Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of childbearing age. Part II: Bipolar disorder
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Uniwersytet Medyczny w Poznaniu, Klinika Psychiatrii Dorosłych
Gdański Uniwersytet Medyczny, Klinika Psychiatrii Dorosłych
Uniwersytet Medyczny w Poznaniu, Zakład Pielęgniarstwa Psychiatrycznego
Uniwersytet Medyczny w Łodzi, Klinika Psychiatrii Dorosłych
Uniwersytet Medyczny we Wrocławiu, Katedra i Klinika Psychiatrii
Pomorski Uniwersytet Medyczny w Szczecinie, Katedra i Klinika Psychiatrii
Warszawski Uniwersytet Medyczny, Klinika Psychiatrii Wydziału Nauk o Zdrowiu
Uniwersytet Jagielloński Collegium Medicum, Klinika Psychiatrii Dorosłych
Submission date: 2019-01-21
Acceptance date: 2019-01-31
Online publication date: 2019-04-30
Publication date: 2019-04-30
Corresponding author
Janusz Rybakowski   

Uniwersytet Medyczny w Poznaniu
Psychiatr Pol 2019;53(2):263-276
In the article, the recommendations of the Polish Psychiatric Association regarding pharmacological treatment of women with bipolar disorder during pregnancy and postpartum period were presented. The issue pertains to every twentieth woman wanting to get pregnant. Before planned pregnancy, it is advisable to obtain a several-month stabilization of psychiatric state, to establish treatment with one mood-stabilizing drug (except for valproate and carbamazepine) or gradual discontinuation of drugs in case of mild course of illness and lack of recurrences in recent two years. In the first trimester of pregnancy, the dose of the mood-stabilizing drug should be reduced (lithium carbonate to 500 mg/day). Depression during pregnancy can be treated with quetiapine or lamotrigine or with antidepressant drug added to a mood-stabilizing drug. Atypical antipsychotics drugs with mood-stabilizing properties can be used in case of (hypo) manic or mixed states. Following the delivery, it is advisable to introduce a moodstabilizing drug as soon as possible to prevent postpartum psychiatric disturbances. In the treatment of postpartum depression, quetiapine can be used or an antidepressant drug added to a mood-stabilizer. Considering breastfeeding, it should be remembered that the infant/maternal ratio of serum drug concentration is low for valproate, olanzapine, quetiapine, sertraline and paroxetine, and high for lithium and lamotrigine. In the case of postpartum psychosis, a hospitalization and antipsychotic treatment are needed.
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