Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T11:50:54.723Z Has data issue: false hasContentIssue false
  • English
  • Français

Between a rock-a-bye and a hard place: mood disorders during the peripartum period

Published online by Cambridge University Press:  19 January 2018

Michael Thomson  and
Verinder Sharma
Michael Thomson
Affiliation:
Department of Psychiatry, Western University, London, Ontario, Canada
Verinder Sharma*
Affiliation:
Department of Psychiatry, Western University, London, Ontario, Canada Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
*
*Address for correspondence: Dr. Verinder Sharma, Department of Psychiatry and Obstetrics and Gynaecology, Western University, London, Ontario, Canada. (Email: vsharma@uwo.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder. Delays in detection as well as misdiagnosis of bipolar disorder as major depressive disorder may put women at risk of many adverse consequences, including symptom exacerbation, psychiatric hospitalization, and suicide. A thorough psychiatric assessment is necessary to establish diagnosis, to address safety issues, and to formulate a treatment plan. Treatment of mood disorders during pregnancy is complicated by the potential risks of fetal exposure to psychotropic medications, and the use of these medications during the postpartum period may result in infant medication exposure through breastmilk. These risks of psychotropic medication exposure must be weighed against the risk of untreated mood disorders. This review will discuss the pathophysiology, epidemiology, diagnosis, and treatment of mood disorders during pregnancy and the postpartum period. Screening tools that can be used in the primary care and obstetrics settings to assist in identifying women with peripartum mood disorders will also be discussed.

Keywords

Antenatalbipolardepressionperipartumpostpartum
Type
CME Review Article
Information
CNS Spectrums , Volume 22 , Supplement S1: CME SUPPLEMENT , December 2017 , pp. 49 - 64
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This activity is supported by an unrestricted educational grant from Sage Therapeutics.

References

1. Pedersen, CB, Mors, O, Bertelsen, A, et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry. 2014; 71(5): 573–581.CrossRefGoogle ScholarPubMed
2. Gaynes, BN, Gavin, N, Meltzer-Brody, S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005;Feb(119): 1–8.Google ScholarPubMed
3. Misri, S, Burgmann, AJ. Postpartum mood disorders: recognizing the symptoms. Can Fam Physician. 1992; 38: 2031–2036.Google ScholarPubMed
4. Grigoriadis, S, Wilton, SA, Kurdak, PA, et al. Perinatal suicide in Ontario, Canada: a 15-year population-based study. CMAJ. 2017; 89(34): e1085–e1092.Google Scholar
5. Brummelte, S, Galea, LA. Postpartum depression: etiology, treatment and consequences for maternal care. Horm Behav. 2016; 77: 153–166.Google Scholar
6. Eckerdal, P, Kollia, N, Lofblad, J, et al. Delineating the association between heavy postpartum haemorrhage and postpartum depression. PLoS One. 2016; 11(1): pe0144274.Google Scholar
7. Pedersen, CB, Johnson, JL, Sliva, S, et al. Antenatal thyroid correlates of postpartum depression. Psychoneuroendocrinology. 2007; 32(3): 235–245.Google Scholar
8. Gur, EB, Genc, M, Eskiciogiu, F, et al. The effect of vitamin D level in pregnancy on postpartum depression. Arch Womens Ment Health. 2015; 18(2): 263–264.CrossRefGoogle ScholarPubMed
9. Wesseloo, R, Kamperman, AM, Munk-Olsen, T, et al. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry. 2016; 173(2): 117–127.CrossRefGoogle ScholarPubMed
10. Hendrick, V, Altshuler, LL, Suri, R. Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics. 1998; 39(2): 93–101.CrossRefGoogle ScholarPubMed
11. Bloch, M, Schmidt, PJ, Danaceau, M, et al. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000; 157(6): 924–930.CrossRefGoogle ScholarPubMed
12. Ahokas, A, Kaukoranta, J, Wahlbeck, K, Alto, M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. J Clin Psychiatry. 2001; 62(5): 332–336.Google Scholar
13. Gregoire, AJ, Kumar, R, Everitt, B, et al. Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996; 347(9006): 930–933.Google Scholar
14. Wisner, KL, Sit, DK, Moses-Kolko, EL, et al. Transdermal estradiol treatment for postpartum depression: a pilot, randomized trial. J Clin Psychopharmacol. 2015; 35(4): 389–395.CrossRefGoogle ScholarPubMed
15. Kanes, S, Colquhoun, H, Gunduz-Bruce, H, et al. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. Lancet. 2017; 390(10093): 480–489.CrossRefGoogle ScholarPubMed
16. O’Connor, E, Rossom, RC, Henninger, M, et al. Screening for depression in adults: an updated systematic evidence review for the U.S. Preventive Services Task Force. Report No.: 14-05208-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2016.Google Scholar
17. Committee on Obstetric Practice. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol. 2015; 125(5): 1268–1271.Google Scholar
18. Munk-Olsen, T, Laursen, TM, Meltzer-Brody, S, et al. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2012; 69(4): 428–434.Google ScholarPubMed
19. Munk-Olsen, T, Laursen, TM, Pedersen, CB, et al. New parents and mental disorders: a population-based register study. JAMA. 2006; 296(21): 2582–2589.Google Scholar
20. Viguera, AC, Tondo, L, Koukopoulos, AE, et al. Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry. 2011; 168(11): 1179–1185.Google Scholar
21. Azorin, JM, Angst, J, Gamma, A, et al. Identifying features of bipolarity in patients with first-episode postpartum depression: findings from the international BRIDGE study. J Affect Disord. 2012; 136(3): 710–715.Google Scholar
22. Rihmer, Z, Gonda, X. Antidepressant-resistant depression and antidepressant-associated suicidal behaviour: the role of underlying bipolarity. Depress Res Treat. 2011; 2011: 906462.Google Scholar
23. Sharma, V. A cautionary note on the use of antidepressants in postpartum depression. Bipolar Disord. 2006; 8(4): 411–414.CrossRefGoogle ScholarPubMed
24. Seo, HJ, Wang, HR, Jun, TY, et al. Factors related to suicidal behavior in patients with bipolar disorder: the effect of mixed features on suicidality. Gen Hosp Psychiatry. 2016; 39: 91–96.CrossRefGoogle ScholarPubMed
25. Sharma, V, Xie, B. Screening for postpartum bipolar disorder: validation of the Mood Disorder Questionnaire. J Affect Disord. 2011; 131(1–3): 408–411.CrossRefGoogle ScholarPubMed
26. Çelik, SB, Bucaktepe, GE, Uludağ, A, Bulut, İU, Erdem, Ö, Altınbaş, K. Screening mixed depression and bipolarity in the postpartum period at a primary health care center. Compr Psychiatry. 2016; 71: 57–62.CrossRefGoogle Scholar
27. Sharma, V, Pope, CJ. Pregnancy and bipolar disorder: a systematic review. J Clin Psychiatry. 2012; 73(11): 1447–1455.Google Scholar
28. Wisner, KL, Sit, DKY, McShea, MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013; 70(5): 490–498.Google Scholar
29. Chaudron, LH, Pies, RW. The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry. 2003; 64(11): 1284–1292.CrossRefGoogle ScholarPubMed
30. Brockington, I. Postpartum psychiatric disorders. Lancet. 2004; 363(9405): 303–310.CrossRefGoogle ScholarPubMed
31. Spinelli, MG. Postpartum psychosis: detection of risk and management. Am J. Psychiatry. 2009; 166(4): 405–408.Google Scholar
32. Kennedy, SH, Lam, RW, McIntyre, RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. pharmacological treatments. Can J Psychiatry. 2016; 61(9): 540–560.CrossRefGoogle Scholar
33. National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health. 2016; https://www.nice.org.uk/guidance/qs115/resources/antenatal-and-postnatal-mental-health-75545299789765.Google Scholar
34. Yatham, LN, Kennedy, SH, Parikh, SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15(1): 1–44.Google Scholar
35. Hernandez-Diaz, S, Smith, CR, Shen, A, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012; 78(21): 1692–1699.Google Scholar
36. Costantine, MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol. 2014; 5: 65.Google Scholar
37. McAllister-Williams, RH, Baldwin, DS, Cantwell, R, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017; 31(5): 519–552.CrossRefGoogle ScholarPubMed
38. Huybrechts, KF, Palmsten, K, Mogun, H, et al. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry. 2013; 35(3): 265–271.Google Scholar
39. Le Strat, Y, Dubertret, C, Le Foll, B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011; 135(1–3): 128–138.CrossRefGoogle ScholarPubMed
40. Lee, AM, Lam, SK, Sze Mun Lau, SM, Chong, CS, Chui, HW, Fong, DY. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007; 110(5): 1102–1112.Google Scholar
41. Coelho, HF, Murray, L, Royal-Lawson, M, Cooper, PJ. Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study. J Affect Disord. 2011; 129(1–3): 348–353.Google Scholar
42. Cohen, LS, Altshuler, LL, Harlow, BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295(5): 499–507.CrossRefGoogle ScholarPubMed
43. MacQueen, GM, Frey, BN, Ismail, Z, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. special populations: youth, women, and the elderly. Can J Psychiatry. 2016; 61(9): 588–603.CrossRefGoogle Scholar
44. Sockol, LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015; 177: 7–21.Google Scholar
45. Claridge, AM. Efficacy of systemically oriented psychotherapies in the treatment of perinatal depression: a meta-analysis. Arch Womens Ment Health. 2014; 17(1): 3–15.CrossRefGoogle ScholarPubMed
46. Dennis, CL, Allen, K. Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database Syst Rev. 2008;(4): cd006795.Google ScholarPubMed
47. Ross, LE, Grigoriadis, S. Selected pregnancy and delivery outcomes after exposure to antidepressant medication. JAMA Psychiatry. 2014; 71(6): 716–717.Google Scholar
48. Ornoy, A, Koren, G. Selective serotonin reuptake inhibitors during pregnancy: do we have now more definite answers related to prenatal exposure? Birth Defects Res. 2017; 109(12): 898–908.Google Scholar
49. Oberlander, TF, Bateman, BT, Palmsten, K, et al. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry. 2006; 63(8): 898–906.Google Scholar
50. Malm, H, Sourander, A, Gissler, M, et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: results from population-based national register data. Am J Psychiatry. 2015; 172(12): 1224–1232.CrossRefGoogle ScholarPubMed
51. Huybrechts, KF, Bateman, BT, Palmsten, K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015; 313(21): 2142–2151.CrossRefGoogle ScholarPubMed
52. Liu, X, Agerbo, E, Ingstrup, GK, et al. Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ. 2017; 358: j3668.CrossRefGoogle ScholarPubMed
53. Bellantuono, C, Vargas, M, Mandarelli, G, et al. The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. 2015; 30(3): 143–151.Google Scholar
54. Smit, M, Dolman, KM, Honig, A. Mirtazapine in pregnancy and lactation—a systematic review. Eur Neuropsychopharmacol. 2016; 26(1): 126–135.CrossRefGoogle ScholarPubMed
55. Cole, JA, Modell, JG, Haight, BR, et al. Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007; 16(5): 474–484.Google Scholar
56. Newport, DJ, Hostetter, AL, Juul, SH, et al. Prenatal psychostimulant and antidepressant exposure and risk of hypertensive disorders of pregnancy. J Clin Psychiatry. 2016; 77(11): 1538–1545.CrossRefGoogle ScholarPubMed
57. Alwan, S, Reefhuis, J, Botto, LD, et al. Maternal use of bupropion and risk for congenital heart defects. Am J Obstet Gynecol. 2010; 203(1): 52e1–6.Google Scholar
58. Huybrechts, KF, Hernandez-Diaz, S, Avorn, J. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014; 371(12): 1168–1169.Google ScholarPubMed
59. Briggs, G. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. In: R. Freeman, ed, Sertraline. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins Health; 2015; 1254–1259.Google Scholar
60. Hendrick, V, Stowe, ZN, Altshuler, LL, et al. Placental passage of antidepressant medications. Am J Psychiatry. 2003; 160(5): 993–996.Google Scholar
61. Pinheiro, E, Bogen, DL, Hoxha, D. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health. 2015; 18: 139–146.CrossRefGoogle ScholarPubMed
62. Vasilakis-Scaramozza, C, Aschengrau, A, Cabral, J, Jick, SS. Antidepressant use during early pregnancy and the risk of congenital anomalies. Pharmacotherapy. 2013; 33(7): 693–700.Google Scholar
63. Robakis, TK, Williams, KE. Biologically based treatment approaches to the patient with resistant perinatal depression. Arch Womens Ment Health. 2013; 16(5): 343–351.Google Scholar
64. Sharma, V, Khan, M, Corpse, C, Sharma, P. Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disord. 2008; 10(6): 742–747.Google Scholar
65. Pugh, NE, Hadjistavropoulus, HD, Hampton, AJ, et al. Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study. Arch Womens Ment Health. 2015; 18(2): 209–219.Google Scholar
66. O’Mahen, HA, Richards, DA, Woodford, J, et al. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med. 2014; 44(8): 1675–1689.Google Scholar
67. Wozney, L, Olthuis, J, Lingley-Pottie, P, et al. Strongest Families™ Managing Our Mood (MOM): a randomized controlled trial of a distance intervention for women with postpartum depression. Arch Womens Ment Health. 2017; 20(4): 525–537.Google Scholar
68. Ngai, FW, Wong, PW, Leung, KY, et al. The effect of telephone based cognitive-behavioral therapy on postnatal depression: a randomized controlled trial. Psychother Psychosom. 2015; 84(5): 294–303.Google Scholar
69. Misri, S, Reebye, P, Corral, M, et al. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004; 65(9): 1236–1241.Google Scholar
70. Appleby, L, Warner, R, Whitton, A, et al. A controlled study of fluoxetine and cognitive-behavioral counseling in the treatment of postnatal depression. BMJ. 1997; 314(7085): 932–936.Google Scholar
71. Bloch, M, Meiboom, H, Lorberblatt, M, et al. The effect of sertraline add-on to brief dynamic psychotherapy for the treatment of postpartum depression: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2012; 73(2): 235–241.Google Scholar
72. Cuijpers, P, De Wit, L, Weitz, E, et al. The combination of psychotherapy and pharmacotherapy in the treatment of adult depression: a comprehensive meta-analysis. Journal of Evidence-Based Psychotherapies. 2015: 147–168.Google Scholar
73. Thomson, M, Sharma, V. Therapeutics of postpartum depression. Expert Rev Neurother. 2017; 17(5): 495–507.Google Scholar
74. Eberhard-Gran, M, Eskild, A, Opjordsmoen, S. Use of psychotropic medications in treating mood disorders during lactation: practical recommendations. CNS Drugs. 2006; 20(3): 187–198.Google Scholar
75. Kendall-Tackett, K, Hale, TW. The use of antidepressants in pregnant and breastfeeding women: a review of recent studies. J Hum Lact. 2010; 26(2): 187–195.Google Scholar
76. Sharma, V, Sommerdyk, C. Are antidepressants effective in the treatment of postpartum depression? A systematic review. Prim Care Companion CNS Disord. 2013; 15(6): PCC.13r01529.Google Scholar
77. De Crescenzo, F, Perelli, F, Armando, M, et al. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. J Affect Disord. 2014; 152–154: 39–44.CrossRefGoogle ScholarPubMed
78. Hantsoo, L, Ward-O’Brien, D, Czarkowski, KA, et al. A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology (Berl). 2014; 231(5): 939–948.CrossRefGoogle ScholarPubMed
79. Wisner, KL, Perel, JM, Peindl, KS, et al. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. 2004; 161(7): 1290–1292.CrossRefGoogle ScholarPubMed
80. Chaudron, LH, Schoenecker, CJ. Bupropion and breastfeeding: a case of a possible infant seizure. J Clin Psychiatry. 2004; 65(6): 881–882.Google Scholar
81. Sharma, V, Khan, M. Identification of bipolar disorder in women with postpartum depression. Bipolar Disord. 2010; 12(3): 335–340.CrossRefGoogle ScholarPubMed
82. Sharma, V, Sommerdyk, C, Xie, B. Aripiprazole augmentation of antidepressants for postpartum depression: a preliminary report. Arch Womens Ment Health. 2015; 18(1): 131–134.Google Scholar
83. 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(4): 284–287.CrossRefGoogle ScholarPubMed
84. Marengo, E, Martino, DJ, Igoa, A, et al. Unplanned pregnancies and reproductive health among women with bipolar disorder. J Affect Disord. 2015; 178: 201–205.Google Scholar
85. Wisner, KL, Hanusa, BH, Peindl, KS, Perel, JM. Prevention of postpartum episodes in women with bipolar disorder. Biol Psychiatry. 2004; 56(8): 592–596.Google Scholar
86. Meador, KJ, Bkaer, GA, Browning, N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013; 12(3): 244–252.Google Scholar
87. Newport, DJ, Stowe, ZN, Viguera, AC, et al. Lamotrigine in bipolar disorder: efficacy during pregnancy. Bipolar Disord. 2008; 10(3): 432–436.Google Scholar
88. Chisolm, MS, Payne, JL. Management of psychotropic drugs during pregnancy. BMJ. 2016; 532: h5918.Google Scholar
89. Ennis, ZN, Damkier, P. Pregnancy exposure to olanzapine, quetiapine, risperidone, aripiprazole and risk of congenital malformations. a systematic review. Basic Clin Pharmacol Toxicol. 2015; 116(4): 315–320.CrossRefGoogle ScholarPubMed
90. Rosso, G, Albert, U, Di Salvo, G, et al. Lithium prophylaxis during pregnancy and the postpartum period in women with lithium responsive bipolar I disorder. Arch Womens Ment Health. 2016; 19: 429–432.Google Scholar
91. Nora, JJ, Nora, AH, Toews, WH. Letter: Lithium, Ebstein’s anomaly, and other congenital heart defects. Lancet. 1974; 2(7880): 594–595.Google Scholar
92. Patorno, E, Huybrechts, KF, Hernandez-Diaz, S. Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med. 2017; 377(9): 893–894.Google Scholar
93. Uguz, F, Sharma, V. Mood stabilizers during breastfeeding: a systematic review of the recent literature. Bipolar Disord. 2016; 18(4): 325–333.Google Scholar
94. Diav-Citrin, O, Shechtman, S, Ornoy, S, et al. Safety of haloperidol and penfluridol in pregnancy: a multicenter, prospective, controlled study. J Clin Psychiatry. 2005; 66(3): 317–322.Google Scholar
95. Coughlin, CG, Blackwell, KA, Bartley, C, et al. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol. 2015; 125(5): 1224–1235.Google Scholar
96. Doyle, K, Heron, J, Berrisford, G, et al. The management of bipolar disorder in the perinatal period and risk factors for postpartum relapse. Eur Psychiatry. 2012; 27(8): 563–569.CrossRefGoogle ScholarPubMed
97. Bergink, V, Kushner, SA. Lithium during pregnancy. Am J Psychiatry. 2014; 171(7): 712–715.CrossRefGoogle ScholarPubMed
98. Sharma, V, Smith, A, Maxmanian, D. Olanzapine in the prevention of postpartum psychosis and mood episodes in bipolar disorder. Bipolar Disord. 2006; 8(4): 400–404.CrossRefGoogle ScholarPubMed
99. Sharma, V, Khan, M, Sommerdyk, C. Quetiapine in the acute treatment of bipolar postpartum depression: a chart review. J Clin Psychopharmacol. 2015; 35(6): 733–735.CrossRefGoogle ScholarPubMed
100. Uguz, F. Second-generation antipsychotics during the lactation period: a comparative systematic review on infant safety. J Clin Psychopharmacol. 2016; 36(3): 244–252.Google Scholar
101. Sharma, V, Mazmanian, D. Sleep loss and postpartum psychosis. Bipolar Disord. 2003; 5(2): 98–105.Google Scholar
102. Mirhosseini, H, Moosavipoor, SA, Nazari, MA, et al. Cognitive behavioral development in children following maternal postpartum depression: a review article. Electron Physician. 2015; 7(8): 1673–1679.Google Scholar
103. Angst, J, Azorin, JM, Bowden, CL, et al. Prevalence and characteristics of undiagnosed bipolar disorder in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry. 2011; 68(8): 791–798.Google Scholar
104. Sharma, V, Corpse, C. Is your depressed postpartum patient bipolar? Curr Psychiatry. 2011; 10(6): 81–82.Google Scholar
105. Leonpacher, AK, Liebers, D, Pirooznia, M, et al. Distinguishing bipolar from unipolar depression: the importance of clinical symptoms and illness features. Psychol Med. 2015; 45(11): 2437–2446.Google Scholar
106. Dudek, D, Jaeschke, R, Siwek, M, Maczka, G, et al. Postpartum depression: identifying associations with bipolarity and personality traits. Preliminary results from a cross-sectional study in Poland. Psychiatry Res. 2014; 215(1): 69–74.CrossRefGoogle ScholarPubMed