Postpartum Mania & Bipolar Disorder

Postpartum

Jun 26

There is quite a bit of discussion these days of postpartum depression as the primary mental health condition that can afflict a new mom. However, there is also postpartum mania – much more rare but very serious.

What is Postpartum Mania?

Mania is a mood episode characterized by symptoms that can include:

Decreased need for sleep
Increased speech, talkativeness, often difficult to interrupt
Increased activity and goal orientated behavior – starting many new projects for example
Increased risky behaviors and impulsive choices – this can include shopping excessively, increased sexual contacts, or substance use
Grandiosity – believing oneself to have beyond human abilities or skills outside of what you do normally
Psychotic symptoms – this can include hallucinations, such as hearing voices or seeing shadows or forms that are not actually present
Disorganized behavior

A woman suffering from a manic episode may have some or most of these symptoms. There is also the possibility of hypomania – a less severe form where the symptoms are not as disturbing and not as functionally impairing, without psychosis.

How common is Postpartum Mania?

Studies report the incidence of postpartum hypomania to be as high as 9-20%. Hypomania, because it is milder and usually associated with increased productivity and decreased need for sleep, often goes unreported because a woman might consider it a helpful change postpartum!

What are the risk factors for developing Postpartum Mania?

As noted above, a cardinal symptom of postpartum mania is a decreased need for sleep. The sleep deprivation of the postpartum period and a newborn can often be a trigger for the onset of a postpartum mood episode.

Other risk factors include a history of mood episodes, a family history of mental illness, and symptoms during pregnancy.

How does Postpartum Mania relate to a diagnosis of Bipolar Disorder?

This is not an easy question to answer. The vast majority of postpartum manic episodes are due to an underlying bipolar illness. However, Bipolar Disorder is characterized both by manic episodes and by depression. If you have previously had depression and now have symptoms of postpartum mania, it is possible the most appropriate diagnosis is Bipolar Disorder. If you have not previously had any mood episodes, it is still possible that a postpartum manic episode means a bipolar diagnosis moving forward, but there are other explanations as well. An accurate diagnosis is important in order to develop an appropriate treatment plan and the right medications.

If I have Bipolar Disorder, what is the risk of a postpartum episode?

The postpartum period is one of the most vulnerable periods in a woman’s life. There are hormonal changes, the stress of a new identity, and sleep deprivation.

Discontinuing medications also increases risk. Many women who take mood stabilizing medications for Bipolar Disorder choose to stop them for pregnancy, because several of these medication can have consequences for the baby.

One study found that women who discontinue medications and are postpartum have three times the risk of relapse compared to non-postpartum women. This suggests it is not just the discontinuation of medications but also the hormonal and other changes that take place postpartum that place a woman at risk. And the recurrent mood episode may be mania or hypomania, but it could also be depression. Depressive episodes are actually more common postpartum in those with diagnosed Bipolar Disorder.

In fact, the risk of a recurrent mood episode postpartum (either depression or mania) in a woman with bipolar illness is as high as 50-75%, depending on the study and on whether the woman choose to continue versus discontinue her medication for pregnancy.

What are the treatment options?

If symptoms are severe, they may require that a woman be hospitalized for several days to ensure her safety and stability, the baby’s safety, and to be able to quickly intervene. There are also intensive outpatient programs, some of which are geared towards mothers, though not available everywhere.

Medications are the mainstay of treatment for mania. It is important to have a thorough discussion with the prescribing doctor about the safety of the medications during lactation (if you plan to breastfeed), and the options for close monitoring, including after symptoms resolve.

Support is also valuable. This includes support from family or friends and partner to help care for the baby, as well as professional support such as psychotherapy.

Fortunately, the symptoms of postpartum mania are treatable, and with symptom improvement and resolution will allow you to enjoy this important time with your baby.

Selected References:
Maina, G. et. al. Recurrence rates of bipolar disorder during the postpartum period: a study on 276 medication-free Italian women. 2014. Archives Womens Mental Health 17:367-372.

Anna Glezer, M.D.

Dr. Glezer began her training at Harvard and then transitioned to the University of California, San Francisco, where she has been a practicing physician, teacher, mentor, and is an associate professor. She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association, and the immediate past President of the Northern California Psychiatric Society.

She has worked with hundreds of women going through the emotional challenges of conception, pregnancy, loss, and postpartum. She has been interviewed for, and her written work has appeared on multiple leading sites, including Huffington Post, Fit Pregnancy, Health Line, Help Guide, and more. She has presented at local and national conferences and published in academic journals. Several years ago, she established the annual Bay Area Maternal Mental Health Conference and launched the educational website Mind Body Pregnancy, aimed to inform women, their partners, and their providers about mental health and emotional issues common in the reproductive years.

She began her private practice to help women throughout the Bay Area access reproductive mental health services and is really passionate about helping as many women as possible.