Bipolar II Postpartum Depression: Detection, Diagnosis, and Treatment

Department of Psychiatry, University of Western Ontario, London, Canada.
American Journal of Psychiatry (Impact Factor: 13.56). 11/2009; 166(11):1217-21. DOI: 10.1176/appi.ajp.2009.08121902
Source: PubMed

ABSTRACT Research on postpartum mood disorders has focused primarily on major depressive disorder, bipolar I disorder, and puerperal psychosis and has largely ignored or neglected bipolar II disorder. Hypomanic symptoms are common after delivery but frequently unrecognized. DSM-IV does not consider early postpartum hypomania as a significant diagnostic feature. Although postpartum hypomania may not cause marked impairment in social or occupational functioning, it is often associated with subsequent, often disabling depression. Preliminary evidence suggests that bipolar II depression arising in the postpartum period is often misdiagnosed as unipolar major depressive disorder. The consequences of the misdiagnosis can be particularly serious because of delayed initiation of appropriate treatment and the inappropriate prescription of antidepressants. Moreover, no pharmacological or psychotherapeutic studies of bipolar postpartum depression are available to guide clinical decision making. Also lacking are screening instruments designed specifically for use before or after delivery in women with suspected bipolar depression. It is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of nonpuerperal bipolar II depression, using medications that are compatible with lactation.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The postpartum period is generally considered a time of heightened vulnerability to bipolar disorder; however, there is controversy about the effect of pregnancy on the course of bipolar disorder. This article reviews the literature on the relationship between pregnancy and bipolar disorder and suggests areas for future research. DATA SOURCES AND STUDY SELECTION: Three electronic databases, MEDLINE (1966-2010), PsycINFO (1840-2010), and EMBASE, were searched on April 30, 2010, using the following keywords: pregnancy, bipolar disorder, manic depressive disorder, suicide, hospitalization, pharmacotherapy, and psychotherapy. The reference lists of articles identified were also searched. All relevant papers published in English were included. RESULTS: A total of 70 articles were identified and included in the review. Evidence from studies using nonclinical samples, some retrospective studies, and studies on psychiatric hospitalization rates is suggestive of a positive effect of pregnancy on bipolar disorder; however, recent studies conducted at tertiary care facilities have reported high rates of recurrence following discontinuation of mood stabilizers. CONCLUSIONS: Understanding the relationship between pregnancy and bipolar disorder has implications for perinatal treatment and etiologic understanding of the disorder. Research is urgently needed to estimate the prevalence of bipolar disorder during pregnancy, using both clinical and nonclinical samples.
    The Journal of Clinical Psychiatry 08/2012; 73(11). DOI:10.4088/JCP.11r07499 · 5.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Previous studies have shown that one-quarter of women with bipolar disorder relapse during pregnancy, and nearly half of bipolar women relapse during the postpartum period. The perinatal period is also associated with an elevated risk for new-onset mood disorder. Bipolar disorder is often unrecognized, and there is often a significant delay between illness onset and proper diagnosis and treatment. The objective of this cross-sectional psychometric study was to investigate the use of the Mood Disorder Questionnaire (MDQ) as a screening tool for bipolar disorder in a community-based population of pregnant and postpartum women. METHOD: 150 women with a mean age of 30.1 years (standard deviation = 5.5 years; range, 17-43 years) who had been referred to a women's mental health program for psychiatric assessment during pregnancy (n = 95) or the postpartum period (n = 55) were enrolled between June 2010 and December 2011. All women completed the MDQ on the day of their first assessment, and the sensitivity and specificity of the MDQ were calculated against DSM-IV-based clinical diagnoses provided by experienced psychiatrists. RESULTS: A total of 18 women (12% of the sample) were diagnosed with bipolar disorder (6 with bipolar I disorder, 10 with bipolar II disorder, and 2 with bipolar disorder not otherwise specified). The traditional scoring of the MDQ yielded poor sensitivity (39%) and excellent specificity (91%). The best-fitting model was a modified scoring algorithm using cutoff scores of 7 or more symptoms on the MDQ without the supplementary questions, yielding excellent sensitivity (89%) and specificity (84%). CONCLUSIONS: The MDQ is a useful instrument for screening for bipolar disorder during both pregnancy and the postpartum period. Considering that perinatal women have an elevated risk of both first-onset and relapse of bipolar disorder, particularly during the postpartum period, routine use of screening tools in perinatal programs is encouraged.
    The Journal of Clinical Psychiatry 10/2012; 73(11). DOI:10.4088/JCP.12m07856 · 5.14 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.
    International Journal of Women's Health 12/2010; 3:1-14. DOI:10.2147/IJWH.S6938