Women and bipolar disorder: an update.

The major clinical challenges facing women with bipolar illness, and the practitioners who care for them, are the management of rapid cycling and of the postpartum period. Among patients with rapid cycling bipolar disorder, the treatment of depression is particularly problematic. The most commonly prescribed mood stabilizers are more potent antimanic than antidepressant agents, and the use of antidepressants may precipitate mania or rapid cycling. The availability of new anticonvulsant medications that may have both mood-stabilizing and antidepressant effects is an important development in this regard. In the postpartum period, women with bipolar illness are at uniquely high risk for relapse. The possible reasons for this high risk, and options for the management of pregnancy and the postpartum period in bipolar women, are discussed.