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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Available from: Verinder Sharma, Dec 04, 2015
    • "Previous studies have revealed that major depressive disorder (MDD) shows higher prevalence in women and associations with suicidal attempt (Jeon et al., 2010, 2014a, 2013, 2014b). However, PPD exhibits features that are distinct from non-PPD (non-postpartum depression), such as higher suicidality (Paris et al., 2009), emotional lability (Beck and Indman, 2005), bipolarity (Sharma et al., 2009), anxiety (Ross et al., 2003), obsessive preoccupation (Gonidakis et al., 2008), premenstrual dysphoric disorder (PMDD) (Sylven et al., 2013), familial aggregation (Forty et al., 2006), and a history of child abuse (Wosu et al., 2015). However, there are limitations to these findings, because of small sample sizes and selection bias from clinic-based surveys. "
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    ABSTRACT: Background: Postpartum depression (PPD) is a type of clinical depression that can affect women after childbirth. Few previous studies have explored the association of depressive and physical symptoms among women with PPD in a nationwide community study. Method: A total of 18,807 adults, randomly selected, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) (response rate 80.2%). PPD was defined as a major depressive episode that began within 4 weeks after delivery. Results: Of 679 female subjects with major depressive disorder (MDD), 14.0% (n=95) experienced PPD. Subjects with PPD were significantly more likely to have higher income, education, and reside in an urban area, compared to those with non-PPD. No significant differences were found in number of children. Multiple logistic regression revealed that the loss of sexual interest was the only symptom among 23 depressive symptoms that was significantly associated with depressive episodes among individuals with PPD (AOR=1.91, 95% CI 1.01-3.60) when compared with non-PPD. Loss of sexual interest was also significantly associated with the subjects with lifetime PPD regardless of depressive episode (AOR=1.93, 95% CI 1.12-3.31). Conversely, loss of confidence and loss of pleasure were less frequent in subjects with PPD. Premenstrual mood change (χ(2)=5.57, p=0.0036) and comorbid alcohol use disorder (χ(2)=5.11, p=0.031) showed a valid association with PPD. Conclusions: Loss of sexual interest and premenstrual mood change were associated with women with PPD, whereas those with non-PPD were not, thereby suggesting the possible link between sexual hormones and PPD.
    No preview · Article · Dec 2015 · Journal of Affective Disorders
    • "In addition, there is general consensus that bipolar depression is highly prevalent particularly in the postpartum period. Unfortunately, the actual prevalence of bipolar postpartum depression is unknown because bipolar depression postpartum is often misdiagnosed as unipolar depression (Sharma et al., 2009; Sharma and Xie, 2011). Accordingly, the present study was designed to identify women in the general postpartum population with high scores on both negative and positive affect ('rapid cycling mood symptoms'). "
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    ABSTRACT: Rapid cycling mood symptoms during the first postpartum week are an important aspect of maternity blues. The aim of this study is to identify women with these rapid cycling mood symptoms in the general population and to investigate possible risk factors of these symptoms. The Maternity Blues Scale (MBS) was validated in The Netherlands in 949 women at one week postpartum. Personal and family history of mood disorders and obstetric demographics were collected and the Edinburgh Postnatal Depression Scale (EPDS) was completed. A 16-item three-factor MBS solution was found: depression, negative and positive affect. The latter two were used to define a rapid cycling mood symptoms group. Using the 75th percentile cut-off, 20 (2%) women reported high negative/high positive affect (rapid cycling mood group) and 65 (7%) women were depressed (EPDS≥11). A previous episode of depression, major life events and instrumental delivery were independently related to depression (OR 3.5, 2.5 and 2.3, respectively) while only a history of depression in first-degree relatives was independently related to rapid cycling mood (OR 3.4, 95% CI 1.2-9.8). Limitations First, no syndromal diagnoses were obtained for depression and rapid cycling mood disorder. Second, history of depression was self-reported (not based on structural psychiatric interviews). Third, our study was not designed to study the longitudinal follow-up of women with rapid cycling mood symptoms. Conclusion the 16-item MBS could be useful in screening programs in detecting postpartum women at risk for (severe) mood disorders. Postpartum women with 'rapid cycling mood symptoms' can be identified with a possible more familiar form of mood disorder. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Feb 2015 · Journal of Affective Disorders
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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.
    Preview · Article · Dec 2010 · International Journal of Women's Health
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