Pharmacotherapy of bipolar II disorder during and after pregnancy

Objectives: The objective of this study was to evaluate the pharmacotherapy of bipolar II disorder during pregnancy and the postpartum period. Methods: The use of psychotropic drugs and recurrence risk during and after pregnancy was studied in a prospective, observational study of 37 women with bipolar II disorder. Results: During pregnancy the majority of participants (54.0%) were not on any psychotropic medication, approximately one third (32%) received monotherapy, and the rest were on combination therapy. In comparison, during the postpartum period only 14% of participants were not on any psychotropic medication, approximately 35% received monotherapy, and over 50% were on combination therapy. While only 13.5% of participants were on 3 or more psychotropic drugs during pregnancy, 21.6% required 3 or more psychotropic drugs after childbirth in order to manage their symptoms. During pregnancy, 51 % of women had a mood episode compared to a recurrence rate of 70% in the postpartum period. Limitations: Small sample size, lack of a control group, and absence of random treatment assignment. Conclusions: The findings of this prospective, observational study indicate that the recurrence risk is much higher after childbirth than during pregnancy in spite of higher utilization of psychotropic drugs in the postpartum period.