delivery even if she is free of symptoms to prevent the occurrence of postpartum mood episodes and postpartum psychosis. This has been best studied with lithium. Although if a woman has been mood stabilized on a different medication, that may be reasonable to restart immediately after delivery as well. Now, with postpartum psychosis, the same has been shown that if women have had postpartum psychosis before, it is a highly recurrent condition. But the risk can be avoided by starting lithium or a mood stabilizer immediately after delivery with lithium being the best studied.

References:

Altshuler, L. L., Hendrick, V., & Cohen, L. S. (2000). An update on mood and anxiety disorders during pregnancy and the postpartum period. Primary care companion to the Journal of clinical psychiatry, 2(6), 217.

Prevention of Postpartum Bipolar Disorder and Psychosis Slide 2 of 7

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12. Take-Home Messages

Learning Objectives:

After completing this activity, the learner will be able to:

Identify women at risk for postpartum mood disorders so as to offer the best possible treatment.
Describe treatment strategies for postpartum mood disorders and apply them accordingly.

Original Release Date: December 5, 2019

Review and Re-release Date: March 1, 2023

Expiration Date: April 1, 2023

Relevant Financial Disclosures:

Marlene Freeman declares the following interests:

- JayMac, Sage: Investigator

- Otsuka, Alkermes, Sunovion: Advisory boards

- Janssen: Independent Data Safety and Monitoring Committee

- Medscape: Steering Committee for Educational Activities

All of the relevant financial relationships listed for these individuals have been mitigated.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Answer the quiz for promoting retention of knowledge.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.