Effects of the Female Reproductive System on Bipolar Disorder

No CrossRef data available. Published online by Cambridge University Press: 07 November 2014 The presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting. Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women. Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families. - Type - Research Article - Information - Copyright - Copyright © Cambridge University Press 2003 1.Freeman, MP, Smith, KW, Freeman, SA, et al.The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002;63:284–287.CrossRefGoogle ScholarPubMed 2.Blehar, MC, DePaulo, JR Jr, Gershon, ES, Reich, T, Simpson, SG, Nurnberger, JI Jr.Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull. 1998;34:239–243.Google ScholarPubMed 3.Leibenluft, E, Ashman, SB, Feldman-Naim, S, Yonkers, KA. Lack of relationship between menstrual cycle phase and mood in a sample of women with rapid cycling bipolar disorder. Biol Psychiatry. 1999;46:577–580.CrossRefGoogle Scholar 4.Rasgon, N, Bauer, M, Glenn, T, Elman, S, Whybrow, PC. Menstrual cycle related mood changes in women with bipolar disorder. Bipolar Disord. 2003;5:48–52.CrossRefGoogle ScholarPubMed 5.Rasgon, N, Bauer, M, Grof, P, et al.Sex-specific self-reported mood changes by patients with bipolar disorder. J Psychiatr Res. 2005;39(1):77–83.CrossRefGoogle ScholarPubMed 6.Becker, OV, Rasgon, NL, Marsh, WK, Glenn, T, Ketter, TA. Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report. Bipolar Disord. 2004;6:435–439.CrossRefGoogle ScholarPubMed 7.Grof, P, Robbins, W, Alda, M, et al.Protective effect of pregnancy in women with lithium-responsive bipolar disorder. J Affect Disord. 2000;61:31–39.CrossRefGoogle ScholarPubMed 8.Viguera, AC, Nonacs, R, Cohen, LS, Tondo, L, Murray, A, Baldessarini, RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157:179–184.CrossRefGoogle ScholarPubMed 9.Hunt, N, Silverstone, T. Does puerperal illness distinguish a subgroup of bipolar patients? J Affect Disord. 1995;34:101–107.CrossRefGoogle ScholarPubMed 10.Davidson, J, Robertson, E. A follow-up study of post partum illness, 1946-1978. Acta Psychiatrica Scand. 1985;71:451–457.CrossRefGoogle ScholarPubMed 11.Platz, C, Kendell, R. A matched-control follow-up and family study of ‘puerperal psychoses’. Br J Psychiatry. 1988;153:90–94.CrossRefGoogle ScholarPubMed 12.McNeil, TF. Cycloid and affective disorders: reproduction, motherhood, postpartum psychoses, and offspring characteristics. In: Marneros, A, Tsuang, M, eds. Affective and Schizoaffective Disorders. Berlin, Germany: Springer; 1990:72–88.CrossRefGoogle Scholar 13.Cohen, LS, Sichel, DA, Robertson, LM, Heckscher, E, Rosenbaum, JF. Postpartum prophylaxis for women with bipolar disorder. Am J Psychiatry. 1995;152:1641–1645.Google ScholarPubMed 14.Ambelas, A. Life events and mania. A special relationship? Br J Psychiatry. 1987;150:235–240.CrossRefGoogle Scholar 15.Rasgon, NL, Marsh, W, Templeton, A, Ketter, TA. Clinical course of bipolar disorder through perimenopause. Poster presented at: 158th Annual Meeting of the American Psychiatric Association. May 21-26, 2005; Atlanta, GA. Abstract NR353.Google Scholar 16.Freeman, EW, Sammel, MD, Rinaudo, PJ, Sheng, L. Premenstrual syndrome as a predictor of menopausal symptoms. Obstet Gynecol. 2004;103(5 pt 1):960–966.CrossRefGoogle ScholarPubMed 17.Kukopulos, A, Reginaldi, D, Laddomada, P, Floris, G, Serra, G, Tondo, L. Course of the manic-depressive cycle and changes caused by treatment. Pharmakopsychiatr Neuropsychopharmakol. 1980;13:156–167.CrossRefGoogle ScholarPubMed