Protective effect of pregnancy in women with lithium-responsive bipolar disorder.
BACKGROUND
Recent psychiatric literature, while indicating a high incidence of postpartum depression, contains a few clinical reports which support our observations that women with episodic bipolar disorder often remain well without treatment during pregnancy. Our retrospective study statistically examines the clinical course of 28 women with RDC typical bipolar disorder, type I, who became pregnant prior to receiving successful lithium prophylaxis.


METHODS
We derived all data from the International Group for the Study of Lithium-treated Patients (IGSLI) database of excellent lithium responders. Data were compared both intraindividually, using data from three 9-month periods - immediately prior to pregnancy, pregnancy and postpartum - and interindividually, using never-pregnant women as controls.


RESULTS
Intraindividual data show that women with typical bipolar disorder, type I, experience significantly fewer and shorter recurrences during pregnancy than either before or after. Interindividual comparisons indicate that the recurrence risk during pregnancy is markedly lower than the clinical course would predict. Moreover, the few recurrences observed during pregnancy all took place in the last 5 weeks.


CONCLUSIONS
Limiting cases to lithium responsive patients could have reduced heterogeneity and perhaps generalizability.


CONCLUSIONS
The findings, nonetheless, indicate a marked improvement of the clinical course of typical bipolar disorder, type I, lithium-responsive, during pregnancy. Exploring the underlying protective mechanisms may lead to new understanding of the pathophysiology of mood disorders and to new approaches to treatment and prevention.
Grof
P
P
Department of Psychiatry, University of Ottawa, Ottawa, Canada. pgrof@rohcg.on.ca
Robbins
W
W
Alda
M
M
Berghoefer
A
A
Vojtechovsky
M
M
Nilsson
A
A
Robertson
C
C
D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000517:prevention & control*; D019052:Depression, Postpartum / Q000503:physiopathology; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012008:Recurrence; D012189:Retrospective Studies
D018692:Antimanic Agents; D016651:Lithium Carbonate