UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Bipolar disorder in pregnant women: Treatment of mania and hypomania

Author
Victoria Hendrick, MD
Section Editors
Paul Keck, MD
Louise Wilkins-Haug, MD, PhD
Deputy Editor
David Solomon, MD

INTRODUCTION

Medications are commonly used to treat pregnant patients, including those with manic and hypomanic episodes [1]. At least one prescription drug is taken by more than 60 percent of pregnant patients [2], and psychotropic drugs are taken by 21 to 33 percent [3,4].

This topic discusses pharmacotherapy for pregnant patients with mania or hypomania. Treatment of bipolar major depression during pregnancy, prenatal maintenance pharmacotherapy for bipolar disorder, the teratogenic and postnatal risks of medications used for bipolar disorder, and the general treatment of mania and hypomania is discussed separately.

(See "Bipolar disorder in pregnant women: Treatment of major depression".)

(See "Bipolar disorder in women: Preconception and prenatal maintenance pharmacotherapy".)

(See "Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy".)

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Sep 26 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004; 161:608.
  2. Newport DJ, Fernandez SV, Juric S, Stowe ZN. Psychopharmacology during pregnancy and lactation. In: The American Psychiatric Publishing Textbook of Psychopharmacology, Fourth Edition, Schatzberg AF, Nemeroff CB. (Eds), American Psychiatric Publishing, Inc., Washington, D.C. 2009. p.1373.
  3. Owen JA. Psychopharmacology. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL. (Ed), American Psychiatric Publishing, Inc., Washington, DC 2011. p.957.
  4. ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 2008; 111:1001.
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  6. Yonkers KA, Vigod S, Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstet Gynecol 2011; 117:961.
  7. Goodwin GM, Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2009; 23:346.
  8. Jones I, Craddock N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry 2005; 186:453.
  9. Burt VK, Bernstein C, Rosenstein WS, Altshuler LL. Bipolar disorder and pregnancy: maintaining psychiatric stability in the real world of obstetric and psychiatric complications. Am J Psychiatry 2010; 167:892.
  10. Shah N. Mood disorder in the perinatal period. BMJ 2012; 344:e1209.
  11. Cipriani A, Barbui C, Salanti G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011; 378:1306.
  12. Frey BN, Macritchie KA, Soares CN, Steiner M. Bipolar disorder in women. In: Bipolar Disorder: Clinical and Neurobiological Foundations, Yatham LN, Maj M. (Eds), Wiley-Blackwell, West Sussex 2010. p.463.
  13. Cohen LS. Treatment of bipolar disorder during pregnancy. J Clin Psychiatry 2007; 68 Suppl 9:4.
  14. Bergink V, Bouvy PF, Vervoort JS, et al. Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry 2012; 169:609.
  15. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002; 159:1.
  16. American Psychiatric Association Practice Guideline for the Treatment of Patients with Bipolar Disorder, Second Edition, 2002. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on August 25, 2011).
  17. Cohen LS, Wang B, Nonacs R, et al. Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am 2010; 33:273.
  18. Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry 2007; 164:1214.
  19. McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry 2005; 66:444.
  20. Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007; 164:1817.
  21. Grunze H, Vieta E, Goodwin GM, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry 2009; 10:85.
  22. Yatham LN, Kennedy SH, Schaffer A, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009; 11:225.
  23. National Institute for Health and Clinical Excellence. Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Clinical Practice Guideline Number 38 http://www.nice.org.uk/ (Accessed on December 30, 2011).
  24. Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol 2008; 28:279.
  25. Diav-Citrin O, Shechtman S, Ornoy S, et al. Safety of haloperidol and penfluridol in pregnancy: a multicenter, prospective, controlled study. J Clin Psychiatry 2005; 66:317.
  26. National Institute for Health and Clinical Excellence. NICE clinical guideline 45. Antenatal and postnatal mental health: Clinical management and service guidance. April 2007 http://www.nice.org.uk/CG045 (Accessed on January 01, 2012).
  27. Janicak PG, Marder SR, Pavuluri MN. Principles and Practice of Psychopharmacotherapy, Fifth Edition, Lippincott Williams & Wilkins, Philadelphia 2011. p.367.
  28. Gentile S. Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophr Bull 2010; 36:518.
  29. Smith LA, Cornelius V, Warnock A, et al. Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials. Bipolar Disord 2007; 9:551.
  30. Burt VK, Stein K. Treatment of women. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales RE, Yodofsky SC, Gabbard GO. (Eds), American Psychiatric Publishing, Inc., Washington, DC 2008. p.1489.
  31. Briggs GG, Freeman RK, Yaffe SJ. Diphenhydramine. In: Drugs in Pregnancy and Lactation, 9th edition, Lippincott Williams & Wilkins, Philadelphia 2009. p.844.
  32. Altshuler LL, Cohen L, Szuba MP, et al. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 1996; 153:592.
  33. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract 2009; 15:183.
  34. Coppola D, Russo LJ, Kwarta RF Jr, et al. Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes. Drug Saf 2007; 30:247.
  35. Jain AE, Lacy T. Psychotropic drugs in pregnancy and lactation. J Psychiatr Pract 2005; 11:177.
  36. Kloos AL, Dubin-Rhodin A, Sackett JC, et al. The impact of mood disorders and their treatment on the pregnant woman, the fetus, and the infant. Curr Psychiatry Rep 2010; 12:96.
  37. Galbally M, Snellen M, Walker S, Permezel M. Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. Aust N Z J Psychiatry 2010; 44:99.
  38. De Hert M, Detraux J, van Winkel R, et al. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol 2011; 8:114.
  39. Choong E, Bondolfi G, Etter M, et al. Psychotropic drug-induced weight gain and other metabolic complications in a Swiss psychiatric population. J Psychiatr Res 2012; 46:540.
  40. Viguera AC, Cohen LS, Baldessarini RJ, Nonacs R. Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry 2002; 47:426.
  41. Gentile S. Drug treatment for mood disorders in pregnancy. Curr Opin Psychiatry 2011; 24:34.
  42. National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 192. December 2014. http://www.nice.org.uk/guidance/cg192 (Accessed on August 27, 2015).
  43. Stewart DE, Vigod SN, Stotland NL. Obstetrics and gynecology. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2011. p.797.
  44. American Psychiatric Association. Use of electroconvulsive therapy in special populations. In: The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, Second Edition, American Psychiatric Association, Washington, DC 2001. p.31.
  45. Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med 2009; 71:235.
  46. Yatham LN, Kennedy SH, O'Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005; 7 Suppl 3:5.
  47. American Psychiatric Association Practice Guideline for the Treatment of Patients With Bipolar Disorder Second Edition http://psychiatryonline.org/guidelines.aspx (Accessed on December 19, 2011).
  48. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1.
  49. Bulbul F, Copoglu US, Alpak G, et al. Electroconvulsive therapy in pregnant patients. Gen Hosp Psychiatry 2013; 35:636.
  50. Pinna M, Manchia M, Pillai G, et al. Efficacy and safety of electroconvulsive therapy in the first trimester of pregnancy: a case of severe manic catatonia. Bipolar Disord 2015; 17:567.
  51. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, third edition. Am J Psychiatry 2010; 167:1.
  52. American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition http://psychiatryonline.org/guidelines.aspx (Accessed on December 19, 2011).
  53. Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Community Psychiatry 1994; 45:444.
  54. Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatry 2001; 46:710.
  55. Yerby MS. Management issues for women with epilepsy: neural tube defects and folic acid supplementation. Neurology 2003; 61:S23.
  56. Radatz M, Ehlers K, Yagen B, et al. Valnoctamide, valpromide and valnoctic acid are much less teratogenic in mice than valproic acid. Epilepsy Res 1998; 30:41.
  57. Bersudsky Y, Applebaum J, Gaiduk Y, et al. Valnoctamide as a valproate substitute with low teratogenic potential in mania: a double-blind, controlled, add-on clinical trial. Bipolar Disord 2010; 12:376.
  58. Burt VK, Suri R, Edelstein C. Treatment of women. In: The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition, Hales RE, Yudofsky SC, Roberts LW. (Eds), American Psychiatric Publishing, Washington, DC 2014. p.1319.
  59. Zappert LN, Rasgon NL. Management of bipolar disorders in women. In: Handbook of Diagnosis and Treatment of Bipolar Disorders, Ketter TA. (Ed), American Psychiatric Publishing, Inc., Washington, DC 2010. p.425.