About this Research Topic
The course of affective disorders is shown to have relation to childbirth, menstrual cycle, menopause and hormonal therapies. There is accumulating evidence that, in at least some women, reproductive events may play a role in increasing the risk of mood episodes in major depressive disorders (MDD) as well in bipolar disorder (BD). Women with mood disorders without treatment are at higher risk of relapse both during and particularly after pregnancy. BD appears to have the highest risk of onset or recurrence in the peripartum period. However, the benefits of medications in the prevention of affective episodes need to be carefully balanced against risks for the fetus during pregnancy, neonatal complications following delivery, and breastfeeding. Concerning menstrual cycle, a putative relationship between menarche and onset of mood disorders has been suggested. Moreover, it is known that women with affective disorders report frequent premenstrual mood disruptions and emotional disturbances during the menopausal transition, while the efficacy of hormonal treatments on mood symptoms is still debated. Lastly, among issues concerning the use of some medications for MDD and BD in women, menstrual and ovarian changes as well as impaired oral contraception have been highlighted.
In the era of personalized treatments and precision psychiatry, it is time to take care of women with mood disorders considering the gender-gap. Instead, there is still a lack of attention to reproductive events and their complex reciprocal interactions with affective disorders and their treatments. Diagnostic boundaries of specific psychiatric conditions related to reproductive events in women remain uncertain. Postpartum depression and premenstrual dysphoric disorder have been considered among clinical markers of BD in studies on bipolar spectrum, and it is not clear if postpartum psychosis represents a subtype of BD or a distinct disorder. Moreover, preconception counselling and management of pregnancy, peripartum and lactation of women with mood disorders should be improved through an updated and evidence-based clinical practice. Recent advances indicate that dedicated prenatal care by multidisciplinary groups comprising of psychiatrists and maternal-fetal medical specialists can contribute to good pregnancy outcomes. Concerning therapies for mood disorders in women, on the one hand there is an urgent need for targeted pharmacological treatment during childbearing age, taking into account subtypes and course specifiers, the impact of medications on reproductive function and their interactions with oral contraceptives. On the other hand, new insights on the role of psychotherapies are required (which techniques, when and for whom).
In light of these issues we intend to collect findings from specialists across various disciplines (psychiatry, psychology, gynecology, neonatology) involved in the management of women with mood disorders. Submissions addressing the following specific themes are of great interest:
• risk of specific peripartum mood episodes (depressive vs manic/mixed);
• postpartum psychosis, prevention and management, risk of suicide and filicide, rates and predictors;
• risk of suicide and filicide, rates and predictors;
• changes in metabolism and drug clearance during pregnancy, teratogenicity risks of medications for mood disorders, both MDD and BD, and postnatal adaptation syndrome
• breastfeeding, risk of disruption of circadian rhythm in women with affective disorders, safety of antidepressants and mood stabilizers during breastfeeding;
• menstrual and ovarian cycle, menarche and menopause, course of MDD and BD and treatments implications, pharmacokinetic interactions of psychopharmacological treatment with oral contraceptive
Submitted manuscripts should be either original research reports, conducted on animal models or human subjects, or review articles.
Keywords: bipolar disorder, pregnancy, peripartum, menstrual cycle, mood stabilizers
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