Newsletter september 2004.pub

M A R I T I M E B I P O L A R R E G I S T R Y
Q E 1 1 H e a l t h S c i e n c e s C e n t r e
A b b i e J . L a n e B l d g . R m . 4 0 3 1
5 9 0 9 V e t e r a n ’ s M e m o r i a l L a n e
H a l i f a x , N o v a S c o t i a
4 7 3 - 5 8 8 4
In this issue of the Registry Newsletter, a women’s reproductive status has a huge influence on the illness itself. Puberty we are pleased to have an article by Dr. often coincides with the earliest Newsletter Date
Claire O’Donovan. Dr. O’Donovan is the director of Mood Disorders at the September 2004
QEII Health Sciences Centre in Halifax and an Associate Professor at Dalhousie Why is rapid-cycling more common in
Women and Bipolar
Disorder
times a year, greatly accelerating the past course of illness, or sometimes this is the first presentation of the illness. A number Dr. Claire O’Donovan
explain this difference. The main theory A patient with bipolar illness needs help duration. Antidepressants used long-term may cause rapid-cycling in a minority of are prone, is also known to accelerate the course of illness, often settling when it is P.M.S. mood fluctuations are tied to the involve tapering an antidepressant, using In bipolar disorder a gender perspective and course are different, but also because Women and Bipolar Disorder
.continued
as switching or combining mood stabilizers. lamotrigine (Lamictal) may interfere with the Why is depression more common?
oral contraceptive pill, necessitating an increase in dose. Women of child-bearing years should more hospitalizations for depression than men. pharmacies) to protect against spina bifida or other neural tube abnormalities in the event of psychological burden in women, variations in an unexpected pregnancy. This is of particular expression of chronic stress on the brain, and importance if on valproate, as the risk is hormonal differences both in the body and the significantly increased. Finally, the risks of an brain. Despite the increased prevalence of acute manic episode include heightened sex depression in women, women are in fact less likely to end their lives by suicide. Attention to consequences, making promiscuity and unsafe thyroid and hormonal status in women as well sexual activity more likely. Women who have as the careful use of antidepressants may be had this experience in past episodes may wish helpful. Similarily, there may be more reliance to look for ways to avoid this should they have “atypicals” such as quetiapine (Seroquel) and I would like to get pregnant. What should I
olanzepine (Zyprexa) which are particularily review with my doctor ?
useful in treating and preventing depression Pregnancy itself is not necessarily destabilizing for bipolar illness. In fact, some studies suggest What issues are important in the decision of
pregnancy. In contrast, the immediate post- child- bearing?
partum period is high risk and as many as 50% of women with the illness will develop a serious episode in the first 30 days, often with decision about having a baby. A child who has psychotic symptoms and an extreme degree of disorganization. This is largely ameliorated by approximately 10% risk of the illness compared preventative medication started as early as day to 1% in the general population. The risk is 1 after the baby is born if medication has been likely higher in children where several family discontinued in pregnancy. Changes in the members have the illness. Compared to other sleep-wake cycle can precipitate an episode; so genetic disorders, this is a low risk but may careful attention to rest and sleep is important factor into the decision-making process, along interferes with sleep, and in the post-partum challenges to stability in pregnancy and post- period when babies need feeding during the partum. Conception may be more difficult Valproate (Epival, Depakote), carbamazepine menstrual irregularities are present or on (Tegretol, Trileptil) as well as lithium to a “atypicals” such as risperidone which can raise lesser degree, can cause abnormalities in the the hormone prolactin’s level in the blood. baby if given in the first trimester. However Conversely medications such as carbamazepine illness itself also carries a risk to the baby
Woman and Bipolar Disorder
.continued
because of the stress hormones, risky behaviour Factors to discuss with your psychiatrist, family
when manic, diminished self-care in depression and doctor and obstetrician if considering a
the risk of suicide and harm to the pregnancy or pregnancy:
baby if psychotic symptoms lead one to believe that it is necessary to end the baby’s life. In fact • The natural cycle of episodes of your illness
homicidal thoughts towards the baby are, for • History of your specific course of illness in
inexplicable reasons, common when psychotic. periods where you may have been off medication
Special tests can be done early on in the pregnancy • The history of risks that have been associated
to test for congenital abnormalities. It should also with prior episodes of your illness e.g. suicidality
be remembered that the baseline rate of congenital when depressed, substance abuse when manic
abnormalities in the general population is 2-3/100 The course of illness in prior pregnancies
History of miscarriages and abortions
• Known family congenital disorders
The dose of medication may need to be increased in • Family planning
the 3rd trimester because of increased output from • Use of other medications, over- the- counter
the heart. Particularly with lithium, the dose then medication, herbals, coffee, alcohol, cigarettes,
needs to be rapidly decreased at the time of birth to and other drugs in pregnancy
avoid toxicity. Some withdrawal symptoms may • Proper nutrition in pregnancy
occur to the baby at the time of delivery also. • Supplements to use in pregnancy if on certain
Finally, a decision with regard to breast feeding medications
will need to be made, taking into account known • Known risks associated with the medication you
information about the amount of the particular are currently taking in the first and other
medication you may be on that is transferred to the trimesters of pregnancy, at birth, in breast
breast milk. “Pump and dump” refers to using the breast milk that has the lowest concentration of • Information on long-term studies in children who
drug, based on when you take your medication. have been exposed to the medication in utero
Again, the cost- benefit of no medication versus no Safer alternatives to the medication you are
breastfeeding versus cautious breast feeding needs currently on
• Specific tests available to check for abnormalities
to be discussed collaboratively with your doctor. in the baby if on medications that carry a risk
For information on specific medication in • If you come off medication and have an episode,
pregnancy and breastfeeding, you can call the what medication is best to use for an acute
Toronto Mother-Risk program at 416-813-6780. depression or mania?
• What are the earliest specific signs and
symptoms of relapse for you?
• Name of two people you will trust to bring you to
your doctor or the hospital if you become ill, and
are unaware
• What is your own experience of parenting?
• What is your own particular set of circumstances
that will impact having and rearing a child?
• What is your support system?
DALHOUSIE UNIVERSITY
Clinical Drug Study


We would like to tell you about an interesting study being done to see if a specific atypical
antipsychotic medication, in addition to a mood stabilizer, is effective in preventing mood
episodes in patients with bipolar I disorder. This study is being conducted at the QE II
Health Sciences Centre by Dr. Alda and his colleagues.
To take part in the study, you must meet the following requirements:
· Have had at least one mood episode in the last two years and are in or currently recovering from an episode of illness within the past six months Have been and are currently treated with Lithium or Epival in addition to a
specific atypical antipsychotic drug since the most recent episode
Men and women who are using reliable contraception Women who are not pregnant or breastfeeding Patients will be recruited from 120 centers in Canada and the USA. About 12 patients will participate from this center. If you would like to learn more about this study, please contact: Susan

Source: http://mood-disorders.medicine.dal.ca/documents/MBR_newsletter_september_2004.pdf