|Stewart 1988||Case-series||4 women with history of postnatal psychosis||Lithium (900–1200 mg/d) immediately after delivery.||All women did not develop postnatal psychosis.|
|Stewart 1991||Case-series||21 high risk post-partum women|
|Lithium (750-1200 mg).|
Started within 24 hours of delivery. N = 16.
Started at 34 weeks. N = 4.
Throughout pregnancy. N = 1.
|Two (10%) relapsed with postnatal psychosis.|
|Austin 1992||Controlled-trial||17 women with bipolar disorder or puerperal affective psychosis.||Lithium, during pregnancy or within 48 hours after birth, for 3 months with serum levels of 0.4 mmol/L or more. N = 9.|
Non-treatment group. N = 8.
|Two (22%) in the lithium group relapsed with postnatal psychosis 10 days postpartum.|
Six (75%) of the non-treatment group relapsed with postnatal psychosis.
|27 women with bipolar disorder who had experienced at >1 episode of bipolar disorder prior to index pregnancy. ||Prophylactic mood stabilisers (lithium). N = 14.|
Did not receive any prophylactic treatment. N = 13.
|No women taking a mood stabiliser developed postpartum psychosis. 1 developed affective instability 3 months postpartum. |
8 who received no treatment experienced manic or depressive relapse within the first 3 months postpartum. No information re postnatal psychosis available.
|Sichel 1995||Case-series||11 women given oestrogen following delivery. 7 had history of puerperal psychosis and 4 of puerperal major depression.||Oral premarin (10 mg/ day) administered following delivery in decreasing dosages over 4 weeks.|
|1 experienced psychosis relapse during first postpartum week.|
|Kumar 2003||Case-series||29 pregnant women with diagnosis of hypomania (bipolar II), mania (bipolar I), or schizoaffective disorder.||Transdermal oestrogen:|
1. 200 µg/day. N = 13.
2. 400 µg/day. N = 3.
3. 800 µg/day. N = 13.
All within 48 hours after delivery and reduced by half every 4 days for 12 days.
|12 relapsed in total.|
Women taking oestrogen 800 µg/day needed less subsequent psychotropic medication and were discharged sooner than those taking lower doses.
|Wisner 2004||Controlled-trial||26 pregnant women diagnoses with bipolar disorder.||Intervention:|
Divalproex sodium (VLP) 250 mg twice a day immediately after birth. N = 15.
Postpartum monitoring alone without medications. N = 11.
|No women developed postnatal psychosis.|
In the intervention group, 10 (67%) developed postpartum hypomania/mania, depression, or mixed-state diagnoses vs 8 (73%) of non-intervention group.
|Sharma 2006||Controlled-trial||25 women with diagnosis of hypomania (bipolar II), mania (bipolar I).||Olanzapine 5–10 mg alone or in combination with an antidepressant or mood stabilizer. N = 11.|
Either antidepressants, mood stabilizers, or no medication for minimum of 4 weeks after delivery. N = 14.
|No postnatal psychosis in olanzapine group.|
2 women (lithium and no medication) experienced postnatal psychosis in non-olanzapine group.
|Bilszta 2010||Controlled-trial||23 women with history of bipolar disorder or postpartum psychosis.|
Controls: 15 healthy pregnant women.
|1. Mood-stabilisers. N = 7.|
2. Antidepressant or antipsychotic. N = 8.
3. No medication. N = 4.
All through pregnancy and postnatal period.
|No women taking a mood stabiliser relapsed during study.|
|Bergink 2012||Case-series||29 women with history of postpartum psychosis without any manic or psychotic symptoms outside postpartum period. ||Lithium prophylaxis (0.8 mmol/L minimum plasma level) immediately postpartum.||4 of 9 women without postpartum prophylaxis and history of postpartum psychosis relapsed (44%).|
No relapse reported among women who initiated postpartum prophylaxis.