Latimer: Preventing postpartum psychosis in women at risk

As in any medical treatment, the goal is always to measure the potential benefits of a treatment against its inherent risks.

As most of us likely are aware, pregnancy and the postpartum period are times of increased risk for women to develop mood symptoms.

This risk is highest among those with a history of psychiatric illness.

While we are aware of the risk and do have treatments to help alleviate postpartum depression or psychosis when it occurs, there has always been a certain amount of discussion surrounding what steps should be taken during pregnancy for those who know they are at the highest risk.

As in any medical treatment, the goal is always to measure the potential benefits of a treatment against its inherent risks.

When it comes to medical treatment during pregnancy, we are always very cautious because of the vulnerability of the unborn baby.

Very often, treatments are delayed or stopped during pregnancy to avoid exposing the fetus to unnecessary risks.

When it comes to psychiatric treatment, things can be complicated. There are some medications we know to be harmful to a developing fetus, yet many psychiatric medications are considered safe to take while pregnant.

Women generally consider whether a relapse of their psychiatric condition is likely to put the baby at risk.

If stopping medication could trigger psychotic symptoms, a deep depression or manic episode, it may be safer for mother and child if treatment is continued.

A relatively recent study of women at risk for relapse in bipolar disorder or postpartum psychosis came to some interesting conclusions.

When it comes to preventing postpartum psychosis or mania, treatment with lithium is known to be effective.

However, in light of the need to balance risks with benefits, researchers compared the effectiveness of continuing lithium treatment throughout pregnancy with starting it immediately postpartum.

For this study, 70 women known to be high risk for postpartum psychosis took part. Those who were not already taking lithium were advised to begin lithium immediately postpartum, while those who were already being treated continued their lithium throughout the pregnancy.

All women with a history of postpartum psychosis (who did not experience psychotic symptoms at other times in their lives) remained stable throughout their pregnancy regardless of whether they were taking lithium.

Nearly half (44 per cent) of women who declined to take lithium postpartum experienced a psychosis relapse.

Of the women with bipolar disorder, almost a quarter relapsed during pregnancy in spite of lithium treatment during pregnancy.

In light of these results, study authors recommend simply starting treatment postpartum for women with a history of psychosis that is limited to the postpartum period. This will reduce unnecessary fetal exposure to medication.

Women with bipolar disorder should likely continue their treatment throughout pregnancy and the postpartum period to avoid relapse.

As always, if you are pregnant or considering having a child, it is best to discuss your medical and psychiatric history with your doctor as early as possible to come up with a plan that will be best suited to your individual situation.

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