Verinder Sharma

• MBBS
• Western University

Background The Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders. Methods CANMAT convened a core editoria...

This case series examines the effect of olanzapine on symptoms of hyperemesis gravidarum in individuals with mood disorders. Patient charts from 2022 to 2024 were reviewed, focusing on those with hyperemesis gravidarum who were treated with olanzapine alone or with other psychotropic drugs for their mood disorder. Of 6 patients with hyperemesis gra...

Both syndromic and subsyndromal episodes of psychiatric disorders are common during and after pregnancy and are associated with adverse consequences for the mother and her baby. Despite remarkable opportunities for the detection of at-risk women, the prevention and treatment of peripartum recurrences of psychiatric disorders remain a challenge for...

The association of weaning with depression has long been recognized. However, interest in the study of post-weaning depression has waned over the last few decades partly due to changes in the nosology of perinatal psychiatric disorders. In this paper, we review the relevant literature and conclude that post-weaning depression is a rare but severe c...

Objective Accurate information on the frequency and prevalence of manic or mixed episodes is important for therapeutic, prognostic, and safety concerns. We aimed to estimate the risk of relapse of manic and mixed episodes after delivery in women with bipolar I disorder or schizoaffective disorder—bipolar type. Methods Following the Preferred Repor...

Introduction: The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature was undertaken and coupled with expert clinical insights to discuss current clinical practice recommendations for PTSD in the perinatal period. Areas covered: This...

Purpose of Review While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal an...

Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients...

Fear of childbirth exists on a continuum of severity, and the most severe form is commonly referred to as tocophobia. Although a rare entity, tocophobia is a common reason for requesting an elective cesarean section. It is generally considered a specific phobia but is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM)...

Introduction: Women are at a high risk of recurrence of depression in the postpartum period. Given the circumscribed duration of the risk period and knowledge of its triggers, postpartum depression should be easily preventable. However, prophylactic drug studies have reported contradictory findings partly due to the heterogeneity of the disorder....

Purpose of review While pharmacotherapy is often used in the treatment of postpartum depression, there have been few positive randomized controlled trials that have supported this practice. Prior studies eliciting the treatment preferences of postpartum women have shown that this population is often hesitant to use antidepressant medications and ha...

Objective: Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD) in women with BD and those of a diagnosis of BD in women with PMDD deserve systematic review. Data Sources: A systematic search of PubMed, EMBASE, CINAHL, PsycINFO, and Co...

Introduction With a lifetime prevalence of 2.3%, obsessive compulsive disorder is a chronic, disabling condition that is associated with significant social and occupational impairment. Up to 30% of individuals with obsessive-compulsive disorder have a lifetime diagnosis of tic disorders. Antiseizure medication is increasingly used for a variety of...

Background To review the phenomenology, nosology, and treatment of postpartum psychosis. Methods Using the keywords postpartum, puerperal, psychosis, bipolar, mania, depression, classification, nosology, phenomenology, diagnosis, suicide, infanticide, and treatment, four electronic databases, MEDLINE/PubMed (1966–2020), PsycINFO (1806–2020), EMBAS...

Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during pe...

The pharmacological treatment of depression consists of stages of trial and error, with less than 40% of patients achieving remission during first medication trial. However, in a large, randomized-controlled trial (RCT) in the U.S. (“GUIDED”), significant improvements in response and remission rates were observed in patients who received treatment...

Hyperemesis gravidarum is a rare but potentially serious complication of pregnancy. Some women with severe symptoms and possibly psychiatric comorbidities remain symptomatic despite the use of currently available treatments. Due to its favorable safety profile, antiemetic efficacy in other conditions, and 5-HT3 antagonism, olanzapine may be a poten...

Abstract Aim: The study aimed to investigate resilience and its association with early exposure to stressful events on the clinical manifestations of bipolar disorders (BDs), such as severity of mood symptoms, suicidal ideation and behaviors focusing on the possible role of insomnia symptoms. Method: A sample of 188 adult participants with BD of...

Both pregnancy and the postpartum period influence the course of bipolar disorder. Discontinuation of mood stabilizers is associated with increased risk of recurrences in pregnancy; however, there is also evidence that pregnancy has a positive effect on the course of bipolar disorder. During the postpartum period, women are at risk of recurrence as...

Aim The study aimed to investigate resilience and its association with early exposure to stressful events on the clinical manifestations of bipolar disorders (BDs), such as severity of mood symptoms, suicidal ideation and behaviors focusing on the possible role of insomnia symptoms. Method A sample of 188 adult participants with BD of type I or II...

Background While there are several accepted screening measures for identifying those with a bipolar disorder, variations in overall classification rates argue for the pursuit of a more discriminating measure. Extant measures, as well as the DSM-5, rate each diagnostic criterion as having equivalent weighting values; an approach which may compromise...

Postpartum depression (PPD) is a major public health problem that affects approximately 12-18% of women and is associated adverse maternal and infant outcome. Given that untreated maternal depression has negative consequences for both the mother and her child, it is important to deploy effective measures to treat or prevent PPD. Antidepressant trea...

Background In this report, we describe a case of domperidone withdrawal in a woman with a history of major depressive disorder and obsessive-compulsive disorder (OCD) who experienced a recurrence of these disorders after stopping domperidone. Case presentation The symptoms improved after the restarting of domperidone and disappeared gradually as t...

Objectives The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendati...

Background: The diagnosis of Bipolar Disorder (BD) is frequently delayed. In this study, we aimed to examine the clinical and demographic factors associated with delayed diagnosis of BD, defined as the difference between the age at first mood episode (depressive, manic, or hypomanic) and the age at the correct diagnosis of BD, using data from a Can...

There has been a longstanding debate as to whether the bipolar disorders differ categorically or dimensionally, with some dimensional or spectrum models including unipolar depressive disorders within a bipolar spectrum model. We analysed manic/hypomanic symptom data in samples of clinically diagnosed bipolar I, bipolar II and unipolar patients, emp...

Background: This study aimed to improve the accuracy of bipolar disorder diagnoses by identifying symptoms that help to distinguish mania/hypomania in bipolar disorders from general ‘happiness’ in those with unipolar depression. Methods: An international sample of 165 bipolar and 29 unipolar depression patients (as diagnosed by their clinician) we...

Background: Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concep...

Studies from several countries have reported occurrence of the highs (hypomanic symptoms) immediately after childbirth; however, questions remain about the relationship of the highs with mood disorders. This systematic review aims to clarify this relationship, critically review important aspects of the highs, and make treatment recommendations and...

Background: It is unclear whether the bipolar disorders (i.e. BP-I/BP-II) differ dimensionally or categorically. This study sought to clarify this issue. Methods: We recruited 165 patients, of which 69 and 96 had clinician-assigned diagnoses of BP-I and BP-II respectively. Their psychiatrists completed a data sheet seeking information on clinical...

Aim The study aimed to investigate the potential pathways mediating early exposure to stressful events and the clinical manifestations of bipolar disorder (BD), such as severity of mood symptoms, hopelessness and suicidal ideation, focusing on the potential role of insomnia symptoms. Method A sample of 162 adult participants with BD I or II were a...

Introduction: Posttraumatic stress disorder (PTSD) affects 3–4% of the pregnant and postpartum population. Despite its high prevalence, there has been very little research on how the disorder should be managed in this population. This is of importance as untreated PTSD has been associated with adverse outcomes both in pregnancy and in child develop...

Antidepressants are the mainstay of drug treatment for moderate or severe postpartum depression. Knowledge of predictors of response could help optimize treatment and reduce the adverse consequences of postpartum depression. The purpose of this systematic review was to ascertain predictors of response or remission to antidepressant treatment in wom...

The traditional system of classifying postpartum psychiatric disorders into maternity blues, postpartum depression, and puerperal psychosis overlooks the clinical significance of hypomanic, manic, or mixed symptoms in the postpartum period. Although common after childbirth, episodes of hypomania or non‐psychotic mania, as well as mixed states, are...

Objective As limitations exist across DSM criteria sets for defining and differentiating the bipolar disorders generally and their component bipolar I (BP‐1) and bipolar II (BP‐II) sub‐types, we sought to generate empirically‐based criteria. Method We formed an international Task Force (TF) comprising members with bipolar disorder expertise, and w...

Introduction Currently conceptualized as an obsessive compulsive and related disorder, trichotillomania, or hair-pulling disorder, is a common illness that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania also have other comorbid diagnoses. Treating trichotillomania with pharmacot...

Mr.AB is a61‐year old divorced male who was referred to our clinic 15 years ago with a history of depression and recurrent panic attacks. He experienced first‐onset of depression as a child, and had several episodes of depression and hypomania before he sought professional help. Family history was positive for depression and anxiety in his siblings...

The peripartum period appears to be a potent trigger of obsessive-compulsive disorder in women; however, due to the lack of awareness and routine screening, women with obsessive-compulsive disorder may be at risk of under- or misdiagnosis. Unfortunately, the missed diagnosis or misdiagnosis can have serious consequences including symptom persistenc...

Although not listed in the DSM‐5, musical obsessions (also known as stuck song syndrome) are generally considered a symptom of obsessive‐compulsive disorder. Occurring alone or concurrently with other symptoms of obsessive‐compulsive disorder, musical obsessions may be common in bipolar disorder. Due to the lack of awareness and availability of pro...

Introduction Despite increased interest in the pharmacotherapy of bipolar disorder during pregnancy and the postpartum period, management of the disorder during these critical periods in a woman’s life remains challenging. Areas covered The authors review the effect of pregnancy and the postpartum period on the course of bipolar disorder, describe...

Background : The HOPE-BD was a naturalistic study established to follow individuals in Canada seeking treatment for bipolar disorder (BD). The study aimed to examine the course of BD and describe how clinical and sociodemographic factors are associated with outcomes. Methods : Individuals with BD had their clinical data recorded at enrolment and w...

Lithium is the current mainstay treatment for both acute and maintenance management of bipolar disorders. However, its narrow therapeutic index and array of side effects, although well-documented, can be challenging to manage. Comparatively, the side effects of lithium that involve the ophthalmic structures are not as well established in the litera...

A 26‐year old single, unemployed, mother of a nine year old boy was referred by her family physician for assessment of recurrent depression. She had been treated with duloxetine 30 mg‐90 mg over the past five years. The medication was initially effective; however, in spite of its regular use she had continued to experience frequent episodes of depr...

The recent conceptualisation of bipolar disorder as a neuroprogressive illness has highlighted the potential importance of prevention and early intervention in high-risk populations. Undiagnosed bipolar disorder early in the disease course is associated with adverse clinical outcomes and impaired functioning for patients, which in turn has economic...

Background: Hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia are conditions that cause significant perinatal and maternal morbidity and mortality. Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-rel...

Bipolar disorder is a prevalent condition among women of reproductive age. It has been associated with high morbidity, worsened obstetrical outcomes and a significant risk of suicide. The management of this disorder during pregnancy and in the postpartum period involves balancing the risks associated with medication exposure versus the risks associ...

To examine postpartum recurrence rates of depression comparing women receiving antidepressant treatment to women not being treated with psychotropic medication. This was a prospective study of 130 women with major depressive disorder (MDD) who attended a tertiary care perinatal clinic during and after pregnancy. Depression recurrence was defined as...

Introduction: Despite the common occurrence of obsessive-compulsive disorder (OCD) after childbirth, the role of pharmacotherapy in its management is unclear. Areas covered: This systematic review aims to determine the role of drugs in the acute and preventative treatment of postpartum OCD. Using PRISMA guidelines, four electronic databases includ...

Objective:: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its delibera...

First-onset or recurrence of obsessive-compulsive disorder (OCD) is common after childbirth. Postpartum OCD can occur alone or in combination with other psychiatric disorders such as mood and anxiety disorders. Putative etiological mechanisms involve consideration of genetic factors, alterations in the serotonin system secondary to changes in level...

Introduction Lamotrigine is a commonly used drug in the treatment of bipolar disorder. Although there are reports of its effectiveness in the management of bipolar disorder and comorbid obsessive-compulsive disorder (OCD), lamotrigine has also been associated with obsessionality in patients with bipolar disorder. Methods Charts of 8 patients with...

Introduction: The development of mania during weaning is an underreported phenomenon that has received little attention in the recent past. Lack of timely diagnosis and effective management can negatively affect not only the mother but also her family. Main issue: I describe the case of a woman who experienced onset of mixed mania during weaning....

The term postpartum depression is used generically to denote occurrence of a depressive episode after childbirth. Emerging research suggests that bipolar disorder is common among women with postpartum depression. Due to the lack of awareness of its existence, bipolar postpartum depression is often misdiagnosed as major depressive disorder, causing...

Childbirth can trigger a variety of psychiatric disorders; however, no disorder is as profoundly affected by childbirth as bipolar disorder. Rates of psychiatric comorbidity especially anxiety disorders, obsessive compulsive disorder, and substance use disorders are quite high in individuals with bipolar disorder. The purpose of this scoping review...

Purpose of review: The management of bipolar disorder during pregnancy requires difficult treatment decisions be made by both women and their clinicians. There is little consensus on management despite the high prevalence of bipolar disorder in reproductive-aged women. In this review, we have summarized the available literature and discuss the bal...

We conducted a systematic review of the literature to determine the prevalence of mood episode recurrences during pregnancy among women with bipolar disorder. Included studies (n = 11) had wide variation in the reported proportions of pregnant women with bipolar disorder who experienced a recurrence (median = 24%, range = 4–73%). There is some evid...

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMA...

Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential...

Background Although quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptom...

Background: Over the past few years there has been a surge of interest in the study of bipolar postpartum depression (PPD); however, questions remain about its prevalence, screening, clinical features, and treatment. Methods: Three electronic databases, MEDLINE/PubMed (1966-2016), PsycINFO (1806-2016), and the Cochrane Database of Systematic Rev...

Antidepressants are commonly recommended for prevention of postpartum depression; however, there is a lack of clarity about their role in the reduction of postpartum recurrences. Surprisingly, there are only two randomized controlled trials, one open trial, and one prospective cohort study on the subject. Evidence in support of the use of antidepre...

Introduction: Postpartum depression is a prevalent disorder affecting many women of reproductive age. Despite increasing public awareness, it is frequently underdiagnosed and undertreated leading to significant maternal morbidity and adverse child outcomes. When identified, postpartum depression is usually treated as major depressive disorder. Many...

Introduction: Many women with bipolar disorder experience significant morbidity during pregnancy and the postpartum period. The use of evidence-based and up-to-date guidelines has the potential to improve maternal and neonatal care. We review the latest clinical practice guidelines to gather recommendations for the peripartum management of bipolar...

Objective: This review examined the safety of mood stabilizers in exposed breastfed infants. Methods: PubMed was searched for English language reports between 1 January 1995 and 30 August 2015 by using combinations of key words breastfeeding, lactation, postpartum period, puerperium, mood stabilizers, lithium, lamotrigine, valproate, carbamazepi...

Background: Risk and protective factors for postpartum depression have been extensively studied, and in recent studies an association between breastfeeding and maternal mood has been reported. The present retrospective, cross-sectional study was conducted to evaluate the association between breastfeeding-related variables and postpartum depression...