Recognition, diagnosis and treatment of postpartum bipolar depression

Abstract

Bipolar disorder is a serious and often chronic disorder characterized by episodes of depression, hypomania, mania or mixed states that affects many individuals worldwide, and is a leading cause of years of ‘healthy’ life lost as a result of disability and premature mortality. For women, bipolar disorder tends to cluster during the childbearing years. Detection of bipolar disorder can be complicated and therefore it is essential that women presenting with mood episodes after childbirth receive a comprehensive examination to allow for accurate diagnosis, with particular attention to manic symptoms. Once a diagnosis of bipolar disorder is confirmed, pharmacotherapy with consideration made to breastfeeding status may be considered alone or in combination with psychotherapy.

Keywords::

• bipolar disorder
• depression
• hypomania
• mania
• pharmacotherapy
• postpartum
• psychotherapy

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

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

Key issues

• Women presenting with postpartum depression should be evaluated for signs of (hypo)mania such as increased goal-directed activity, racing thoughts, decreased sleep requirement, distractibility, irritability and over-talkativeness.

• Childbirth may trigger a first episode of bipolar disorder or relapse of an existing disorder, and may also be a period of elevated risk for conversion from major depressive disorder to bipolar disorder.

• Misdiagnosis of postpartum bipolar depression may lead to inappropriate treatment which may exacerbate existing mood symptoms, induce a manic episode or accelerate cycle frequency.

• The Edinburgh Postnatal Depression Scale is commonly used to detect depression in the postpartum period, while tools for detecting (hypo)mania include the Mood Disorder Questionnaire, hypomania Checklist-32 and the highs scale. The Mood Disorder Questionnaire in particular has been validated for use in patients with bipolar disorder during and after pregnancy.

• Current treatment options for postpartum bipolar depression are similar to bipolar depression occurring at other times, with consideration being given to the patient's breastfeeding status and compatibility with lactation.

• Minimizing sleep disturbance and maximizing social support are important in the therapeutic management of bipolar disorder.

• Psychotherapy, and psychoeducation in particular, may be advantageous for patients in addition to their pharmacological treatment.

• More research to allow for standardized screening and specific treatment guidelines for women with postpartum bipolar depression is urgently needed to ensure these patents are being accurately diagnosed and treated during such a vulnerable phase in their lives.