There is increasingly more discussion these days about postpartum depression. This is good news, because creating a greater understandingthrough informed and compassionate conversation reduces the stigma around new mothers seeking mental health treatment. But what remains less understood is postpartum bipolar disorder. This genetically-based mood disorder is often misdiagnosed and mistreated. And when symptoms of bipolar begin during pregnancy or after childbirth, the effects can be particularly devastating.
(The term peripartum is officially used for both during and after pregnancy, but here I’ll use postpartum because it tends to be more familiar.)
Postpartum bipolar disorder is marked by the same symptoms of bipolar that anyone else with the disorder would experience. Starting with either mania or depression, women with postpartum bipolar disorder can experience severe up-swings that include feelings of euphoria, grandiose self-image, high irritability and agitation, decreased desire to sleep, racing thoughts, impulsive and often destructive behaviors, or go through periods of profound depression, which can include feelings of hopelessness and suicidal thoughts or actions. And, just like any other type of bipolar onset, postpartum bipolar disorder often goes unidentified and untreated for too long.
It’s important to remember that bipolar disorder, in general, is a mental illness that has genetic and neurological foundations. That means bipolar is hereditary and is essentially coded in the individual’s DNA. As the braindevelops, these genetic factors affect how the brain handles emotional regulation resulting in mood swings that can last for several days. Commonly, the first signs of bipolar disorder occur during adolescence. But it’s also not unusual for symptoms to occur when significant hormonal changes occur during pregnancy or after childbirth. And along with these changes, the more typical issues of stress, excitement and pain associated with pregnancy and childbirth can worsen a bipolar condition, often carrying underlying symptoms of depression or mania to the emotional surface.
The Problems with Identifying Postpartum Bipolar Disorder
Symptoms of postpartum bipolar disorder don’t always start right away. Many women begin showing mood swings in the days or weeks after delivery. This can make an accurate diagnosis of bipolar even more difficult, since either the new mother or the mental health professional may not immediately connect these symptoms to postpartum triggers for bipolar disorder.
Along with common difficulties in identifying postpartum bipolar, many women go untreated. This is definitely detrimental to the new mother, but may also affect the baby both before and after birth, as well as other family members. Often, women are afraid of revealing their symptoms to others, including their doctors. If depressed, they can fear being harshly judged by others for not being happy or productive enough during this special time in life. Or they themselves may wonder if they are flawed as mothers, not feeling enough affection for their babies. If manic, they can become hyperactive or irritable and anxious. Many in this state may also lash out in uncharacteristic anger. In the worst form of the disorder, some women develop psychotic symptoms, including hallucinations and delusional or paranoid thoughts.
What is most alarming about bipolar is the very high rate of suicide associated with the disorder. Women with postpartum bipolar disorder will often conceal suicidal thoughts, fearing what may happen to them or that someone might take their babies away from them. But the bottom line is this: Nobody is at fault for having bipolar disorder, but with knowledge, support and good treatment, people can live successfully with the disorder throughout their lives while minimizing the risks that come with it.
What You Can Do About Postpartum Bipolar
It’s most critical to get professional care as soon as possible. So here are a few important tips if you think you have postpartum bipolar, or if someone you know may have it.
First, if there is any personal or family history of mood swings or any serious mental illness for that matter, there is a much greater chance for postpartum bipolar disorder. This is great information to share with your doctor, including your OB/GYN or a psychiatrist. If you’re already in treatment for bipolar, discuss all medication issues with your doctors before getting pregnant, if possible. If you discover you’re pregnant while in treatment, don’t just stop medications without first talking with the prescribing physician and reviewing all options towards maintaining good mental health. And this should happen as quickly as possible since untreated mood swings can not only affect the mother’s health, but fetal development, as well (Kingston, Tough, & Whitfield, 2012).
Also, if you’re in treatment for depression, and you’re either not improving as expected or becoming more agitated and irritable on medication, you may have the first signs of bipolar disorder. Again, bring this to your doctor’s attention right away. Certain antidepressant medications can actually induce mania in people who have an underlying bipolar disorder (APA, 2013).
If you believe you’re experiencing symptoms at all, it can be frightening to discuss the feelings of a possible bipolar disorder with anyone, including doctors and other health providers. But again, know that it’s not your fault for feeling this way. Many women have told me that getting treatment for postpartum bipolar disorder gave them better opportunities for good health for themselves and their loved ones. Having bipolar doesn’t mean you’re a bad mother. Instead, reaching out for care can save you from many painful and potentially destructive moments.
And if you love someone who may have postpartum bipolar disorder, know that you can become an important supportive member of her care team. Offering some basic facts about postpartum bipolar, along with encouragement that she’s not alone, may be just what she needs to move forward with proper treatment.