Could acute postpartum blues signal bipolar disorder?

Here is a topic that’s been making headlines with major news outlets all this week.  In a new study from Denmark, researchers found that women treated for severe psychiatric conditions including major depression shortly after giving birth were more likely to be diagnosed as bipolar later in life compared to those whose first psychiatric episode happened at any other time.

Using Danish registries, they found 120,000 women treated in an inpatient hospital or outpatient clinic for their first bout of severe depression or another psychiatric condition starting around 1970. Of those, 2,900 had those episodes within a year after giving birth to their first child.

That didn’t include women with an initial diagnosis of bipolar disorder, since the researchers were interested in women with other psychoses that later became bipolar.

Over the next decade and a half, close to 3,100 of all women initially given a different diagnosis were ultimately diagnosed with bipolar disorder. Of women who had their initial psychiatric episode in the first month after giving birth, 14 percent were eventually diagnosed as bipolar. That compared to between four and five percent of women who were first treated in the rest of the year after giving birth or at any other time.

“Clinically these findings make absolute sense,” said Dr. Verinder Sharma, an obstetrician and gynecologist who studies bipolar disorder at the University of Western Ontario in London, Canada. “We have seen that childbirth is a potent and specific trigger of bipolar disorder.”

As a bipolar sufferer who was thrown into their worst-ever bout with the illness shortly after giving birth to my son, I don’t find this surprising at all.

What I would like to know is if there are any readers out there who had their first psychiatric episode within one month postpartum.  For anyone whose journey into Bipolar happened at that time, what were the events after baby came that led to the BP diagnosis?  I’m curious to see if your first few months of postpartum experiences (as a BP Newbie) parallel that of my own (diagnosed 8 years prior to giving birth).

I’d love to jump in on this.

Before my son was even born, they wanted to do a maternal depression screening. I answered that I already had an MDD diagnosis from my teens, but I hadn’t been treated in years. They gave me the statistics at the time. One in ten mothers experiences postpartum depression. When a mood disorder is established before a pregnancy, that number drops to one in five. If a mood episode happens during pregnancy, then the number drops to one in three. Not very good odds. So, I was placed on a watch list. I would get calls every now and again to check up on my mood and mental health. No visits, just calls.

Pregnancy agreed with my mental health. In fact, it agreed so well that I was less moody than most other expecting mothers I knew! The only thing that happened was I developed acute anxiety and a serious phobia during that time. I was almost agoraphobic at the end.

The second after my son was born into this world, I felt the shift. My husband cried. I wanted to cry. I had been through so much in the last 38 weeks and 13 hours. All I wanted was to not be pregnant anymore (hellish pregnancy physically) and to meet my son. I wanted to cry for everything, joy, exhaustion, loss, loneliness, and so much more. But I didn’t. Because I felt, deep in my bones, that if I cried, they would think I was crazy and take my son away from me.

I wish I would’ve spoken up about it and just been honest. I really do. It could have spared my family the serious postpartum depression / psychosis that followed.

I remembered the next day, I wanted to grab T.D. and leave. I wanted to run back home and not be there. They were watching me. They were judging me. I was a failure of a mother because T.D. wouldn’t breastfeed, even with the help of the nurses. My husband didn’t love me anymore. I was just a vessel for his son. I was a mother now. Mothers don’t exist as people once their children are brought into the world.

I was paranoid from the very first day.

At night, we sent T.D. to the nursery because we knew that was the last time we’d sleep before bringing him home. But I couldn’t sleep. I sat up, staring at late night infomercials blankly. I was alone in that huge birthing suite. I laid alone in my uncomfortable bed. It was the first time since we were together that C.S. and I had slept apart. I watched him slumber peacefully on the pullout and long to be with him. I felt isolated. I felt an emptiness that swallowed me whole.

When I got home, it got worse. I recall an incident in the car, three days after T.D. was born, when we were headed to get a breast pump. I told C.S. how I was feeling, but in a robot like manner. I said to him, very disconnected from it, “I wonder if I’ll feel this way forever.”

I cried all of the time. I never wanted to be left alone. When C.S. went back to work, I pleaded with him to stay with me. Just another day. I couldn’t be alone. But I couldn’t have anyone else there either. I was a mess. I didn’t want anyone to see me such a mess or they would think I was an incompetent mother. They’d stare. They’d tell their friends. And before I knew it, I’d lose everything. My friends, my husband, my son, my life.

He did go back to work anyway. We desperately needed the money. And I was alone again. I refused to see anyone for two months. I refused to have my mother come and help me. I was a fit mother. T.D. was thriving. But I didn’t feel that way.

Finally, one day I broke. I broke down and called my mother, hysterically sobbing to the point where she couldn’t even understand me. She rushed over and took us back to her house. It got better there. I finally slept for the first time in a long time. The company made me feel a little better. But the worst was yet to come.

I was irritable all of the time. I was reactive and volatile. Everything was a personal attack. I was infuriated by the smallest things. Eventually, I started punching and kicking appliances, walls, you name it. I became violent. And the damned delusions and paranoia wouldn’t stop. No matter what I did, what I said, I couldn’t make it go away. I couldn’t make myself believe that I wasn’t a horrible mother, a horrible person, a horrible wife and that my family would stay in tact.

I started alienating my own husband. The man who supported me and loved me unconditionally, no matter how I was behaving. I was violent. i started drinking heavily. I had to put an end to it. This wasn’t me. I wasn’t like this before. I was always responsible and level-headed. I’d never attack the ones I loved. But, it became apparent that was coming closer. I’d sooner die than lay my hands on my family. So, I sought help. I came to understand that there was something very wrong with me.

And that’s the beginning of the road to diagnosis and treatment. I firmly believe that they should do screenings in the hospital before the mothers are even allowed to leave. Then, I think it should be a part of the six week workup. There is no reason that new mothers and their children should have to suffer from maternal depression and / or psychosis. I never alienated my son, but my husband took the brunt force of everything I held back from T.D. It wasn’t fair or right in any way. If health care professionals were a little more mindful, all of that may never have happened.

You’re absolutely right – they should do screenings in the hospital and then check in with anyone at risk every two weeks for at least eight weeks postpartum.

Thanks so much for sharing your story. Although I was first diagnosed about eight years prior to becoming pregnant, we have had very similar experiences. Pregnancy was wonderful mood-wise. People would always tell me I was a lot funnier and happier while pregnant. The physical aide of the pregnancy was a nightmare, though (pre-term labor nine times). I’ve always wondered if the preexisting chemical imbalance had anything to do with the physical side of things being so horrible. The mental BS started the day I came home from the hospital. I sat up and cried all night long and then became full-on manic. When you sought help, did you start with your OBGYN or did you head straight for a mental health professional? I made the mistake of starting with my OB. I figured she would be the obvious Dr. to know something about treating postpartum depression, right? Well, she put me on Prozac and boy, did I get worse from there. It took me two years to get straightened out from childbirth and the incorrect postpartum treatment that came after.

So, I have to ask – and don’t feel obligated to answer. Do you think you were Bipolar before your pregnancy or did pregnancy tip you over the edge?

I went straight to the mental health professionals. Since I already had an MDD diagnosis, I knew that there was something worse than that going on.

I likened it to the raging emotions of my teen years. It felt exactly the same. Except, I was not quite as violent. The aggressive tendencies were what scared me the most. I knew it needed immediate attention.

The good news is because I already carried and MDD Dx, they could immediately rule it out. I had already been through years of ineffective treatment.

Here’s the thing. When I was in college, one of my classes was called, “Abnormal Human Behavior”. It was a class on the most common adult psychiatric disorders. At the end of the class, we were required to write a case study. I wrote mine on myself. At the time, I determined I was BP II. She agreed with me. I didn’t really take it seriously. Bipolar II, *scoff* big deal!

I had forgotten all about it until i was doing some screenings online while I was waiting to see a doctor. I realized that BP II fit everything. That’s why the Dx didn’t bother me. It was actually kind of a relief. I knew I was finally going to get the right treatment to help me.

In a way, I wish I had known the seriousness of the suspicion of BP really was. In the class, we covered symptoms, but not the reality of the illness. But, had I known, I may not be in the position I’m in today. I like where I’m at. So, I wouldn’t take anything back at all.

But, the screening should be standard. It would significantly reduce the ill effects of postpartum depression / psychosis. I would never harm my child. But, not all mothers end up that way. Andrea Yates?

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