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Cited by 488Bipolar Disorder and TreatmentMaternal Mental Health During Pregnancy and PostpartumPersonality Disorders and Psychopathology

Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance

Viguera, Adele C., Nonacs, Ruta, Cohen, Lee S., Tondo, Leonardo, Murray, Aoife, Baldessarini, Ross J.·2000·American Journal of Psychiatry
DOI 10.1176/appi.ajp.157.2.179
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Abstract

OBJECTIVE: Pregnancy poses major challenges for the treatment of bipolar disorder, and information to guide clinical care remains very sparse. The authors sought to determine the illness recurrence risk for women with bipolar disorder who discontinue lithium maintenance during pregnancy. METHOD: The authors retrospectively compared recurrence rates and survival functions for 101 women with DSM-IV bipolar disorder (68 type I, 33 type II) during pregnancy and postpartum (N=42) or during equivalent periods (weeks 1-40 and 41-64) for age-matched nonpregnant subjects (N=59) after either rapid (1-14 days) or gradual (15-30 days) discontinuation of lithium. Recurrence rates also were obtained for the year before discontinuing lithium. RESULTS: Rates of recurrence during the first 40 weeks after lithium discontinuation were similar for pregnant (52%) and nonpregnant women (58%) but had been much lower for both in the year before treatment was discontinued (21%). Among subjects who remained stable over the first 40 weeks after lithium discontinuation, postpartum recurrences were 2.9 times more frequent than recurrences in nonpregnant women during weeks 41-64 (70% versus 24%). Depressive or dysphoric-mixed episodes were more prevalent in pregnant than nonpregnant women (63% versus 38% of recurrences). Recurrence risk was greater after rapid than after gradual discontinuation, and for patients with more prior affective episodes, but was similar for diagnostic types I and II. CONCLUSIONS: Rates of recurrence during the first 40 weeks after lithium discontinuation were similar for pregnant and nonpregnant women but then sharply increased postpartum. Risk was much lower during preceding treatment and less with gradual discontinuation. Treatment planning for potentially pregnant women with bipolar disorder should consider the relative risks of fetal exposure to mood stabilizers versus the high recurrence risks after discontinuing lithium.

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  • In a retrospective comparison of women with bipolar disorder receiving tertiary psychiatric care, recurrence rates over the first 40 weeks after lithium discontinuation were similar for pregnant (52%) and non-pregnant (58%) women, but both were much lower in the year before discontinuation (21%).

    “Viguera et al. [37] retrospectively compared recurrence rates and survival functions for women with bipolar disorder in two groups receiving tertiary psychiatric care treatment. One group discontinued lithium during childbearing, and the other discontinued lithium but was non-childbearing. Rates of recurrence over the first 40 weeks after lithium discontinuation were similar for pregnant (52%) and”

    From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [37]

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Authors
Viguera, A. C., Nonacs, R., Cohen, L. S., Tondo, L., Murray, A., & Baldessarini, R. J.
Affiliations
Harvard University (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2000-02-01
Volume
157
Issue
2
Pages
179-184
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.157.2.179
OpenAlex
W2099302241
Cited by
488
References
54
Citations by year
2026: 5 · 2025: 9 · 2024: 11 · 2023: 13 · 2022: 20 · 2021: 39 · 2020: 12 · 2019: 21 · 2018: 15 · 2017: 24 · 2016: 22 · 2015: 20 · 2014: 22 · 2013: 18 · 2012: 22
FWCI
9.91
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k05mh047370-25, 5k23mh001609-05)
  • National Institute of Mental Health (MH-01609, MH47370)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
bipolar disorder, pregnancy, lithium discontinuation, postpartum recurrence, mood stabilizers, prenatal exposure, bipolar I disorder, bipolar II disorder, depressive episodes, mixed states
MeSH terms
Bipolar Disorder, Female, Humans, Lithium, Pregnancy, Pregnancy Complications, Puerperal Disorders, Recurrence, Retrospective Studies, Risk Factors, Substance Withdrawal Syndrome, Survival Analysis, Age of Onset, Risk Assessment

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