Management of bipolar II disorder during pregnancy and the postpartum period--Motherisk Update 2008.

The spectrum of bipolar disorder (BPD) includes BP I, BP II, and BP not otherwise specified(NOS). The latter two conditions are thought to have a combined lifetime prevalence of 3.5%compared to a prevalence rate of 1.0% for BP I.Despite the combined high prevalence of BP II and BP NOS, surprisingly little is known about the course and treatment of these disorders during pregnancy and the postpartum period. Brief hypomanic symptoms occur in the early puerperium in as many as 15% of women, and there is preliminary evidence that postpartum depression in some patients may be related to BP II or BP NOS. Yet there is paucity of data on the acute, and maintenance treatment of major depressive episodes during pregnancy in women with BP II and BP NOS. And there are no psychopharmacological studies on the acute or maintenance treatment of bipolar postpartum depression to guide clinical decision making. Also, there is a lack of screening instruments designed specifically for use before or after delivery in women with suspected bipolar disorder. This paper reviews the current literature on the diagnosis, and treatment of BP II and BP NOS during pregnancy and in the postpartum period and makes recommendations for the detection and treatment of these disorders.