Diagnosis and treatment of postpartum bipolar depression

Abstract

The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment – thereby precipitating (hypo)mania, rapid cycling or a mixed episode – or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation.

Keywords::

• bipolar disorder
• lactation
• postpartum bipolar depression
• postpartum hypomania
• postpartum psychosis
• screening
• treatment

Financial & competing interests disclosure

Verinder Sharma has received grant support from, participated on scientific advisory boards for, or served on the speakers’ bureaus of Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Ontario Mental Health Foundation, Pfizer, Servier and Stanley Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Reproduced with permission from [11].

Reproduced with permission from [11].