M A R I T I M E B I P O L A R R E G I S T R Y Q E 1 1 H e a l t h S c i e n c e s C e n t r e A b b i e J. L a n e B l d g. R m. 4 0 3 1 5 9 0 9 V e t e r a n ' s M e m o r i a l L a n e H a l i f a x , N o v a S c o t i a 4 7 3 - 5 8 8 4 In this issue of the Registry Newsletter,
a women's reproductive status has a huge influence on the illness itself. Puberty
we are pleased to have an article by Dr.
often coincides with the earliest Newsletter Date Claire O'Donovan. Dr. O'Donovan is the director of Mood Disorders at the September 2004 QEII Health Sciences Centre in Halifax and an Associate Professor at Dalhousie Why is rapid-cycling more common in Women and Bipolar Disorder
times a year, greatly accelerating the past
course of illness, or sometimes this is the
first presentation of the illness. A number
Dr. Claire O'Donovan
explain this difference. The main theory
A patient with bipolar illness needs help
duration. Antidepressants used long-term
may cause rapid-cycling in a minority of
are prone, is also known to accelerate the
course of illness, often settling when it is
P.M.S. mood fluctuations are tied to the
involve tapering an antidepressant, using
In bipolar disorder a gender perspective
and course are different, but also because
Women and Bipolar Disorder .continued
as switching or combining mood stabilizers.
lamotrigine (Lamictal) may interfere with the
Why is depression more common?
oral contraceptive pill, necessitating an increase
in dose. Women of child-bearing years should
more hospitalizations for depression than men.
pharmacies) to protect against spina bifida or
other neural tube abnormalities in the event of
psychological burden in women, variations in
an unexpected pregnancy. This is of particular
expression of chronic stress on the brain, and
importance if on valproate, as the risk is
hormonal differences both in the body and the
significantly increased. Finally, the risks of an
brain. Despite the increased prevalence of
acute manic episode include heightened sex
depression in women, women are in fact less
likely to end their lives by suicide. Attention to
consequences, making promiscuity and unsafe
thyroid and hormonal status in women as well
sexual activity more likely. Women who have
as the careful use of antidepressants may be
had this experience in past episodes may wish
helpful. Similarily, there may be more reliance
to look for ways to avoid this should they have
"atypicals" such as quetiapine (Seroquel) and
I would like to get pregnant. What should I
olanzepine (Zyprexa) which are particularily
review with my doctor ?
useful in treating and preventing depression
Pregnancy itself is not necessarily destabilizing
for bipolar illness. In fact, some studies suggest
What issues are important in the decision of
pregnancy. In contrast, the immediate post-
child- bearing?
partum period is high risk and as many as 50%
of women with the illness will develop a
serious episode in the first 30 days, often with
decision about having a baby. A child who has
psychotic symptoms and an extreme degree of
disorganization. This is largely ameliorated by
approximately 10% risk of the illness compared
preventative medication started as early as day
to 1% in the general population. The risk is
1 after the baby is born if medication has been
likely higher in children where several family
discontinued in pregnancy. Changes in the
members have the illness. Compared to other
sleep-wake cycle can precipitate an episode; so
genetic disorders, this is a low risk but may
careful attention to rest and sleep is important
factor into the decision-making process, along
interferes with sleep, and in the post-partum
challenges to stability in pregnancy and post-
period when babies need feeding during the
partum. Conception may be more difficult
Valproate (Epival, Depakote), carbamazepine
menstrual irregularities are present or on
(Tegretol, Trileptil) as well as lithium to a
"atypicals" such as risperidone which can raise
lesser degree, can cause abnormalities in the
the hormone prolactin's level in the blood.
baby if given in the first trimester. However
Conversely medications such as carbamazepine
illness itself also carries a risk to the baby
Woman and Bipolar Disorder .continued
because of the stress hormones, risky behaviour
Factors to discuss with your psychiatrist, family
when manic, diminished self-care in depression and
doctor and obstetrician if considering a
the risk of suicide and harm to the pregnancy or
pregnancy:
baby if psychotic symptoms lead one to believe
that it is necessary to end the baby's life. In fact
• The natural cycle of episodes of your illness
homicidal thoughts towards the baby are, for
• History of your specific course of illness in
inexplicable reasons, common when psychotic.
periods where you may have been off medication
Special tests can be done early on in the pregnancy
• The history of risks that have been associated
to test for congenital abnormalities. It should also
with prior episodes of your illness e.g. suicidality
be remembered that the baseline rate of congenital
when depressed, substance abuse when manic
abnormalities in the general population is 2-3/100
The course of illness in prior pregnancies History of miscarriages and abortions
• Known family congenital disorders
The dose of medication may need to be increased in
• Family planning
the 3rd trimester because of increased output from
• Use of other medications, over- the- counter
the heart. Particularly with lithium, the dose then
medication, herbals, coffee, alcohol, cigarettes,
needs to be rapidly decreased at the time of birth to
and other drugs in pregnancy
avoid toxicity. Some withdrawal symptoms may
• Proper nutrition in pregnancy
occur to the baby at the time of delivery also.
• Supplements to use in pregnancy if on certain
Finally, a decision with regard to breast feeding
medications
will need to be made, taking into account known
• Known risks associated with the medication you
information about the amount of the particular
are currently taking in the first and other
medication you may be on that is transferred to the
trimesters of pregnancy, at birth, in breast
breast milk. "Pump and dump" refers to using the
breast milk that has the lowest concentration of
• Information on long-term studies in children who
drug, based on when you take your medication.
have been exposed to the medication in utero
Again, the cost- benefit of no medication versus no
Safer alternatives to the medication you are
breastfeeding versus cautious breast feeding needs
currently on
• Specific tests available to check for abnormalities
to be discussed collaboratively with your doctor.
in the baby if on medications that carry a risk
For information on specific medication in
• If you come off medication and have an episode,
pregnancy and breastfeeding, you can call the
what medication is best to use for an acute
Toronto Mother-Risk program at 416-813-6780.
depression or mania?
• What are the earliest specific signs and symptoms of relapse for you?
• Name of two people you will trust to bring you to your doctor or the hospital if you become ill, and are unaware
• What is your own experience of parenting?
• What is your own particular set of circumstances that will impact having and rearing a child?
• What is your support system? DALHOUSIE UNIVERSITY Clinical Drug Study
We would like to tell you about an interesting study being done to see if a specific atypical antipsychotic medication, in addition to a mood stabilizer, is effective in preventing mood episodes in patients with bipolar I disorder. This study is being conducted at the QE II Health Sciences Centre by Dr. Alda and his colleagues. To take part in the study, you must meet the following requirements:
. Have had at least one mood episode in the last two years and are in or currently
recovering from an episode of illness within the past six months
Have been and are currently treated with Lithium or Epival in addition to a specific atypical antipsychotic drug since the most recent episode
Men and women who are using reliable contraception
Women who are not pregnant or breastfeeding
Patients will be recruited from 120 centers in Canada and the USA. About 12 patients will participate from this center. If you would like to learn more about this study, please contact: Susan
Molecular Pathology of these pathways could be used clinically, we conducted a randomized phase II trial based on letrozole (LET arm) with or Laboratory without ‘metronomic’ oral cyclophosphamide. PI3K, AKT, and mTOR were assessed on tumour specimens collected before and after treatment in patients randomized in this trial. The primary aim was to explore the changes of these molecu
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