Bipolar Disorder in Women –Meeting the Challenge. Nicole Harrington Cirino M.D. Wildwood Psychiatric Resource Center Beaverton, Oregon www.wildwoodpsych.com. Disclosure. GlaxoSmithKline Speakers Bureau Pfizer Pharmaceuticals Inc. Speakers Bureau Educational Grants
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Nicole Harrington Cirino M.D.
Wildwood Psychiatric Resource Center
Off label use of products will be discussed
Women with Bipolar Disorder describe…. worse overall health and well-being compared with men (MCOS-SF-20) despite equivalent Global Assessment of Function (GAF) scores.
Leibenluft E . Am J Psychiatry 1996;153:163-173.
Psychiatric Clinics of North America 26 (3) Sept 2003
Endo et al, 1978; Luggin et al, 1984; Abramowitz et al, 1982;
Jacobs and Charles, 1970; Blehar et al, 1998;
Wehr et al, 1988; Leibenluft et al, 1999
1 Viguera AC, et al. Am J Psych 2002;159:2102-2104.
2 Freeman MP, et al. J Clin Psychiatry 2002;63:264-267.
3 Bouffard S et al. Presented at the American Psychiatric Association Meeting, 2001.
Considered to neither protect nor worsen symptoms
Postpartum period clearly destabilizes mood
1) Pariser, Ann Clin Psychiatry 1993 2) Jefferson et al, 1987
n =120 (of 54,087 births)
Admissions / month
-2 Years-1 Year Childbirth +1 Year +2 Years
Kendall RE et al. Br J Psychiatry 1987;150:662-673.
Grof P et al. J of Affect Disorders 2000;61:31-39.
Viguera AC, et al. Can J Psych 2002;47:426-436.
Nonacs, APA 1998
Cohen, Am J Psychiatry 1995
With Li prophylaxis = 10%
Without Li prophylaxis = 60%
1 Blehar MC et al. Psychopharmacology Bull. 1998;34:239-243.
2 Kukopulos A et al. Phamakopsychiatr Neuropsychophamakol. 1980;13:156-167.
3 Wehr TA et al. Am J Psychiatry 1988;145:179-84.
4 Freeman MP et al. J Clin Psychiatry 2002;63:284-287.
1) Franks, 1995
2) Bauer et al, 1995
8%Prevalence of Menstrual Disturbances in Bipolar Women
Lithium Group(N = 10)
Divalproex Sodium Group
(N = 10)
Rasgon NL, Altshuler LL, Gudeman D et al. J Clin Psychiatry. 2000;61(3):173-178
Lobo RA et al, Ann Intern Med 2000
Atypical AntipsychoticsEffect of Mood Stabilizers (CYP3A4 reduction) on Oral Contraceptive Efficacy
*Oral Contraceptives stimulate metabolism of Lamotrigine, and reduce plasma concentrations by 40-60%
-Toxicity may occur when OCP is discontinued (or pill free week)
Risperidone, others increase Prolactin
Introduction to the Risk/Benefit Ratio
A. Controlled studies fail to demonstrate risk in humans
B. No controlled studies in women, animal studies do not show risk or adverse effect in animal studies.
C Adverse effects in animals, no controlled trials in women
D Evidence of human risk exist
FDA categories are not necessary helpful.
Must rely on evidence based information in the literature.
1ST Trimester- Morphologic risk
As of March 2006:
Lamotrigine Pregnancy Registry. Interim Report. 1 September 1992 through 31 March 2006.
Mild to Moderate Illness
Severe Bipolar illness
Chaudron, Jefferson. J Clin Psych 2000;61:79-90; Am J Psychiatry 161:4 April 2004
J Clinical Psychiatry 2002:63