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Treating Postpartum Depression
Postpartum Depression: Diagnosis and Treatment

Section 13
Bipolar Disorder and Postpartum Depression

CEU Question 13 | CEU Test | Table of Contents | Depression
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In the last section, we discussed Eating Disorders and Postpartum.  This included pregnancy and the course of the eating disorder and the eating disorder and the baby.

In this section, we will discuss Bipolar Disorder and Postpartum.  This will include postpartum psychosis and depression and bipolar disorder.

Like depression, bipolar disorder seems to be triggered by a number of factors, including family history, personality type, environmental factors, such as the degree of psychosocial support, stressors such as childbirth, and the hormonal changes women experience during their childbearing years.

As is true of virtually all psychiatric disorders, diagnosing bipolar disorder is a matter of recognizing the point at which the normal ups and downs of day-to-day life cross the line, so to speak, into clinical illness. 

♦ Postpartum Psychosis
First, let’s discuss postpartum psychosis.  Women with bipolar illness are at high risk for relapsing in the postpartum period and are seven times more likely than the general population to require hospitalization for their first episode of postpartum depression, and have a hundredfold higher risk for developing postpartum psychosis.

Postpartum psychosis occurs suddenly in one to two of every one thousand women after childbirth and is now believed to be closely linked to, if not a variant of, bipolar disorder

The danger, of course, is that when postpartum psychosis does occur, both mother and child are at serious risk.  It appears virtually out of the blue, with acute instability of mood, often hypomania, disorganized behavior, and, most seriously perhaps, hallucinations or delusions, usually revolving around the infant. 

These women are often preoccupied with thoughts of harming their babies, and many of them are, in fact, in danger of acting out their thoughts.  Because of that, when a woman is depressed in the postpartum period, and particularly if her depression has a psychotic component, it is always a medical emergency.  In bipolar women, the depression can switch to mania so quickly that very often even the woman’s partner doesn’t have time to see it coming, which is exactly what happened in Evette’s case.

Evette, age 30, was an occupational therapist who worked with mothers and children on a daily basis.  Her husband, Craig, age 34, was a college professor and they had a very good, stable marriage.  When they determined the time was just right, Evette became pregnant.

Craig, however, had recently been promoted, was extremely busy with his students, and was likely to be interrupted by one of them, even at home, at any hour of the day or night.  Evette therefore decided that once her baby was born, she would go to live with her mother for a while in order to have the uninterrupted help and support she would need at that time.  Evette’s mother had prepared a bedroom for her and had even hired a nanny. 

What Evette didn’t know, however, because it had never been discussed, was that her mother had suffered an acute episode of postpartum psychosis that had required hospitalization.  Evette’s mother was very much aware that Evette was at risk for developing the same illness.

During the third week of her stay, Evette began to develop what her mother immediately recognized as signs of postpartum psychosis.  Evette was unusually happy, to the point of seeming euphoric, and was going on shopping sprees virtually every day, buying huge quantities of outfits the baby didn’t need.  By the end of the episode, she’d accumulated more than five hundred pieces of infant clothing.

The escalation of Evette’s mood occurred so rapidly that by the third day she started to become irritable and hostile, vehemently denying there was anything wrong.  Because Evette was unable to sleep, she stayed up all night making grandiose plans for herself and the baby.  At that point, both Craig and Evette’s mother knew that she had to be hospitalized.  Evette was admitted immediately and put on a mood stabilizer. 

♦ Depression and Bipolar Disorder
Second, depression that is not related to bipolar illness can also be accompanied by delusions and hallucinations.  This was the case for the second young woman for whom I was called upon to testify in court. 

When I met Millie... she was pregnant and beginning to experience depressive symptoms with paranoid delusions about something being wrong with her baby.  Millie was started on a combination of antidepressants and an antipsychotic without a mood stabilizer.  I kept in touch with Millie and she scheduled sessions occasionally until she moved to another, more remote city and I lost contact with her entirely.

The next I heard about Millie was several months later, when I received a phone call from a prosecuting attorney informing me that Millie had shaken her thirteen-day-old infant because she was no longer able to tolerate the baby’s crying and was still convinced that he wasn’t normal.  When I went to see Millie in conjunction with my testimony, I learned that once she had left my care she had stopped taking her medications and had continued to show symptoms of depression and paranoid delusions after the baby’s birth.

In this section, we have discussed bipolar disorders and postpartum.  This has included postpartum psychosis and depression and bipolar disorder.

In the next section, we will discuss postpartum dads.  This will include dads and depression and the "Ten reassurances and advice" technique.

Peer-Reviewed Journal Article References:
Davenport, Y. B., & Adland, M. L. (1982). Postpartum psychoses in female and male bipolar manic-depressive patients. American Journal of Orthopsychiatry, 52(2), 288–297.

Fredriksen, E., von Soest, T., Smith, L., & Moe, V. (2017). Patterns of pregnancy and postpartum depressive symptoms: Latent class trajectories and predictors. Journal of Abnormal Psychology, 126(2), 173–183.

Gilkes, M., Perich, T., & Meade, T. (2019). Predictors of self-stigma in bipolar disorder: Depression, mania, and perceived cognitive function. Stigma and Health, 4(3), 330–336.

Kudinova, A. Y., Woody, M. L., James, K. M., Burkhouse, K. L., Feurer, C., Foster, C. E., & Gibb, B. E. (2019). Maternal major depression and synchrony of facial affect during mother-child interactions. Journal of Abnormal Psychology, 128(4), 284–294. 

Lafarge, C., Usher, L., Mitchell, K., & Fox, P. (2020). The role of rumination in adjusting to termination of pregnancy for fetal abnormality: Rumination as a predictor and mediator of posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 101–109.

Online Continuing Education QUESTION 13
What are some factors that can trigger bipolar disorder in new mothers? To select and enter your answer go to CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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