It is estimated that one out of every 10 women will experience symptoms associated with postpartum depression after pregnancy. This includes intense feelings of anxiety, depression and despair that make it impossible for them to deal with their daily lives.
Similar to the feelings experienced with bipolar disorder, research is currently being done to see if there is a link between the two.
Some studies have already indicated that pregnant women with bipolar disorder are more likely to experience postpartum depression, while others have found that the two mood disorders can be easily confused by health care practitioners. This often leads to the wrong treatment plan, which can leave new mothers feeling even more lost and alone. Understanding the differences between postpartum depression and postpartum bipolar depression (bipolar, peripartum onset) will increase your chances of receiving the right treatment.1
Childbirth and Bipolar Disorder
It is normal for new mothers to experience dramatic and sudden mood shifts. Feelings of intense joy and love are common, but some women also experience those at the opposite end of the spectrum. It is estimated that up to 70 percent of women experience some of the symptoms associated with the “baby blues” a few days after giving birth. This typically includes sudden bouts of anger or crying, trouble eating and sleeping, along with feelings of self-doubt. In many cases these feelings go away on their own, and typically only last a few days.
If you are dealing with bipolar disorder your chances of having postpartum depression are significantly higher than in women that are healthy or have major depression.
According to research it is estimated that up to two-thirds of pregnant women with bipolar I or II disorder will deal with severe depression after delivery.
Overall pregnancy is considered to be a “positive” experience. Bipolar women that are pregnant tend to have a decreased risk for suicide and psychiatric admission due to a lessening of their symptoms. Since bipolar disorders are caused by a chemical imbalance in the brain, early research suggests that the hormones released during pregnancy might have a temporary stabilizing effect. This also helps to explain why women with bipolar disorder are more vulnerable after delivery.
Bipolar and PPD Confusion
Unfortunately it is not uncommon for women with bipolar disorder to not be diagnosed before pregnancy. When their symptoms start to reappear after delivery, they are often misdiagnosed with postpartum depression (PPD). A recent study found that out of 56 women diagnosed with postpartum depression, 54 percent actually suffered from bipolar disorder.
The confusion between the two mood disorders is thought to be due to the similarity of the symptoms, and health care practitioners missing the “manic” aspect of bipolar disorders. A large majority of new mothers experience strong feelings of elation, hyperactivity and an inability to sleep, all of which are signs of bipolar disorder. Women often fail to report these symptoms to their physicians, and it is not uncommon for them to be missed by their doctors.
When health care providers finally do pick up on the deep lows the bipolar disorder is often misdiagnosed as postpartum depression.
Confusing bipolar disorder with postpartum depression can result in devastating consequences. The wrong medications can cause a new mother’s symptoms to worsen, and in some cases require hospitalization. The frequency of misdiagnosis has led a few health professionals to suggest that all pregnant women be checked for bipolar disorder during their first trimester. This will allow physicians to have a baseline in which mood swings after pregnancy can be measured.2
Being able to detect manic episodes and distinguish them from normal post pregnancy reactions is key in correctly diagnosing the mood disorder.
Bipolar Disorder and Postpartum Psychosis
Postpartum psychosis is often missed even though pregnant women with bipolar disorder are at a higher risk. Part of this is due to its rarity, along with many physicians reluctance to diagnose a patient with the severe disorder. Many health care professionals are also hesitant to prescribe lithium to nursing mothers, even though it is currently the best treatment option.
Postpartum psychosis and PPD are two different mood disorders, and should not be confused. New mothers with bipolar disorder suffering from postpartum psychosis have a significantly higher risk of harming themselves or their babies than women diagnosed with PPD.
According to a review from Stanford University, Northwestern Medicine and Erasmus Medical Center in the Netherlands postpartum psychosis is usually a result of bipolar disorder and is often misdiagnosed due to rarity and lack of comprehensive research.
Even though lithium is recognized as the best treatment option for new mothers with postpartum psychosis, there is still an underlying fear that the medication could harm the baby. According to Dr. Katherine Wisner, professor and psychiatrist at Northwestern University of Medicine the potential side effects of the medication are far less severe than leaving the disorder untreated.
A small study of breastfeeding mothers on lithium found that their infants did not experience any side effects. While no one wants to prescribe medication to a pregnant or breastfeeding woman leaving this disorder uncontrolled can result in harm to the infant or even suicide.
Most health care professionals are aware that diagnosing and treating this disorder can prevent serious tragedy, the fact that it only occurs in one to two women out of 1,000 makes it difficult to properly diagnose and study.
Adding to the confusion regarding proper diagnosis is the fact that there are two types of postpartum psychosis. Some women only experience postpartum episodes, while others have difficulty with manic mood swings throughout their pregnancy. Women diagnosed with chronic bipolar disorder should be treated throughout their pregnancy, and be closely monitored for any changes to their body’s metabolic rate. This will affect their dosage.
Acute onset postpartum psychosis is harder to detect, since it occurs during the time most women experience PPD. The symptoms are also more severe, with new mothers suddenly appearing confused, disorganized and even delirious. Many women being treated for sudden postpartum psychosis report having dark delusions that makes them want to hurt themselves or their babies.
With bipolar disorder occurring in one to five percent of women postpartum psychosis does present a real threat to new mothers and their infants. Safe and effective treatment is available, and it is important for both mothers and their babies.