Publications by authors named "Crystal T Clark"

21 Publications

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Psychotropic drug use in perinatal women with bipolar disorder.

Authors:
Crystal T Clark

Semin Perinatol 2020 Apr 25;44(3):151230. Epub 2020 Jan 25.

Department of Psychiatry and Behavioral Sciences, Department of Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, United States. Electronic address:

Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological changes during pregnancy are associated with decreases in the plasma concentrations of the majority of mood stabilizing medications. Regular symptom and drug concentration monitoring for lithium and anticonvulsants with reflexive dose adjustment improves the probability of sustained symptom remission across pregnancy. The elimination clearance trajectory across pregnancy for psychotropics dictates the frequency of laboratory monitoring and dose adjustment. The literature on the pharmacokinetics of lithium, lamotrigine, carbamazepine and atypical antipsychotics during pregnancy and postpartum are reviewed, recommendations for symptom and laboratory monitoring are proposed and recommendations for dose adjustments are presented.
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http://dx.doi.org/10.1016/j.semperi.2020.151230DOI Listing
April 2020

The Gut Microbiome in Bipolar Disorder and Pharmacotherapy Management.

Neuropsychobiology 2020 13;79(1):43-49. Epub 2019 Nov 13.

Department of Psychiatry, Northwestern University, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois, USA.

The gut microbiome is a complex and dynamic community of commensal, symbiotic, and pathogenic microorganisms that exist in a bidirectional relationship with the host. Bacterial functions in the gut play a critical role in healthy host functioning, and its disruption can contribute to many medical conditions. The relationship between gut microbiota and the brain has gained attention in mental health due to the mounting evidence supporting the association of gut bacteria with mood and behavior. Patients with bipolar disorder exhibit an increased frequency of gastrointestinal illnesses such as inflammatory bowel disease, which mechanistically has been linked to microbial community function. While the heterogeneity in microbial communities between individuals might be associated with disease risk, it may also moderate the efficacy or adverse effects associated with the use of medication. The following review highlights published evidence linking the function of gut microbiota both to bipolar disorder risk and to the effect of medications that influence microbiota, inflammation, and mood symptoms.
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http://dx.doi.org/10.1159/000504496DOI Listing
November 2020

Risk-Benefit assessment of infant exposure to lithium through breast milk: a systematic review of the literature.

Int Rev Psychiatry 2019 05 10;31(3):295-304. Epub 2019 Jun 10.

c Asher Center for the Study and Treatment of Depressive Disorders, Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology , Northwestern University , Chicago , IL , USA.

The continuation of lithium while breastfeeding is a controversial topic, and clinical recommendations vary. A systematic review was completed of available data on lithium and breastfeeding to determine the degree of lithium exposure through breast milk and assess the potential risk to the infant. Databases, including PubMed MEDLINE, Embase, PsycINFO, Web of Science, Scopus, and Cochrane CENTRAL Register of Controlled Trials databases, were searched for articles on lithium and breastfeeding from the start dates of the databases through December 2018. Articles were included if the report included at least one maternal serum/plasma and/or breast milk lithium concentration and one infant serum/plasma lithium concentration. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Twelve articles, all case reports, were selected for inclusion out of 441 articles that were found and 230 that were reviewed from the search. Data are limited on the safety of lithium continuation while breastfeeding. Among the adverse effects reported, it is difficult to differentiate poor outcomes from factors affecting infant health, concomitant medications, and gestational lithium exposure. Recommendations on whether to continue lithium while breastfeeding must be personalized to the individual woman and her infant.
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http://dx.doi.org/10.1080/09540261.2019.1586657DOI Listing
May 2019

Use of Antipsychotic Drugs During Pregnancy.

Curr Treat Options Psychiatry 2019 Mar 30;6(1):17-31. Epub 2019 Jan 30.

Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.

Purpose Of Review: Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes.

Recent Findings: The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments.

Summary: In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.
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http://dx.doi.org/10.1007/s40501-019-0165-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410162PMC
March 2019

Validity of the WHIPLASHED as a tool to identify bipolar disorder in women.

J Affect Disord 2019 03 17;246:69-73. Epub 2018 Dec 17.

Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA; Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.

Background: The aim of this study was to investigate the validity of the WHIPLASHED clinician-administered interview, a mnemonic of questions on clinical factors and illness course used to screen for bipolar disorder, as a self-report questionnaire.

Methods: Participants (n = 82) were females recruited from an outpatient academic women's mental health clinic. Relevant symptom data were extracted from a self-report questionnaire designed to parallel the WHIPLASHED interview questions. A score of ≥5 on WHIPLASHED was defined as a positive screen for bipolar spectrum disorder by its developer. We examined the capacity of self-reported WHIPLASHED scores ≥5 to differentiate bipolar from unipolar depression in women. Diagnostic assessments were conducted with the Mini International Neuropsychiatric Interview.

Results: Women were diagnosed with unipolar (n = 54) and bipolar (n = 28) depression. The majority of subjects were white (67%), employed (68%) and married (57%) with a mean age of 36.8 years. The receiver operating characteristic curve demonstrated that WHIPLASHED had strong predictive ability (AUC = 0.877) in differentiating bipolar from unipolar depression. A cutoff score of ≥5 generated 96% sensitivity and 52% specificity, while raising the threshold to 6 generated 89% sensitivity and 76% specificity for a bipolar disorder diagnosis.

Limitations: Our sample was small and composed of female patients at a single treatment center.

Conclusions: In this sample, WHIPLASHED was a valid screening tool to differentiate bipolar from unipolar depression. While existing instruments focus on primary symptoms of bipolar disorder, the WHIPLASHED is useful in exploring subtypes of bipolar disorder in which depression dominates the clinical course.
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http://dx.doi.org/10.1016/j.jad.2018.12.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563604PMC
March 2019

Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes.

J Affect Disord 2019 01 18;243:220-225. Epub 2018 Sep 18.

Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.

Objective: The hypotheses were: (1) pregnant women with bipolar disorder (BD) have less favorable pregnancy outcomes than unaffected women, and (2) psychotropic treated women with BD have better outcomes than un-medicated women.

Method: This prospective study included 174 mother-infant dyads. Women had BD without psychotropic exposure (BD-NP, n = 38), BD with psychotropic treatment (BD-P, n = 49), or neither psychotropic exposure nor major mood disorder (Comp, n = 87). Maternal characteristics were completed at 20 weeks gestation and evaluated for associations with delivery and birth outcomes. We performed multiple regressions on infant outcomes with adjustment for maternal age, race, employment status, use of illicit drugs and pre-pregnancy BMI.

Results: The BP-P, BP-NP and Comp groups varied significantly on sociodemographic characteristics. Women with BD were more likely to be less educated, unemployed, single, and use tobacco and illicit drugs than women in the Comp group. Compared to women with BD-NP, women with BD-P were more likely to be older and educated. Approximately 10% of all infants were delivered preterm. No significant differences in outcome occurred for APGAR scores < 8, NICU admissions, sex or infant length. Infants of mothers with BD-NP had significantly smaller head circumferences (HC) than the other groups, adjustment for confounding variables mitigated this association.

Conclusions: The overall pregnancy outcomes for women with BD were similar to those in the Comp group. The reduced HC in women with untreated BD appears due to factors related to disadvantaged sociodemographic status, a higher proportion of female births, and/or a protective effect of medication in the BD-P group.
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http://dx.doi.org/10.1016/j.jad.2018.09.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548542PMC
January 2019

Treatment of Peripartum Bipolar Disorder.

Obstet Gynecol Clin North Am 2018 Sep;45(3):403-417

Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 St. Clair Street, Chicago, IL 60611, USA.

Bipolar disorder affects women throughout their childbearing years. During the perinatal period, women with bipolar disorder are vulnerable to depressive episode recurrences and have an increased risk for postpartum psychosis. Perinatal screening is critical to identify women at risk. Although medications are the mainstay of treatment, the choice of pharmacotherapy must be made by the patient based on a risk-benefit discussion with her physician. For optimal dosing in pregnancy, therapeutic drug monitoring may be required to maintain effective drug concentrations. Residual symptoms of bipolar depression are treatable with bright light therapy as an alternative to medication augmentation.
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http://dx.doi.org/10.1016/j.ogc.2018.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548543PMC
September 2018

Increasing Diagnosis and Treatment of Perinatal Depression in Latinas and African American Women: Addressing Stigma Is Not Enough.

Womens Health Issues 2018 May - Jun;28(3):201-204. Epub 2018 Feb 19.

University College London, London, UK.

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http://dx.doi.org/10.1016/j.whi.2018.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038800PMC
October 2018

Quetiapine Dose Adjustments in Pregnant and Postpartum Women With Bipolar Disorder.

J Clin Psychopharmacol 2018 02;38(1):89-91

Northwestern University Feinberg, School of Medicine, Chicago, IL The Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg, School of Medicine, Chicago, IL.

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http://dx.doi.org/10.1097/JCP.0000000000000820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734989PMC
February 2018

Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study.

Bipolar Disord 2017 06 30;19(4):295-304. Epub 2017 Jun 30.

Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

Objective: We conducted a prospective naturalistic study of pregnant women with bipolar disorder (BD) to evaluate symptoms of BD across childbearing and assess whether pharmacotherapy reduced their severity.

Methods: Assessments were scheduled at 20, 30, and 36 weeks' gestation and 2, 12, 26, and 52 weeks postpartum. Symptoms were assessed using the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Supplement (SIGH-ADS) and Mania Rating Scale (MRS).

Results: Pregnant women (N=152) with BD were evaluated; 88 women (58%) were treated and 64 untreated (42%) with psychotropic drugs during pregnancy. Among the 88 women treated, 23 (26%) discontinued their medication in the first trimester and the remaining 65 (74%) were exposed throughout pregnancy or in the second and third trimesters. More than two-thirds (73%) of the women who remained in the study took psychotropic agents postpartum. The mean scores on the SIGH-ADS were in the mild range of depressive symptoms in both the psychotropic-treated and untreated groups in both pregnancy and postpartum. The majority of women had no or few symptoms of mania. Of the pregnant women treated with psychotropic agents, 66% received a guideline-concordant drug, and 34% received either antidepressant monotherapy (for BD I) or mono- or polypharmacy with a variety of other agents.

Conclusions: This sample of perinatal women with BD was characterized by mild residual symptoms of depression independent of pharmacotherapy, which poses a risk for recurrence and impaired parenting. The treatment of childbearing women with BD deserves urgent clinical and research attention to improve psychiatric outcomes.
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http://dx.doi.org/10.1111/bdi.12500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594856PMC
June 2017

Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: A population-based cohort study.

J Affect Disord 2017 08 3;218:394-397. Epub 2017 May 3.

Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands.

Background: Women with bipolar disorder are at high risk for relapse/recurrence postpartum. Among all mood stabilizers, lithium has the largest evidence base for efficacy in the peripartum period, but lamotrigine is increasingly prescribed for bipolar spectrum disorders during pregnancy. The aim of this study was to investigate whether lamotrigine use during pregnancy is as effective as lithium in the prevention of severe episodes postpartum.

Methods: Danish national registries were used to identify pregnancies of women with a diagnosis of bipolar spectrum disorders at the time of conception who used lamotrigine or lithium during pregnancy. We compared the risk of inpatient psychiatric admission within three months postpartum between women who used lamotrigine (N=55) versus lithium (N=59) during pregnancy. A logistic regression model was used to calculate crude and adjusted odds ratios.

Results: We did not find a significant difference in the risk of postpartum psychiatric admission between women who used lamotrigine versus lithium during pregnancy (7.3% versus 15.3% respectively, adjusted OR 0.83; 95% CI 0.22-3.14). We adjusted for year of delivery, parity, previous admissions and antidepressant/benzodiazepine use during pregnancy. Other variables did not differ substantially between groups.

Limitations: We used an observational design and therefore patients were not randomized to lamotrigine or lithium. The study has a small sample size.

Conclusions: Lamotrigine was not inferior to lithium in the prevention of severe postpartum episodes. Our findings suggest lamotrigine could be a reasonable alternative treatment option for bipolar disorder during pregnancy in patients with vulnerability for depression and may prevent severe episodes postpartum.
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http://dx.doi.org/10.1016/j.jad.2017.04.070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530731PMC
August 2017

Perspectives from Patients and Healthcare Providers on the Practice of Maternal Placentophagy.

J Altern Complement Med 2017 Jan 17;23(1):60-67. Epub 2016 Nov 17.

3 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL.

Purpose: Placentophagy (maternal consumption of the placenta) has become increasingly prevalent in the past decade among women seeking to promote health and healing during the postpartum period. The purpose of this study was to assess patient and provider familiarity with and attitudes toward placentophagy, as well as patients' willingness to try placentophagy.

Methods: Two cross-sectional surveys with questions regarding placentophagy practice were distributed to healthcare providers and patients. The provider survey was distributed via email listservers to international perinatal professional organizations and to obstetrics and gynecology, nurse midwifery, family medicine, and psychiatry departments at three urban hospitals. Patient surveys were administered in person at an urban hospital in Chicago, Illinois.

Results: Approximately two thirds (66%; n = 100) of patients and most (89%; n = 161) of providers were familiar with placentophagy. Patients with a history of a self-reported mental health disorder were more likely to be willing to consider placentophagy and to believe that healthcare providers should discuss it with their patients.

Conclusions: Most providers and patients have heard of placentophagy but are unsure of its benefits and/or risks. Further research examining the potential therapeutic efficacy and/or risks of placentophagy is needed.
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http://dx.doi.org/10.1089/acm.2016.0147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913118PMC
January 2017

Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period.

J Affect Disord 2016 Oct 28;203:111-120. Epub 2016 May 28.

University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, United States.

Background: Unipolar and bipolar depression identified in the postpartum period have a heterogeneous etiology. The objectives of this study are to examine the risk factors that distinguish the timing of onset for unipolar and bipolar depression and the associations between depression onset by diagnosis, and general and atypical depressive symptoms.

Methods: Symptoms of depression were assessed at 4- to 6-weeks postpartum by the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms in an obstetrical sample of 727 women. Data were analyzed using ANOVA, Chi-square, and linear regression.

Results: Mothers with postpartum onset of depression were more likely to be older, Caucasian, educated, married/cohabitating, have one or no previous child, and have private insurance in contrast to mothers with pre-pregnancy and prenatal onset of depression. Mothers with bipolar depression were more likely to have a pre-pregnancy onset. Three general and two atypical depressive symptoms distinguished pre-pregnancy, during pregnancy, and postpartum depression onset, and the presence of agitation distinguished between unipolar and bipolar depression.

Limitations: The sample was urban, which may not be generalizable to other populations. The study was cross-sectional, which excludes potential late onset of depression (after 4-6 weeks) in the first postpartum year.

Conclusions: A collective set of factors predicted the onset of depression identified in the postpartum for mothers distinguished by episodes of unipolar versus bipolar depression, which can inform clinical interventions. Future research on the onset of major depressive episodes could inform prophylactic and early psychiatric interventions.
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http://dx.doi.org/10.1016/j.jad.2016.05.063DOI Listing
October 2016

Response to Eskola et al.

Am J Psychiatry 2015 Aug;172(8):797

From the Department of Psychiatry, University of North Carolina at Chapel Hill; the Department of Obstetrics/Gynecology and the Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine; the Department of Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh; and the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston.

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http://dx.doi.org/10.1176/appi.ajp.2015.15030377rDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592132PMC
August 2015

DOES SCREENING WITH THE MDQ AND EPDS IMPROVE IDENTIFICATION OF BIPOLAR DISORDER IN AN OBSTETRICAL SAMPLE?

Depress Anxiety 2015 Jul 8;32(7):518-26. Epub 2015 Jun 8.

Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Background: Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period.

Methods: Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4-6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID).

Results: Positive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion.

Conclusion: Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
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http://dx.doi.org/10.1002/da.22373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588053PMC
July 2015

Placentophagy: therapeutic miracle or myth?

Arch Womens Ment Health 2015 Oct 4;18(5):673-80. Epub 2015 Jun 4.

Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, 676 St. Clair, Suite 1000, Chicago, IL, 60611, USA.

Postpartum women are consuming their placentas encapsulated, cooked, and raw for the prevention of postpartum depression (PPD), pain relief, and other health benefits. Placentophagy is supported by health advocates who assert that the placenta retains hormones and nutrients that are beneficial to the mother. A computerized search was conducted using PubMed, Medline Ovid, and PsychINFO between January 1950 and January 2014. Keywords included placentophagy, placentophagia, maternal placentophagia, maternal placentophagy, human placentophagia, and human placentophagy. A total of 49 articles were identified. Empirical studies of human or animal consumption of human placentas were included. Editorial commentaries were excluded. Animal placentophagy studies were chosen based on their relevance to human practice. Ten articles (four human, six animal) were selected for inclusion. A minority of women in developed countries perceive placentophagy to reduce PPD risk and enhance recovery. Experimental animal research in support of pain reduction has not been applied in humans. Studies investigating placenta consumption for facilitating uterine contraction, resumption of normal cyclic estrogen cycle, and milk production are inconclusive. The health benefits and risks of placentophagy require further investigation of the retained contents of raw, cooked, and encapsulated placenta and its effects on the postpartum woman.
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http://dx.doi.org/10.1007/s00737-015-0538-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580132PMC
October 2015

Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model.

Am J Psychiatry 2015 Mar 13;172(3):227-36. Epub 2015 Jan 13.

From the Department of Psychiatry, University of North Carolina at Chapel Hill; the Department of Obstetrics/Gynecology and the Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh School of Medicine; the Department of Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh; and the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston.

Objective: In this conceptual review, the authors propose a novel mechanistic candidate in the etiology of depression with onset in the menopause transition ("perimenopausal depression") involving alterations in stress-responsive pathways, induced by ovarian hormone fluctuation.

Method: The relevant literature in perimenopausal depression, including prevalence, predictors, and treatment with estrogen therapy, was reviewed. Subsequently, the growing evidence from animal models and clinical research in other reproductive mood disorders was synthesized to describe a heuristic model of perimenopausal depression development.

Results: The rate of major depressive disorder and clinically meaningful elevations in depressive symptoms increases two- to threefold during the menopause transition. While the mechanisms by which ovarian hormone fluctuation might impact mood are poorly understood, growing evidence from basic and clinical research suggests that fluctuations in ovarian hormones and derived neurosteroids result in alterations in regulation of the HPA axis by γ-aminobutyric acid (GABA). The authors' heuristic model suggests that for some women, failure of the GABAA receptor to regulate overall GABA-ergic tone in the face of shifting levels of these neurosteroids may induce HPA axis dysfunction, thereby increasing sensitivity to stress and generating greater vulnerability to depression.

Conclusions: The proposed model provides a basis for understanding the mechanisms by which the changing hormonal environment of the menopause transition may interact with the psychosocial environment of midlife to contribute to perimenopausal depression risk. Future research investigating this model may inform the development of novel pharmacological treatments for perimenopausal depression and related disorders, such as postpartum depression and premenstrual dysphoric disorder.
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http://dx.doi.org/10.1176/appi.ajp.2014.14070918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513660PMC
March 2015

Double duty: does epidural labor analgesia reduce both pain and postpartum depression?

Anesth Analg 2014 Aug;119(2):219-21

From the *Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry; and †Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.

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http://dx.doi.org/10.1213/ANE.0000000000000322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476630PMC
August 2014

Response to Sharma and Sommerdyk.

Am J Psychiatry 2014 Mar;171(3):371

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http://dx.doi.org/10.1176/appi.ajp.2014.13111493rDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347811PMC
March 2014

Lamotrigine dosing for pregnant patients with bipolar disorder.

Am J Psychiatry 2013 Nov;170(11):1240-7

Objective: Little information is available on the need for dosage changes for lamotrigine in pregnant women with bipolar disorder. The authors present new data on serial serum levels of lamotrigine in pregnant patients on lamotrigine monotherapy. They also review the epilepsy literature on use of lamotrigine during pregnancy.

Method: Lamotrigine serum samples were obtained from eight mother-infant pairs at different time points during pregnancy and the postpartum period.

Results: All of the women were taking lamotrigine throughout pregnancy. Serum-level-to-dose ratios were lower during pregnancy than the postpartum period. Lamotrigine was taken once daily in doses ranging from 100 mg to 300 mg. Three patients had an increase of 50 mg to their daily dose across pregnancy. The change in serum lamotrigine levels in the postpartum period ranged from a 30% decrease to a 640% increase compared with the first level obtained during pregnancy. Level-to-dose ratios obtained within 4 weeks after delivery reflected a mean level 402% greater than the baseline level during gestation. Compared with the third trimester, lamotrigine serum concentration increased an average of 154% within 5 weeks after delivery. The most dramatic increase in lamotrigine serum level early after delivery occurred at 1.5 weeks. The mean infant cord level was 66% of the maternal serum level at delivery. The mean breast-fed infant serum level was 32.5% of the maternal serum levels.

Conclusions: The pattern of lamotrigine changes during pregnancy in these women with bipolar disorder was consistent with that described in the epilepsy literature.
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http://dx.doi.org/10.1176/appi.ajp.2013.13010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154145PMC
November 2013