Pregnant and postpartum women with bipolar disorder more frequently have significant mental health and early mothering challenges than other perinatal women undergoing psychiatric treatment, according to a study in the Journal of Affective Disorders. The findings indicate the importance of properly identifying the disorder and developing specific treatments for women during and after pregnancy, the lead author said.
“Similar to what you find with bipolar disorder in the nonperinatal population, the overall level of clinical severity and functional impairment really stands out as being of concern,” said Cynthia Battle, associate professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University.
“It’s a highly vulnerable time for these women,” said Battle, who is also a psychologist at Butler Hospital and Women & Infants Hospital. “They have increased functional demands at this time.”
Pregnancy often disrupts sleep and parenting a newborn can involve getting up several times a night for months, for example. Such sleep problems can potentially trigger new mood episodes among women with bipolar disorder, Battle said. Also, some women go off their medicines while pregnant out of concern for the health of the fetus, leaving their condition untreated.
Last fall a study led by Dr. Verinder Sharma, a psychiatrist from the Schulich School of Medicine & Dentistry, found that the occurrence of conversion from depression to bipolar disorder in postpartum women was 11-18 times higher than reported in non-postpartum women.
“If you look at the literature on postpartum mental illness, there’s lots of emphasis on postpartum depression; not much attention is paid to bipolar disorder,” Sharma said.
Both studies stress the importance of watching carefully for symptoms of mania that distinguish bipolar disorder from depression because most women seek treatment for their depressive symptoms only, unaware of any history of mania or family history of mania. “Asking those kinds of questions to help clarify whether this is unipolar depression vs. bipolar is going to be important to guide treatment,” Battle said.
This research intrigues me because it was after giving birth to my second child that I was diagnosed as bipolar. The first 30 years of my life I struggled from major depressive disorder with some anxiety and obsessive-compulsive stuff thrown in. I wish I had known to look out for symptoms of mania or hypomania because I had to fall hard in order to figure out the bliss wasn’t all fun and games.
Having been hospitalized twice in those postpartum years, I can appreciate why bipolar disorder is especially challenging for new moms, and even more so when they don’t know what their illness is, and are existing from manic high to manic high, crashing hard in between.
Upon diagnosis, Battle said, the next question is “How can we best support women in making reasonable treatment decisions when faced with bipolar disorder during pregnancy?”
One option could be guiding patients to switch to medications that are safer during pregnancy or breastfeeding, so that they don’t go off medications altogether. Connecting them to effective psychosocial therapies is also important.
Battle said she is part of a team working to develop a specialized psychosocial intervention for perinatal women with bipolar disorder.
In addition to Battle, other authors are Lauren Weinstock and Margaret Howard.
Source: Brown University