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1.
Bipolar Disord ; 19(4): 295-304, 2017 06.
Article in English | MEDLINE | ID: mdl-28665044

ABSTRACT

OBJECTIVE: We conducted a prospective naturalistic study of pregnant women with bipolar disorder (BD) to evaluate symptoms of BD across childbearing and assess whether pharmacotherapy reduced their severity. METHODS: Assessments were scheduled at 20, 30, and 36 weeks' gestation and 2, 12, 26, and 52 weeks postpartum. Symptoms were assessed using the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Supplement (SIGH-ADS) and Mania Rating Scale (MRS). RESULTS: Pregnant women (N=152) with BD were evaluated; 88 women (58%) were treated and 64 untreated (42%) with psychotropic drugs during pregnancy. Among the 88 women treated, 23 (26%) discontinued their medication in the first trimester and the remaining 65 (74%) were exposed throughout pregnancy or in the second and third trimesters. More than two-thirds (73%) of the women who remained in the study took psychotropic agents postpartum. The mean scores on the SIGH-ADS were in the mild range of depressive symptoms in both the psychotropic-treated and untreated groups in both pregnancy and postpartum. The majority of women had no or few symptoms of mania. Of the pregnant women treated with psychotropic agents, 66% received a guideline-concordant drug, and 34% received either antidepressant monotherapy (for BD I) or mono- or polypharmacy with a variety of other agents. CONCLUSIONS: This sample of perinatal women with BD was characterized by mild residual symptoms of depression independent of pharmacotherapy, which poses a risk for recurrence and impaired parenting. The treatment of childbearing women with BD deserves urgent clinical and research attention to improve psychiatric outcomes.


Subject(s)
Bipolar Disorder , Postpartum Period/psychology , Pregnancy Complications , Pregnant Women/psychology , Psychotropic Drugs/therapeutic use , Puerperal Disorders , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Female , Gestational Age , Humans , Medication Therapy Management , Outcome and Process Assessment, Health Care , Perinatal Care/methods , Perinatal Care/statistics & numerical data , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Pregnancy Complications/psychology , Prospective Studies , Psychiatric Status Rating Scales , Puerperal Disorders/diagnosis , Puerperal Disorders/drug therapy , Puerperal Disorders/psychology , Secondary Prevention/methods , United States
2.
Arch Womens Ment Health ; 18(5): 673-80, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26043976

ABSTRACT

Postpartum women are consuming their placentas encapsulated, cooked, and raw for the prevention of postpartum depression (PPD), pain relief, and other health benefits. Placentophagy is supported by health advocates who assert that the placenta retains hormones and nutrients that are beneficial to the mother. A computerized search was conducted using PubMed, Medline Ovid, and PsychINFO between January 1950 and January 2014. Keywords included placentophagy, placentophagia, maternal placentophagia, maternal placentophagy, human placentophagia, and human placentophagy. A total of 49 articles were identified. Empirical studies of human or animal consumption of human placentas were included. Editorial commentaries were excluded. Animal placentophagy studies were chosen based on their relevance to human practice. Ten articles (four human, six animal) were selected for inclusion. A minority of women in developed countries perceive placentophagy to reduce PPD risk and enhance recovery. Experimental animal research in support of pain reduction has not been applied in humans. Studies investigating placenta consumption for facilitating uterine contraction, resumption of normal cyclic estrogen cycle, and milk production are inconclusive. The health benefits and risks of placentophagy require further investigation of the retained contents of raw, cooked, and encapsulated placenta and its effects on the postpartum woman.


Subject(s)
Eating , Placenta , Postpartum Period , Adult , Animals , Depression, Postpartum/prevention & control , Feeding Behavior , Female , Humans , Maternal Behavior , Postnatal Care/methods , Pregnancy
3.
J Clin Psychopharmacol ; 35(4): 389-95, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26061609

ABSTRACT

Postpartum depression occurs in 14.5% of women in the first 3 months after birth. This study was an 8-week acute phase randomized trial with 3 cells (transdermal estradiol [E2], sertraline [SERT], and placebo [PL]) for the treatment of postpartum major depressive disorder. However, the study was stopped after batch analysis revealed that the E2 serum concentrations were lower than prestudy projections. This paper explores our experiences that will inform future investigations of therapeutic E2 use. Explanations for the low E2 concentrations were as follows: (1) study patch nonadhesion, which did not explain the low concentrations across the entire sample. (2) Ineffective transdermal patch preparations, although 2 different patch preparations were used and no significant main effect of patch type on E2 concentrations was found. (3) Obesity, at study entry, E2-treated women had body mass index of 32.9 (7.4) (mean [SD]). No pharmacokinetic data comparing E2 concentrations from transdermal patches in obese women versus normal weight controls are available. (4) Induction of cytochrome P450 (CYP450) 3A4 and other E2 elimination pathways in pregnancy. CYP4503A4 is induced in pregnancy and is a pathway for the metabolism of E2. Conversion to estrone and phase II metabolism via glucuronidation and sulfation, which also increase in pregnancy, are routes of E2 elimination. The time required for these pathways to normalize after delivery has not been elucidated. The observation that transdermal E2 doses greater than 100 µg/d did not increase serum concentrations was unexpected. Another hypothesis consistent with this observation is suppression of endogenous E2 secretion with increasing exogenous E2 dosing.


Subject(s)
Depression, Postpartum/diagnosis , Depression, Postpartum/drug therapy , Estradiol/administration & dosage , Administration, Cutaneous , Adult , Depression, Postpartum/psychology , Female , Humans , Pilot Projects , Sertraline/administration & dosage , Treatment Outcome , Young Adult
4.
Am J Obstet Gynecol ; 210(1): 32-7, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23911382

ABSTRACT

Although obstetricians commonly care for pregnant patients with psychiatric disorders, little has been written about the implications of managing a pregnancy during a prolonged psychiatric hospitalization for severe mental illness. Multidisciplinary care may optimize obstetric and psychiatric outcomes. We describe a severely mentally ill patient at 27 weeks' gestation (G1P0) who was admitted after a suicide attempt. She exhibited intermittently worsening depression and anxiety throughout a 2-month inpatient psychiatric hospitalization, during which her psychiatric and obstetric providers collaborated regarding her care. We review recommendations for antepartum and intrapartum treatment of the acutely suicidal and severely mentally ill patient and, in particular, the evidence that a multidisciplinary coordinated approach to planning can maximize patient physical and mental health and facilitate preparedness for delivery.


Subject(s)
Mental Disorders/psychology , Mentally Ill Persons/psychology , Pregnancy Complications/psychology , Delivery of Health Care , Female , Hospitalization , Humans , Interdisciplinary Communication , Pregnancy , Suicidal Ideation
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