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Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

Abstract The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the journal of clinical psychiatry
Publication Year Start




PMID- 28570797
OWN - NLM
STAT- MEDLINE
DA  - 20170601
DCOM- 20170616
LR  - 20170616
IS  - 1555-2101 (Electronic)
IS  - 0160-6689 (Linking)
VI  - 78
IP  - 5
DP  - 2017 May
TI  - Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A
      Danish Nationwide Register-Based Cohort Study.
PG  - e469-e476
LID - 10.4088/JCP.16m10970 [doi]
LID - 16m10970 [pii]
AB  - OBJECTIVE: The first-onset affective episode requiring inpatient treatment in the
      postpartum period can be a marker of bipolar disorder, but it is unknown whether 
      milder postpartum affective episodes are also indicators of underlying
      bipolarity. Therefore, we aimed to study whether women with a nonpsychotic
      postpartum affective episode treated with antidepressants have an increased risk 
      of bipolar disorder. METHODS: A register-based cohort study was conducted in
      Denmark of 122,622 parous women without psychiatric history who received a
      first-time antidepressant prescription during 1997-2012. We compared women with a
      first-time antidepressant prescription, which was our indicator of a first-onset 
      affective disorder, within 1 year postpartum to women with a first-time
      antidepressant prescription outside the postpartum period. Our outcome was
      psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and 
      we estimated hazard ratios using Cox regressions. RESULTS: The risk of bipolar
      disorder among women with a postpartum affective episode was higher than that in 
      women with an affective episode outside the postpartum period. The risk of
      bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant
      monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy 
      plus a subsequent prescription for anxiolytics when these therapies were compared
      to antidepressant monotherapy outside the postpartum period. CONCLUSIONS:
      First-onset nonpsychotic postpartum affective disorder can be a marker of
      underlying bipolarity. Women who fill an antidepressant prescription following
      childbirth should be asked about hypomanic or manic symptoms and monitored long
      term. Clinically, when antidepressant monotherapy is ineffective or the
      individual woman experiences persistent and concerning symptoms, health
      professionals should consider a possible bipolar spectrum disorder.
FAU - Liu, Xiaoqin
AU  - Liu X
AD  - The National Center for Register-based Research, Aarhus University, Fuglesangs
      Alle 4, 8210 Aarhus V, Denmark. [email protected]
AD  - The National Center for Register-based Research, Aarhus University, Aarhus,
      Denmark.
FAU - Agerbo, Esben
AU  - Agerbo E
AD  - The National Center for Register-based Research, Aarhus University, Aarhus,
      Denmark.
AD  - CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, 
      Denmark.
AD  - Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH,
      Aarhus, Denmark.
FAU - Li, Jiong
AU  - Li J
AD  - Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
FAU - Meltzer-Brody, Samantha
AU  - Meltzer-Brody S
AD  - Department of Psychiatry, University of North Carolina at Chapel Hill School of
      Medicine, Chapel Hill, North Carolina, USA.
FAU - Bergink, Veerle
AU  - Bergink V
AD  - The National Center for Register-based Research, Aarhus University, Aarhus,
      Denmark.
AD  - The Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.
FAU - Munk-Olsen, Trine
AU  - Munk-Olsen T
AD  - The National Center for Register-based Research, Aarhus University, Aarhus,
      Denmark.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
SB  - IM
MH  - Adult
MH  - Anxiety Disorders/*diagnosis/*epidemiology/genetics/psychology
MH  - Bipolar Disorder/diagnosis/*epidemiology/genetics/psychology
MH  - Cohort Studies
MH  - Denmark
MH  - Depression, Postpartum/*diagnosis/*epidemiology/genetics/psychology
MH  - Female
MH  - Genetic Predisposition to Disease/genetics
MH  - Humans
MH  - Proportional Hazards Models
MH  - Puerperal Disorders/*diagnosis/*epidemiology/genetics/psychology
MH  - Registries
MH  - Risk Factors
EDAT- 2017/06/02 06:00
MHDA- 2017/06/18 06:00
CRDT- 2017/06/02 06:00
PHST- 2016/05/24 [received]
PHST- 2016/09/08 [accepted]
AID - 10.4088/JCP.16m10970 [doi]
PST - ppublish
SO  - J Clin Psychiatry. 2017 May;78(5):e469-e476. doi: 10.4088/JCP.16m10970.

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