Postpartum psychosis big risk for mothers with bipolar disorder

From Northwestern University:

CHICAGO — Pregnant women with bipolar disorder and their families and physicians should be aware of a significantly higher risk for developing postpartum psychosis, according to a new Northwestern Medicine review of literature on the rare and under-researched disorder.

Postpartum psychosis almost always stems from bipolar disorder but is often missed because of its rarity and lack of research on the subject, according to the review from Northwestern Medicine, Stanford University and Erasmus Medical Center in the Netherlands.

Compounding the problem, physicians are reluctant to prescribe lithium for breastfeeding women for fear that the drug will negatively impact the baby. However, a small number of lithium-treated mothers and breastfed babies have been studied and the infants had no adverse effects with careful followup, Wisner said. Lithium is the most effective and fast-acting drug to treat postpartum psychosis.

Postpartum psychosis increases the risk for a mother harming or killing her baby or herself.

“More often than not, the risk of the medication is less than the risk of the uncontrolled disorder,” said senior author Dr. Katherine Wisner, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine psychiatrist.

“This is a really serious disorder, and no one likes to treat women with medication during pregnancy or breastfeeding, but there’s certainly very high risk in not treating as well, such as the risk for suicide,” Wisner said.

Lithium is recommended as the first line of medication, according to the review, which was published today, Sept. 9, in The American Journal of Psychiatry.

Awareness of the treatable disorder and diagnosing it can prevent tragedy, according to the review. But because only one or two out of every 1,000 mothers are affected and the lack of research on the disorder, …

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