Prevention of postpartum episodes in women with bipolar disorder

Background The aim of this study was to evaluate the efficacy of divalproex (VLP) to prevent episode recurrence in postpartum women with bipolar disorder. Methods The design was a single-blind, nonrandomized clinical trial. Subjects were enrolled during pregnancy and chose either VLP plus symptom monitoring or monitoring without medication for immediate postpartum management. Mania and depression symptoms were assessed weekly for 20 weeks by an independent evaluator. Results Data were available for 26 women. There were no significant differences between groups in the proportions of women who developed postpartum hypomania/mania, depression, or mixed states. The time to development of episodes also did not vary between groups. Women who were treated with VLP tended to have lower levels of hypomanic/manic symptoms. Conclusions Divalproex was not significantly more effective than monitoring without drug for the prevention of postpartum episodes of bipolar disorder. The most prudent pharmacologic plan is to use the drug(s) to which the individual woman has responded and prepare a plan for rapid augmentation if a breakthrough episode occurs.