Lots of media outlets reported that severe postpartum mental illness, including postpartum depression, is linked to later development of bipolar disorder. First of all, we already knew that one of the biggest risk factors for postpartum psychosis is that a woman has bipolar disorder, whether it has been diagnosed or not. Here’s what happened this week:
The International Federation of Gynecology and Obstetrics reported on a new study finding that “women who have postpartum psychosis have a greater risk of developing bipolar disorder”. What? So they get it after the fact, as if the PP caused it?
A Reuters wire story had the headline “Could acute postpartum blues signal bipolar disorder?” Acute postpartum blues? Oh geez. Postpartum depression or baby blues don’t lead to or signal bipolar disorder.
The LA Times reported that “14% of the women [in the study] with a first-time psychiatric problem that occurred just after childbirth went on to develop bipolar disorder within 15 years.” Develop? Or were they finally correctly diagnosed? Which is it? This kind of language is going to freak out every single person who has had any type of postpartum mental illness. They’re all going to believe that bipolar disorder is lurking around the corner. Yet I don’t think that was the point of the study.
As I understand it the study says severe psychiatric symptoms, especially in the first month postpartum, could be a sign of bipolar disorder. This is important for doctors to know, because women with a first major episode of bipolar disorder in the postpartum period are often misdiagnosed with postpartum depression and treated with antidepressants that can exacerbate mania. From later in the Reuters story:
Doctors, Munk-Olsen told Reuters Health, should “think about when women have their onset, and you might have an indication that there is an underlying bipolar disorder. We want these women to be diagnosed correctly, in order to help them in the best way.”
That makes more sense. When you look at the study abstract, it essentially says that “a psychiatric episode in the immediate postpartum period” is a predictor of bipolar disorder, which is something we already knew.
Usually, a severe psychiatric episode in the first few weeks postpartum refers to those women who have postpartum psychosis, not those with postpartum depression or anxiety. The way a lot of the health reporters wrote about it, any postpartum psychiatric illness may be an early marker for an underlying bipolar disorder, or may even cause one to become bipolar. I don’t get that from what I’m reading.
I checked in with an expert to make sure I’m not misunderstanding this, and yes, the most likely diagnosis after postpartum psychosis is bipolar disorder, though it’s certainly not a guarantee that someone with postpartum psychosis is dipolar.
So, no Reuters health writers, just so you know, “acute postpartum blues”, whatever they are, DO NOT signal bipolar disorder.