Bipolar II Postpartum Depression: Detection, Diagnosis, and Treatment

Department of Psychiatry, University of Western Ontario, London, Canada.
American Journal of Psychiatry (Impact Factor: 12.3). 11/2009; 166(11):1217-21. DOI: 10.1176/appi.ajp.2009.08121902
Source: PubMed


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.

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    • "On the other extreme, postpartum psychosis is a psychiatric emergency that requires immediate intervention, and is characterized by the rapid onset of severe mood swings, a waxing and waning sensorium, delusions, hallucinations or disorganized behaviors, and a relatively high incidence of suicidal ideation or homicidal ideation toward the infant.35 Women presenting with a depressive episode, mood elevation, or psychotic symptoms should be screened for any prior history of mania or hypomania to rule out previously undiagnosed bipolar disorder.36 Anxiety disorders are common in perinatal women, and women may have depression comorbid with obsessive-compulsive symptoms, generalized anxiety disorder, panic disorder or post-traumatic stress disorder.37 "
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    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):1-14. DOI:10.2147/IJWH.S6938
    • "His second theme, ‘there is a diasthasis of bipolarity in treatment-resistant depression,’ is also a new concept for further investigation. He is also interested in the psychopharmacological management of bipolar disorder.[1617] Parikh is another researcher who has made a mark in this field; his area of interest mainly being neurochemistry, genetic polymorphism, socio-demography, and management issues. "
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    ABSTRACT: Psychiatrists of Indian origin are popular in Canada, being firmly rooted in the Canadian mental health system, and they have been making considerable contributions internationally. The Indian Psychiatric Society has long been collaborating with and inviting contributions from overseas Indian psychiatrists, particularly those in academics, and this collaboration has fructified well. There are several different challenges these psychiatrists have had to face in their own specialty work, with having to adjust to a new culture, new ways of living, and new ways of work. Our colleagues of Indian origin have demonstrated excellence in almost all fields of mental health and neurosciences. There are many popular teachers, outstanding researchers, and psychiatrists in community practice and community development. The Early Psychosis Program, Mood and Anxiety Program, Perinatal Psychiatry, Women's Mental Health, and Postpartum Mental Health are some of their key areas of research. Our basic scientists are involved in experimental design, neurochemistry, imaging, and genetics, where they have made their mark with acclaim. This article highlights some of the achievements of a few members and is by no means completely representative of the entire work that psychiatrists of Indian origin are doing in Canada, providing readers with a glimpse of our labors away from home.
    Indian Journal of Psychiatry 01/2010; 52(Suppl 1):S64-7. DOI:10.4103/0019-5545.69213
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    American Journal of Psychiatry 11/2009; 166(11):1201-4. DOI:10.1176/appi.ajp.2009.09081185 · 12.30 Impact Factor
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