Welcoming a new child into the world should be a joyous experience, but in some cases, new mothers with a diagnosis of bipolar disorder may be at risk of postpartum psychosis. The truth is that many women experience significant mental health challenges during pregnancy and after giving birth.
Two of these potential challenges are postpartum depression and postpartum psychosis:
- Experts estimate that as many as one in every seven women who give birth will experience postpartum depression. In the United States, this means that about 600,000 women may have episodes of postpartum depression in a typical year.
- The estimated prevalence of postpartum psychosis is between .0089%–0.26%. This corresponds with an annual rate of 320–9,400 cases.
Although postpartum psychosis is far less common than postpartum depression, it’s equally disruptive. In fact, women’s health expert Lauren M. Osborne, MD, describes postpartum psychosis as “the most dangerous and the least understood of perinatal psychiatric disorders.”
In recent decades, as researchers sought to learn more about postpartum psychosis, several studies focused on its connection to bipolar disorder.
What Is Postpartum Psychosis?
According to Osborne’s September 2018 article in the journal Obstetrics and Gynecology Clinics of North America, the first recorded instance of postpartum psychosis occurred in 400 B.C., when the legendary Greek physician Hippocrates described a patient displaying confusion, delusions, and insomnia shortly after giving birth to twins.
Through the ensuing millennia, many other healthcare providers noted and attempted to treat women with similar symptoms. However, as indicated by Osborne’s use of “least understood” when describing postpartum psychosis, there’s no consensus on criteria for identifying and treating this mental health disorder.
Most people who develop postpartum psychosis show symptoms within six weeks of giving birth. Citing a clinical cohort study that involved 130 cases of postpartum psychosis, Osborne reported that the following common symptoms:
- Confusion
- Disorganized thoughts
- Depersonalization
- Insomnia
- Irritability
- Delusions
- Hallucinations
- Mania
- Agitation
- Depression
To underscore the severity of postpartum psychosis, this condition can dramatically increase risk of suicidal ideation and thoughts of infanticide.
Note: If you or someone in your life experiences postpartum thoughts of suicide or infanticide, please get help immediately. If you reside in the United States, dial 988 for the Suicide & Crisis Lifeline or visit https://988lifeline.org/.
When you contact this resource, a trained professional can connect you with appropriate support services in your area. The 988 Suicide & Crisis Lifeline operates 24 hours a day, seven days a week, 365 days a year.
Postpartum Psychosis & Bipolar Disorder
Several studies report that women with bipolar disorder are at increased risk for postpartum psychosis and other childbirth-related mental health concerns.
A recent report includes the following statistics about bipolar disorder and pregnancy:
- Compared to women with major depressive disorder, women with bipolar disorder are 50% more likely to develop postpartum depression.
- Women with bipolar disorder are at seven times higher risk of being hospitalized for a mood disorder, compared to women without bipolar disorder.
- The risk of postpartum psychosis is 25%–50% among women who have bipolar disorder. That’s 100 times greater than the risk among the general public.
Studies conducted both before and after Clark’s and Weisner’s research support the findings that bipolar disorder increases risk for postpartum psychosis and other postpartum mental health disorders.
The authors of a May 2006 review in the Journal of Women’s Health emphasize the connection between bipolar disorder and postpartum psychosis.
After a review of previously published research, they concluded:
“Postpartum psychosis is an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery.”
In other words, though the symptoms of postpartum psychosis “resemble a clinical picture of delirium,” the study authors believe most women who report these experiences after childbirth actually have bipolar disorder. To support this conclusion, they observe:
- A 1995 study found that 95% of people with postpartum psychosis met the criteria for a cyclic mood disorder (such as bipolar disorder) when assessed five years later.
- 50% of the women in the 1995 study were misdiagnosed when they first showed symptoms of postpartum psychosis.
- Four other studies found that 43%–66% of women with postpartum depression actually had a primary cyclic mood disorder.
The good news, the team reported, is that women who receive appropriate treatment for postpartum psychosis can make a successful recovery.
According to two studies, 75%–86% of women with bipolar disorder and postpartum psychosis remained symptom-free after their first psychotic episode. Getting help within one month of giving birth may be the key to preventing long-term harm.
Treatment Options for Postpartum Psychosis
Among women with a history of bipolar disorder and/or postpartum psychosis, the careful use of medication may reduce risk of postpartum relapse.
An October 2015 review in the American Journal of Psychiatry confirms that treatment – especially medication – offers considerable benefits.
This review, conducted by an international team from the Netherlands and Denmark, based their findings on an assessment of 37 studies published between March 1986 and October 2014. These studies involved 4,023 patients and 5,700 deliveries.
The review team found that prophylactic pharmacotherapy – i.e, taking medication prior to experiencing symptoms – improved mental health outcomes among pregnant patients with a history of either bipolar disorder or postpartum psychosis.
Bipolar Disorder, Pregnancy, Psychosis, and Medication
- The overall rate of postpartum relapse was 37% among women with bipolar disorder and 31% among those with a history of postpartum psychosis.
- Patients with bipolar disorder had a 66% risk of relapse in the absence of medication during pregnancy. In the presence of medication during pregnancy, relapse risk dropped to 23%.
- Patients with bipolar disorder who did not take medication after giving birth had a relapse rate of 65%. The relapse rate among those who took medication during the postpartum period was 29%.
- Among patients with a history of postpartum psychosis, those who remained medication-free during the postpartum period had a 30%–44% chance of relapse. In two studies involving patients who received lithium after giving birth, the relapse rate ranged from 0%–14%.
Of course, virtually all prescription medications can cause distressing side effects. In the case of pregnant women, these effects can include harm to the fetus. As the review team noted, this means that women and their healthcare providers must consider both the potential benefits and the possible damage that can result from using pharmacotherapeutic interventions to prevent postpartum mental health challenges.
Here’s how the research team describes these findings:
“Medication prophylaxis during pregnancy in women with bipolar disorder appears important not only to maintain mood stability during pregnancy, but also for postpartum relapse prevention. However, the benefits of prophylactic pharmacotherapy during pregnancy should be weighed against the potential adverse effects of in utero medication exposure.”
In the case of women with a history of postpartum psychosis, research suggests they can avoid the possible risks of taking mood-stabilizing medications during pregnancy, as long as they take these medications in the immediately after giving birth.
“For women with a history of isolated postpartum psychosis, the initiation of prophylaxis immediately after delivery appears to be highly effective for relapse prevention and eliminates the risk of in utero medication exposure,” the review team wrote.
Find Help for Bipolar Disorder in Southern California
As the research cited throughout this post indicates, mental health treatment can be an essential element of care for women who have bipolar disorder and are either pregnant or planning to become pregnant.
Crownview Psychiatric Institute provides comprehensive, personalized services for adults with bipolar disorder and other complex mental health conditions. Our innovative and highly supportive programming incorporates medication, therapy, education, and wraparound services to help patients make sustained progress toward improved health and better overall quality of life.
To learn more about treatment options for bipolar disorder at CPI, or to schedule an assessment for yourself or a loved one, please visit our Contact page or call our center today.
Gianna Melendez
Jodie Dahl, CpHT