Differentiating Bipolar Depression from Postpartum Depression
All pregnant women should be screened for bipolar disorder, according to a recent article by Verinder Sharma, MB, BS, professor of psychiatry and obstetrics and gynecology at the University of Western Ontario, London, Ontario, and colleagues. This is because bipolar depression may be misdiagnosed as major depressive disorder in the postpartum period, resulting in delays in appropriate treatment.
All pregnant women should be screened for bipolar disorder, according to a recent article by Verinder Sharma, MB, BS, professor of psychiatry and obstetrics and gynecology at the University of Western Ontario, London, Ontario, and colleagues. This is because bipolar depression may be misdiagnosed as major depressive disorder in the postpartum period, resulting in delays in appropriate treatment.1
Another study by Sharma and colleagues found that 54% of 56 patients who had received a referral diagnosis of postpartum depression were later found to have bipolar disorder.2 There are few studies of bipolar depression in the postpartum period. This may lead to the lack of recognition of symptoms.
Yet bipolar depression in the postpartum period is common. In a small study of 30 women with bipolar I and II disorder, 67% experienced a postpartum mood episode within 1 month. All of these patients experienced symptom recurrence in subsequent deliveries.3
Once symptoms of postpartum depression are identified, patients should also be screened for mania and hypomania, according to Sharma and colleagues. Symptoms of hypomania after delivery may be difficult to distinguish from the happiness that a mother feels at the birth of a child. However, these are important to identify, and symptoms may include increased goal-directed activity, a tendency to be overtalkative, exhibiting racing thoughts, a decreased need for sleep, distractibility, and irritability. Symptoms of hypomania may be common, having been shown to occur in 9% to 20% of all patients.4,5
That’s why universal screening of all pregnant patients is necessary, and this may simply include inquiries about personal and family history of bipolar disorder. Early identification can lead to formal risk assessment and planning for patient care.
References:
References
1. Sharma V, Burt VK, Ritchie HL. Bipolar II postpartum depression: detection, diagnosis, and treatment.
Am J Psychiatry
. 2009;166:1217-1221.
2. Sharma V, Khan M, Corpse C, Sharma P. Missed bipolarity and psychiatric comorbidity in women with postpartum depression.
Bipolar Disord
. 2008;10:742-747.
3. Freeman MP, Smith KW, Freeman SA, et al. The impact of reproductive events on the course of bipolar disorder in women.
J Clin Psychiatry
. 2002;63:284-287.
4. Webster J, Pritchard MA, Creedy D, East C. A simplified predictiveindex for the detection of women at risk for postnatal depression.
Birth
. 2003;30:101-108.
5. Heron J, Craddock N, Jones I. Postnatal euphoria: are “the highs” an indicator of bipolarity?
Bipolar Disord
. 2005;7:103-110.
