Effect of optimized treatment on the postpartum recurrence in women with bipolar I disorder: A case series

• This case series describes the postpartum course of BDI among high-risk women receiving optimized treatment aimed specifically at the prevention of mania. • A targeted treatment approach including the provision of information about the effect of pregnancy and postpartum on the course of the disorder, close monitoring, early detection of emerging symptoms, and treatment aimed at the prevention of manic/mixed episodes contributed to the positive outcome in the postpartum period. • Multicenter studies are necessary to assess the effect of a multimodal treatment including psychoeducation, social rhythm therapy, and targeted pharmacotherapy in the prevention of postpartum recurrence in women with BDI. Women with bipolar I disorder are at a high risk of recurrence postpartum. This case series describes the postpartum course of bipolar I disorder among women receiving optimized treatment aimed specifically at the prevention of mania. Clinical records of 12 pregnant females with bipolar I disorder who were seen consecutively at a perinatal clinic between 2020 and 2023 were reviewed to assess the effect of treatment including psychoeducation, good sleep hygiene, avoidance of antidepressants, and use of sedating atypical antipsychotics on postpartum recurrence. All except one patient had been hospitalized for bipolar disorder. The mean follow-up period was 56 ± 73 weeks postpartum. Only two patients (16.7%) had a relapse (both depression) during the postpartum period. No one required psychiatric hospitalization. Small sample size, retrospective design, and lack of comparison group. Combining psychoeducation, social rhythm therapy, and targeted pharmacotherapy may be effective in the prevention of postpartum recurrence in women with bipolar I disorder.