Within 24 hours of her second daughter’s birth, Dyane Harwood felt elated. From the moment she came home from the hospital, she started writing. Furiously. She wrote while nursing her daughter and going to the bathroom. She wrote on her hands, on the bathroom mirror, inside books and on tabletops. She yearned to write down every thought she was having. She wrote so much that her wrists ached—her carpal tunnel returning—and she was in constant pain.
She also had endless energy and a newfound enthusiasm for life. She felt like she could run a long race. She couldn’t sit still, and her speech was fast and frenetic. She barely slept. Her normally low self-esteem soared. She had no appetite and was losing weight.
Six weeks later Harwood was diagnosed with postpartum bipolar disorder, which she chronicles in her powerful, information-packed memoir Birth of a New Brain: Healing from Postpartum Bipolar Disorder. (Today, she’d be diagnosed with bipolar disorder, “peripartum onset,” per the DSM-5). Her compulsive urge to write is actually a condition called hypergraphia, which is associated with bipolar disorder.
When we think of postpartum conditions, we think of depression and anxiety. Rarely does bipolar disorder come to mind, and yet according to Postpartum Support International, “Many women are diagnosed for the first time with bipolar depression or mania during pregnancy or postpartum.” According to perinatal psychiatrist and researcher Dr. Verinder Sharma, “We know childbirth is perhaps the most important and most potent trigger of bipolar disorder.”
It’s not known what causes postpartum bipolar disorder. Currently, one theory is that neuroendocrine changes during pregnancy and postpartum contribute to creating an underlying vulnerability to bipolar disorder, said Amy-Rose White, LCSW, a perinatal psychotherapist and maternal mental health and couples specialist.
“Women with these illnesses have what we often refer to as the ‘hormone sensitive brain.’ This type of brain is more likely to reveal an underlying predisposition to sensitivity to the dramatic fluctuation of estrogen and progesterone during and after pregnancy.”
A family history of mental illness also may predispose women to postpartum mood disorders. For instance, Harwood’s father had bipolar disorder. (Interestingly, she didn’t have any symptoms after the birth of her first child.)
Among women who are diagnosed with postpartum depression, about 22 percent actually have bipolar disorder, White said. Women who’ve had “treatment-resistant” depression for years—antidepressants and/or psychotherapy haven’t reduced their symptoms—may actually have bipolar II disorder, she said.
Signs and Symptoms
What does postpartum bipolar disorder look like? Generally, women don’t act or feel like themselves, White said. She noted that bipolar I disorder includes severe episodes of sadness; tearfulness; hopelessness; guilt; and lack of interest in activities previously enjoyed. This is followed by episodes of extreme energy; rapid speech; racing thoughts (e.g., about the baby’s health); grandiose ideas, decreased need for sleep; and unusual or out-of-character behavior.
For instance, White shared these examples: Moms might engage in excessive spending or spend the entire night painting their baby’s room. Moms might spend hours getting rid of old baby clothes. They might drive with their kids to visit a friend, who lives in another state. Their words might be hard to follow, sparking arguments with their spouses.
Depressive episodes also commonly have symptoms of anxiety, agitation or irritability, White said. Women might feel detached and like they’re going through the motions, she said. Many women can appear highly functional. “[B]abies are usually fed and cleaned and diapered, but mom may feel very checked out on the inside and only those close to her may detect the difference in her mood and facial expressions.”
Women who have bipolar II have similar depressive symptoms that are less severe, and instead of mania, they have “hypomania,” which can present with subtle symptoms. “For many women, this has involved symptoms in the past that were not diagnosed that actually make them feel more alert, energetic, and even ‘like themselves,’” White said.
If you notice these symptoms in yourself or a loved one, it’s vital to seek proper evaluation and treatment from a mental health professional right away. Treatment consists of a combination of medications—such as a mood stabilizer and antidepressant—along with psychotherapy. White has found that family therapy is helpful in fostering compassion, understanding and a plan that meets everyone’s needs.
“Sometimes, electroconvulsive therapy is indicated,” said Samantha Meltzer-Brody, MD, MPH, an associate professor and director of the Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders.
For some moms bipolar disorder can turn into psychosis. “We know that women with a history of bipolar disorder have 20 times the risk of developing postpartum psychosis than someone without bipolar disorder,” Meltzer-Brody said.
Psychotic symptoms might include an abrupt change in personality or functioning and delusional thoughts, she said. For instance, moms may believe their babies are in danger and that harming them will keep them safe, White said. They may see or hear things that others don’t.
Both experts underscored that any sign of psychotic symptoms is considered a medical emergency, and warrants going to the ER immediately. Moms shouldn’t be left alone or left alone with their baby, White said.
Since her diagnosis, Harwood has tried a slew of medications, been hospitalized seven times, and had two courses of ECT. She’s been considered the worst-case scenario. Yet, as she writes in Birth of a New Brain, she’s gotten her “life back on track” (thanks to a combination of medication and therapy).
“If you’re struggling, please don’t give up hope—you can attain mental health and enjoy your life again!” Harwood writes. Postpartum bipolar disorder is highly treatable. The key is to get help right away.