Lithium in the Prevention of Postpartum Recurrence of Mood Disorders: A Systematic Review and Meta-Analysis
In brief
Lithium-treated women had 21% postpartum relapse, versus 41% without lithium
Across eight studies involving 554 women with bipolar disorder, pooled postpartum recurrence was 21% among those treated with lithium and 41% among those not treated. This difference suggests lithium may help prevent relapse, but the evidence is limited and could be affected by differences between patients who received treatment and those who did not.
- Journal
- The Journal of clinical psychiatry (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Verinder Sharma, Emily L Dietrich, Boseok Cha, Christina Gonzalez-Torres, Dwight Mazmanian
- PMID
- 42949427
- DOI
- 10.4088/JCP.26r16567
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 2 November 2026): Meta-analysis addresses lithium prophylaxis for postpartum bipolar recurrence
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.