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Published online by Cambridge University Press:  07 November 2014

Terence A. Ketter
Affiliation:
Dr. Ketter is professor of psychiatry in the Department of Psychiatry and Behavioral Sciences and chief of the Bipolar Disorders Clinic at, Stanford University School of Medicinein Stanford, California.
Trisha Suppes
Affiliation:
Dr. Suppes is professor of psychiatry in the Department of Psychiatry at the, University of Texas Southwestern Medical Centerin Dallas.
Martha J. Morrell
Affiliation:
Dr. Morrell is clinical professor of neurology in the Department of Neurology at, Stanford Universityand chief medical officer of NeuroPace, Inc, a company involved in development of a medical device to treat epilepsy.
Natalie Rasgon
Affiliation:
Dr. Rasgon is associate professor of psychiatry in the Department of Psychiatry and Behavioral Sciences, director of the Behavioral Neuroendocrinology Program, and co-director of the Women's Wellness Clinic at, Stanford University School of Medicinein California.
Lee S. Cohen
Affiliation:
Dr. Cohen is director of the Perinatal and Reproductive Psychiatry Clinical Research Program within the Clinical Psychopharmacology Unit of, Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.
Adele C. Viguera
Affiliation:
Dr. Viguera is associate director of the Perinatal and Reproductive Psychiatry Program at, Massachusetts General Hospital and assistant professor of psychiatryat Harvard Medical School in Boston.

Abstract

The 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.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2003

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