POSTPARTUM PROPHYLAXIS FOR WOMEN WITH BIPOLAR DISORDER

Objective: The postpartum period has typically been considered a time of heightened vulnerability for development of affective disorders, an d women with bipolar disorder have consistently demonstrated vulnerabi lity to puerperal worsening of mood. This retrospective study examined the extent to which mood-stabilizing agents provide prophylactic bene fit to bipolar women during the postpartum period. Method: The clinica l course of 27 women meeting the DSM-III-R criteria for bipolar disord er was followed during pregnancy and the postpartum period. Informatio n regarding severity of illness (as measured by number of episodes of mania, depression, or both) was obtained, in addition to data on pharm acotherapy (if any) received before, during, and after pregnancy. The extent to which the prophylactic use of antimanic agents minimized the risk of relapse was explored. Results: Only one of the 14 patients ta king prophylactic agents during the acute puerperium relapsed within t he first 3 months postpartum, while sight of the 13 who did not receiv e antimanic drugs showed evidence of recurrent affective instability d uring those 3 months. A survival analysis indicated that the women rec eiving prophylactic treatment with mood stabilizers maintained well-be ing significantly longer than the women who did not receive such treat ment. Conclusions: Women with bipolar disorder appear to benefit from puerperal prophylaxis with mood stabilizers, Consistent with results o f earlier studies, postpartum prophylaxis was associated with lower ra tes of relapse into affective disorders. The findings have implication s for the early identification and treatment of subgroups of women at particular risk for puerperal illness.