Does Postpartum Depression Lead to Bipolar Disorder?

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postpartum depressionDoes postpartum depression lead to bipolar disorder? No, but you might mistakenly think that if you read some of the headlines this week.

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?

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.

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  1. In my science class this semester we looked at case studies and media headlines that "described" them. We talked at length about all the filters this kind of information goes through and how misleading media articles are, especially with the language they use.

    I would encourage everyone to do what you did concerning these articles and what I've started to do: read the case studies themselves. Or at least their abstracts. Don't just go off of how the media presents it, because their editing sucks these days….

    Thanks for pointing this out. I wish they had discussed previous mental health history that may have made these women at risk, the use of antidepressants that can trigger BP, etc…you know, THE FACTS. Not just conjecture or over drawn conclusions….

    • That's one of the reasons why, wherever possible, I always try to link to the abstracts so PP readers can see them themselves.

  2. If "they" spent more time researching ways to prevent it, "they" would be much more productive than using dramatic headlines to scare the @#$! out of PPD Women. If only we all had a way to experience the illnesses of others, if only for an hour or a day…a little compassion goes a long way.

  3. Thank you for posting on this. “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. ”

    This is EXACTLY what I went through and if someone had been more informed, I could have avoided a year and a half of heartbreak for myself and my family. I was diagnosed, after months and months of different antidepressants and ever-escalating hypomania/depressive episodes (nearly every day by the end of my breakdown), with bipolar II. If I hadn’t been so trusting, if I had seen a psychiatrist right away instead of accepting a prescription from my well-meaning OB at my 6 week check-up, if someone had noted my reaction to the anti-depressants as abnormal… lots of ifs.

    But mostly, if this information was more accurately distributed and understood and made more accessible, a lot of heartbreak could be avoided. Would I still have had PPD? Undoubtedly. Did my underlying (and undiagnosed) BP II exacerbate it? Maybe so. Would I have still tried to kill myself if I’d instead been directed to more knowledgable counsel? I’d like to think not.

    The media has a responsibility that, more and more, has been lost in the ratings. That loss filters down into every aspect of our lives, whether they like it or not.

    • It's not just the media, Megan, but also many doctors who aren't aware that they need to consider bipolar disorder if someone presents with symptoms in the first month. It seems like many just automatically assume PPD, and so they treat the mom with antidepressants. Then these moms end up spending a year wondering why they aren't getting any better when they see others with PPD improving and recovering.

      • I guess that's what I was trying to get at. Too many people, including doctors (and very unfortunately doctors), take news stories at face value without looking deeper. So their lack of attention leaks down into important areas. I have to admit that I've fought a long battle against blaming my OB for the drastic turn my PPD took. At the time, it made me feel better that if he didn't think it mattered much then I was fine. Seeing this makes me equally as angry at the news outlets for twisting important health information as it does at him for not bothering to be more well informed. Double-edged sword. (And maybe I am just a WEE bit bitter, too. Ha!)

        • I don't blame our media for this. And I don't blame individual doctors either really. The problem is that perinatal mood and anxiety disorders simply are not taught to doctors-in-training either in medical school or at the residency level. I wonder why that is.

          Obs are explicitly taught to screen for and treat gestational diabetes. They can't just throw up their hands and say "Well I'm not an endocrinologist". Same with pregnacy-induced hypertension. Providers get taught how to detect it, how to treat it and what to do if the treatments aren't working. Same with post-partum uterine infections. Docs can't just say "Well here's a list of infectious disease specialists, infections aren't really my forte". So why is it that we as a society have decided that docs-in-training don't have to learn even the basics of the most common complication of pregnancy and birth? How can we change this?

          • That is very true, Al. We don't do much to train our doctors about perinatal mood and anxiety disorders, so in many ways it is not their fault they don't know these things.

  4. I really truly 100% know that my postpartum depression and anxiety diagnosis completely overshadowed the fact that I was really dealing with a triggered bipolar disorder.

    3 years I suffered.

    Three.

    Doctors SHOULD consider this a possiblity when dealing with a patient who presents with PPD. They must.

    And the media has the responsibility of not jumping to drastic conclusions…but we all know how that pans out.

    There have been numerous women in the blogsphere recently who have been diagnosed with PPD and are now bipolar. I've recieved a lot emails and tweets from women reaching out to me and telling me that they think that they are bipolar because they're not getting better. The best that I can do is to bring it up with their doctors..and hopefully they listen fully.

  5. Psychiatry is very complex. Seems to me every OB should have a working relationship with one and require a visit before decisions are made about drugs. My case is fairly simple but I've tried to stop the medicine twice now with the help of my OB without a stitch of therapy. Thank goodness I've seen that I need help because she is happy to just give the drugs and expect them to fix everything. I'm also glad that I saw this here first, but if I had seen the news I would have asked my excellent therapist about it.

    • Psychiatry can be very complex. Some cases of postpartum depression are straightforward and often respond well to common medications like Zoloft, Prozac etc. Others, like those in the above research, represent "unmasked" bipolar or some other condition.

      I think at a minimum, OBs, Midwives and Family Doctors should be able to know how to ask the standard questions that can help distinguish between straightforward cases and potentially more complicated cases. They should know how to ask about hypomanic symptoms and self-harm thoughts. They should know how to ask about intrusive thoughts and know to check a thyroid cascade. They should take a complete personal and family psychiatric history. This set of skills is "Psychiatry 101". Unfortunately doctors-in-training are not routinely and systematically taught this skill set. Some docs learned it in training and some didn't.

      The problem with requiring that all OBs refer to a psychiatrist before prescribing a medication is that there are simply not enough psychiatrists to go around. Nowhere near enough. Our country has a severe shortage of psychiatrists, and that is not going to change anytime soon. If an individual woman has the wherewithal to get herself to a psychiatrist, and especially a psychiatrist with a specialty in peripartum psychiatry, good for her! But this still leaves the great majority of affected women suffering.

      So I think we need to start with the way providers of obstetric care are trained. Doctors-in-training need to be systematically taught the Psychiatry 101 skills. It should be a required part of becoming Board Certified.

  6. My PPD was what triggered my Bipolar Disorder. As I understand it, you're born bipolar or not. Sometimes it takes something big in order to trigger it. For me, that something big was PPD. After 2 1/2 years my depression, anxiety, etc… didn't lift, it continued and I was hospitalized for suicidal ideation. So in my case PPD didn't "cause" bipolar disorder but it surely set the ticking time bomb off for explosion.

  7. I have been hearing very encouraging comments about progesterone therapy for PPD and PPPsychosis. Anyone have any experience with this treatment?

  8. Some very common triggers for bipolar people are major (sometimes minor) changes in daily routine and sleep patterns.

    Guess what having a baby comes with?

    Not to mention the possible alterations in neurotransmitter activity going on during the pregnancy itself.

  9. i have a friend who was diagnosed with bipolar disorder after she has her firstborn an the doctors blame the pregnancy so they told her NO MORE BABIES or she will be need to be hospitalize. it sound so bad because she is just 20 years old.