Considerations in managing bipolar disorder in the postpartum
Managing a patient with bipolar disorder in the postpartum is complex and requires a multidisciplinary approach involving the patient’s general practitioner, psychiatrist and paediatrician. If possible, refer the patient to a specialist perinatal mental health service.
See also Considerations in managing bipolar disorder in females of childbearing potential.
The risk of relapse or postpartum psychosis in the postpartum period is at least 30%. Advise a patient with bipolar disorder who has chosen to avoid taking a psychotropic during their pregnancy to start a drug used for bipolar disorder prophylaxis immediately after delivery to reduce the risk of relapse or postpartum psychosis. Ideally, prophylaxis should be planned with the patient and their psychiatrist during the pregnancy and be overseen by their psychiatrist. Lithium has the most evidence of efficacy in this scenario, but its use may be limited by its contraindication in breastfeeding or if lithium was previously poorly tolerated or ineffective. If lithium is used, see Approach to perinatal lithium use for advice.
If a patient has remained on drug therapy during pregnancy, continue the same treatment in the postpartum; however, consider the breastfeeding safety profile of the drug and the effect of changing pharmacokinetics and pharmacodynamics after birth.