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Lancet Psychiatry. 2019 Sep;6(9):786-792. doi: 10.1016/S2215-0366(19)30092-6. Epub 2019 Apr 10.

Childbirth and prevention of bipolar disorder: an opportunity for change.

Author information

1
Department of Psychiatry and Department of Obstetrics and Gynecology, Western University, London, ON, Canada; Parkwood Institute, London, ON, Canada. Electronic address: vsharma@uwo.ca.
2
Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.
3
Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Florey Institute for Neuroscience and Mental Health, and the Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
4
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
5
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
6
Cleveland Clinic, Cleveland, OH, USA; Massachusetts General Hospital, Boston, MA, USA.
7
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.

Abstract

The recent conceptualisation of bipolar disorder as a neuroprogressive illness has highlighted the potential importance of prevention and early intervention in high-risk populations. Undiagnosed bipolar disorder early in the disease course is associated with adverse clinical outcomes and impaired functioning for patients, which in turn has economic consequences. Despite the mounting evidence that childbirth is one of the most potent and specific triggers of manic symptoms, studies are not available on the effectiveness of targeted interventions in the prevention of bipolar disorder in women who have recently given birth. In this Personal View, we describe the clinical characteristics of women at risk of developing bipolar disorder after childbirth, before discussing opportunities for prevention and early intervention and outlining challenges in the assessment and management of women at risk of transitioning to bipolar disorder after childbirth. Existing evidence, although scarce, supports a clinical staging model by which at-risk women are managed with a variety of behavioural and pharmacological interventions aimed at preventing bipolar disorder. Close monitoring and early intervention might reduce the risk of hypomanic or manic symptoms in women at risk of developing bipolar disorder after childbirth; however, the potential benefits of early identification and intervention need to be carefully balanced against the additional risks for affected women.

PMID:
30981755
DOI:
10.1016/S2215-0366(19)30092-6
[Indexed for MEDLINE]

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