- Pooled postpartum recurrence was 0.21 (95% CI 0.15 to 0.29) with lithium versus 0.41 (95% CI 0.33 to 0.50) without lithium.
- Majority of prophylaxis was initiated during pregnancy (51.9%), and discontinuation studies provided indirect evidence supporting lithium effectiveness.
- Interpretation requires caution due to confounding by indication and limited available literature.
J Clin Psychiatry. 2026 Oct 26;87(4):26r16567. doi: 10.4088/JCP.26r16567.
ABSTRACT
Background: Women with bipolar disorder are at increased risk for relapse/recurrence during the postpartum period. This risk decreases with prophylactic pharmacologic treatment, compared to those who remain medication-free. Lithium use in preventing relapse has been studied extensively in individuals with bipolar disorder, though its specific use in the postpartum has not received as much attention.
Objective: The aim of this systematic review (CRD420261357096) was to estimate risk of postpartum relapse, specifically in women with bipolar disorder who received lithium prophylactically versus those who discontinued it during pregnancy.
Study Selection: Following PRISMA guidelines, reviewers screened 45 studies focused on women with bipolar I or II disorders from searches of PubMed, PsycINFO, and Cochrane databases conducted on April 2, 2026, that were written in English.
Data Extraction: Two independent observers extracted data using a data extraction form created on Covidence. Random-effects meta-analysis of recurrence proportions, between-study variance, heterogeneity, and leave-one-out sensitivity analyses were conducted.
Results: Eight studies (554 women) providing information on the prophylactic effect of lithium during the postpartum period, and 2 studies evaluating the impact of lithium discontinuation on postpartum relapse, were identified. The pooled recurrence proportion was 0.21 (95% CI 0.15-0.29) in lithium-treated patients and 0.41 (95% CI 0.33-0.50) in lithium-untreated patients. The most common timing of prophylaxis initiation was during pregnancy (51.9%). Studies examining the impact of lithium discontinuation provided indirect evidence of its effectiveness in preventing postpartum recurrence.
Conclusion: Findings from our meta-analysis suggest that lithium is effective in preventing postpartum recurrence of mood disorders; however, caution is warranted when interpreting study results because of confounding by indication and limited literature.
PMID:42949427 | DOI:10.4088/JCP.26r16567
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