Background
The aim of this study was to evaluate the efficacy of divalproex (VLP) to prevent
episode recurrence in postpartum women with bipolar disorder.
Methods
The design was a single-blind, nonrandomized clinical trial. Subjects were enrolled
during pregnancy and chose either VLP plus symptom monitoring or monitoring without
medication for immediate postpartum management. Mania and depression symptoms were
assessed weekly for 20 weeks by an independent evaluator.
Results
Data were available for 26 women. There were no significant differences between groups
in the proportions of women who developed postpartum hypomania/mania, depression,
or mixed states. The time to development of episodes also did not vary between groups.
Women who were treated with VLP tended to have lower levels of hypomanic/manic symptoms.
Conclusions
Divalproex was not significantly more effective than monitoring without drug for the
prevention of postpartum episodes of bipolar disorder. The most prudent pharmacologic
plan is to use the drug(s) to which the individual woman has responded and prepare
a plan for rapid augmentation if a breakthrough episode occurs.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Puerperal affective psychosis.Br J Psychiatry. 1992; 161: 692-694
- Correlation of subjective side effects with plasma concentrations of nortriptyline.Br Med J. 1970; 4: 18-21
- The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale.Acta Psychiatrica Scand. 1979; 59: 420-430
- Effects of gonadal steroids in women with a history of postpartum depression.Am J Psychiatry. 2000; 157: 924-930
- Efficacy of divalproex vs. lithium and placebo in the treatment of mania.JAMA. 1994; 271: 918-924
- The relationship between postpartum psychosis and bipolar disorder.J Clin Psychiatry. 2003; 64: 1284-1292
- Postpartum prophylaxis for women with bipolar disorder.Am J Psychiatry. 1995; 152: 1641-1645
- Life events at the onset of bipolar affective illness.Am J Psychiatry. 1979; 136: 508-511
- A diagnostic interview.Arch Gen Psychiatry. 1978; 35: 837-844
- What makes clinical research ethical?.JAMA. 2000; 283: 2701-2711
- Structured Clinical Interview for DSM-IV (SCID-I and II), (Version 2.0).Biometrics Research Department, New York1994 (New York State Psychiatric Institute)
- The impact of reproductive events on the course of bipolar disorder in women.J Clin Psychiatry. 2002; 63: 284-287
- A rating scale for depression.J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
- Epidemiology of puerperal psychoses.Br J Psychiatry. 1987; 150: 662-673
- Monitoring lithium in breast milk.Ther Drug Monitoring. 2003; 25: 364-366
- Serum valproate levels in 6 breastfeeding mother-infant pairs.J Clin Psychiatry. 2000; 61: 170-172
- Special issues in trial design and use of placebo in bipolar illness.Biol Psychiatry. 2000; 47: 727-732
- Graphic representation of the life course of illness in patients with affective disorder.Am J Psychiatry. 1988; 145: 844-848
- Postpartum psychosis in patients with manic depressive disease.J Nerv Ment Dis. 1970; 151: 60-68
- Lithium and pregnancy—III. Lithium ingestion by children breast-fed by women on lithium treatment.Br Med J. 1973; 2: 137-138
- Sleep loss and postpartum psychosis.Bipolar Disord. 2003; 5: 98-105
- Prophylactic lithium in puerperal psychosis.Br J Psychiatry. 1991; 158: 393-397
- Response to sleep deprivation in three women with postpartum psychosis.J Clin Psychiatry. 1992; 53: 204-206
- Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance.Am J Psychiatry. 2000; 157: 179-184
- Psychiatric illness in women with young children.J Affect Disord. 1995; 34: 1-11
- Prevention of recurrent postpartum depression.J Clin Psychiatry. 2001; 62: 82-86
- Psychobiology of postpartum mood disorders.Semin Reprod Endocrinol. 1997; 15: 77-89
- Management of bipolar disorder during pregnancy and the postpartum period.Am J Psychiatry. 2004; 161: 608-620
Article info
Publication history
Accepted:
July 30,
2004
Received in revised form:
July 22,
2004
Received:
May 14,
2004
Identification
Copyright
© 2004 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
