Up to half of women who experience clinical depression after giving birth may experience postpartum bipolar disorder.
Welcoming a newborn into the world can be exhausting, exciting, and bewildering.
It’s natural to experience a wide range of emotions after having a baby. But what if your moods seem to reach severe levels?
If shortly after giving birth, your highs seem manic, or your lows feel like depression, you may want to talk with your doctor about a condition called postpartum bipolar disorder.
Postpartum depression and postpartum bipolar disorder fall under the umbrella of perinatal mood and anxiety disorders (PMADs).
PMADs are a set of disorders characterized by mood and anxiety symptoms that can occur anytime during pregnancy or up to one year after delivery.
For reference, the term “postpartum” refers specifically to the time after giving birth, while “perinatal” also covers pregnancy.
Women with PPD experience symptoms of depression after giving birth. This may include feelings of hopelessness, low mood, extreme fatigue, or difficulty bonding with the baby.
Postpartum depression may be called “unipolar” depression, meaning it consists of depression alone, or it may be “bipolar” depression, meaning the depressive episodes alternate or mix with manic episodes.
Postpartum bipolar disorder
Women with postpartum bipolar disorder may first present with symptoms of depression, or they may present with mania or hypomania. Postpartum bipolar features the same symptoms as bipolar disorder.
Since depression is a common first symptom in women with postpartum bipolar disorder, it can be difficult to know whether it’s unipolar or bipolar PPD.
2017 research has shown that anywhere from 21.4% to 54% of women with postpartum depression have a previous diagnosis of bipolar disorder.
Is postpartum bipolar disorder more severe?
Of all psychiatric disorders, bipolar disorder poses the highest risk of hospitalization during the postpartum period.
Compared to the general population, women with postpartum bipolar disorder have a
Compared to non-postpartum women with bipolar disorder, those who’ve just given birth are
In addition, compared to women with major depressive disorder (MDD), those with bipolar disorder are at greater risk for mood worsening immediately after birth. They are also
Both genetic and environmental factors play a significant role in developing postpartum bipolar disorder.
The biggest factors that may influence the development of postpartum bipolar include:
- first-degree family member with bipolar disorder
- history of bipolar disorder
- history of postpartum depression
- history of postpartum psychosis
Environmental factors that may raise the risk of postpartum bipolar disorder include:
- low social support
- unemployment or poverty
- young age at the time of birth
- low education
Triggers for postpartum disorder may include:
- sleep deprivation
- major hormonal changes (such as during pregnancy or childbirth)
- traumatic birth experience
Women with bipolar disorder who stop taking their medications before or during pregnancy have a
Can PPD cause bipolar disorder?
Postpartum depression doesn’t cause bipolar disorder. Depression is a symptom of postpartum bipolar disorder, and for many women, it’s the first recognized symptom after giving birth.
Because of this, many women with postpartum bipolar disorder are misdiagnosed with unipolar PPD rather than postpartum bipolar disorder. This is particularly true if symptoms of mania or hypomania haven’t occurred yet or if they’ve previously gone undiagnosed.
Postpartum bipolar disorder can begin with either depression or mania/hypomania.
Mania and hypomania are the “high” moods of bipolar disorder. Mania presents with more severe symptoms that result in significant impairment, while hypomania is less disruptive and may be overlooked as natural excitement.
Psychotic symptoms, such as hallucinations and delusions, can occur in mania and severe depression.
Symptoms of mania or hypomania may include:
- highly elevated mood
- feelings of grandiosity
- wired or energized
- racing thoughts
- easily distracted/ lack of concentration
- extremely talkative, pressured speech
- decreased need for sleep
- agitation or irritability
Symptoms of depression in postpartum bipolar disorder include:
- low mood
- fatigue or low energy
- anxiety or worry
- feeling empty or hopeless
- feeling disconnected from the baby
- feeling unable to properly care for baby
- feeling guilty about being a “bad parent”
- anger or irritability
- excessive crying
- difficulty sleeping or oversleeping
- appetite changes
- loss of interest in hobbies or activities
- feeling withdrawn from loved ones
- panic attacks
- worries about harming the baby
- leaden paralysis (feeling of heaviness in arms and legs)
In some people, depressive and manic symptoms occur together. This is called a “mixed state” and may lead to significant agitation or irritability.
Treatment for postpartum bipolar disorder may involve a healthcare team, including a psychiatrist, obstetrician-gynecologist (OB/GYN), therapist, and possibly other specialists.
If you’ve been diagnosed with postpartum bipolar disorder, you may be prescribed mood-balancing medications and other treatments.
When doctors decide on the right treatment for postpartum bipolar disorder, they may look at the following:
- symptom severity
- medication tolerability
- your response to past treatments
- safety concerns
- chestfeeding preferences
Potential medications for postpartum bipolar disorder include:
In addition to medication, postpartum women experiencing severe depressive episodes are sometimes treated with bright light therapy. It’s believed that bright light therapy helps stabilize the circadian rhythm and positively affects mood-lifting neurotransmitters.
But like all antidepressant treatments, light therapy can induce mania. Therefore, it should be avoided if you’re experiencing mania, hypomania, or a mixed mood state.
If you believe you’re experiencing symptoms of postpartum bipolar disorder, know you’re not alone.
Consider speaking with your healthcare professional to discuss your symptoms and potential treatment options. Getting started on the right treatment can make all the difference in how you feel.