Recent changes expanded the scope of mental health parity in the Commonwealth of Massachusetts, which requires insurance companies to cover specified diagnoses on a “nondiscriminatory basis”. This means that copayments, deductibles, coinsurance, unit of service limits- such as hospital days and outpatient visits, and/or annual or lifetime maximums are no greater for mental disorders when [...]

Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy.  Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians.  Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data [...]

Atypical antipsychotics are increasingly used to treat psychiatric disorders such as bipolar disorder or schizophrenia.  In spite of the important role they play for many patients in treating serious psychiatric disorders, atypicals have been associated with negative side effects that may worsen a patient’s cardiovascular health profile.  This includes a greater risk for weight gain, [...]

Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women’s Mental Health.  We discussed a patient’s situation recently that highlighted the controversial area about how to prevent mood episodes in a woman [...]

Premenstrual worsening of mood is common among women with depression, but little is known about how often women with bipolar disorder experience worsening of their mood premenstrually. In a study by Payne et al. (2007), premenstrual symptoms were reported by twice as many women diagnosed with mood disorders (mixture of  Bipolar Disorder and Major Depressive [...]

Earlier this year, Dr. Lee S. Cohen, Director of the MGH Center for Women’s Mental Health, spoke with Dr. Mehmet Oz from Oprah.com and a woman with bipolar disorder about mood disorders during pregnancy and weighing the risks of treatment options. Click here to listen to the interview on Oprah.com.

Lamotrigine (Lamictal) has been effectively used for the maintenance treatment of bipolar disorder. Many women suffering from bipolar disorder are of childbearing age; therefore an adequate contraception is a major concern that needs to be addressed in this population. Special consideration should be taken when patients taking lamotrigine plan to use oral contraceptives (OCs).  Studies [...]

A recent population-based case-control study published in the American Journal of Obstetrics & Gynecology used Washington State birth certificates linked to hospital discharge data to evaluate the association between hospitalization for a psychiatric illness before delivery and risk of postpartum suicide attempt. The study compared women hospitalized for a postpartum suicide attempt (n = 355) [...]

The most recent issue of the New England Journal of Medicine includes the presentation of a case from the Center for Women’s Mental Health of a woman with bipolar disorder who developed postpartum psychosis after the birth of her child. The case highlights some of the clinical challenges in treating patients with bipolar disorder during [...]

Recently, the Massachusetts House of Representatives passed the Mental Health Parity House Bill 4423, which mandates that insurers and government programs cover mental health in the same capacity that they cover physical health. The Bill was introduced by Representative Ruth Balser (D-Newton). This bill builds on the first Mental Health Parity House Bill (2000) which [...]

As many of the traditional mood stabilizers used to treat bipolar disorder, including lithium and valproic acid, carry some teratogenic risk and the reproductive safety of other medications, including the atypical antipsychotic agents, has not been well-characterized, many women with bipolar disorder decide to discontinue their treatment during pregnancy. A new study from Dr. Adele [...]

Are you an expectant mother? Do you have questions about bipolar disorder and antidepressants or mood-stabilizers during pregnancy? If you are pregnant and diagnosed with bipolar disorder (or manic depression), you may be eligible for this research study. Participants meet with research coordinators and psychiatrists who specialize in bipolar illness during pregnancy. For more information [...]

Polycystic ovarian syndrome (PCOS) occurs in 4-7% of women and is characterized by irregular menstrual cycles and hyperandrogenism (facial hair, acne, male-pattern hair loss, acne, or elevated male hormone levels). The majority of women with PCOS also suffer from obesity and insulin resistance. PCOS has been associated with a spectrum of health problems including infertility, [...]

Driven by concerns regarding fetal exposure to psychotropic medications, many women with psychiatric illness attempt to discontinue their pharmacologic treatment during pregnancy; however, recent studies indicate that this approach may not be appropriate for all women. Dr. Adele Viguera and her colleagues at the Center for Women’s Mental Health have reported that among pregnant women [...]

Early reports suggested that women with bipolar disorder may be at lower risk for onset or relapse of this disorder during pregnancy and that some women may be able to remain well during pregnancy despite medication discontinuation. However, more recent studies have suggested that recurrence of affective illness during pregnancy is relatively common among women [...]

Preliminary reports have suggested that menstrual irregularity may occur more commonly in women with mood disorders than in the general population. What has been unclear, however, is whether these menstrual cycle irregularities reflect an underlying disruption of the hypothalamic-pituitary-gonadal (HPG) axis in women with mood disorders or are caused by the psychotropic medications used to [...]

It is clear that women with bipolar disorder are at high risk for relapse during the immediate postpartum period (Viguera 2000). There is evidence that the resumption of lithium prior to or within 24-48 hours of delivery can significantly reduce the risk of postpartum illness (Cohen 1995). While this intervention is the current standard of [...]

Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of congenital malformations in children exposed to these medications during the first trimester of pregnancy. For women who need a mood stabilizer during pregnancy, lithium is the safest option; however, when used [...]

For women with bipolar disorder who are planning a pregnancy, it is common practice to discontinue mood stabilizers prior to attempts to conceive, since the mood stabilizers most commonly used to treat bipolar disorder (lithium, valproic acid, and carbamazepine) all carry some risk of birth defect. The problem with this approach is that, after discontinuation [...]

Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of birth defects or congenital malformations in children exposed to these medications during the first trimester of pregnancy. For this reason, many women with bipolar disorder choose to discontinue maintenance treatment during [...]