Bipolar Disorder in Pregnant and New Mothers
What is Bipolar Disorder?
Bipolar disorder is a mental illness marked by extreme mood shifts. Symptoms can include an extremely elevated mood called mania or low time called depression. Many women are diagnosed for the first time with bipolar depression or mania during pregnancy or postpartum.
The criteria for a diagnosis of a bipolar mood disorder is that the symptoms last longer than one week and interfere with functioning and relationships. Sometimes the highs and lows seem to happen at almost the same time; this is called a mixed episode. These cycles and emotional states are more than the moodiness of pregnancy or postpartum.
Many women with bipolar disorder have healthy pregnancies and babies, but there are some risks around having a baby with the condition.
If you have bipolar disorder you may be at risk of:
developing postpartum psychosis, particularly if other women in your family have had postpartum psychosis
developing postnatal depression
your condition coming back (having a relapse) during your pregnancy if you have had any severe episodes recently and/or need medication to prevent relapse.
Types of bipolar disorder
There are two main types of bipolar disorder: Bipolar I and Bipolar II.
This classic form of bipolar disorder used to be called “manic depression.” In bipolar I, manic phases are clear. The person’s behavior and shifts in mood are extreme, and their behavior quickly escalates until they’re out of control. The person may end up in the emergency room if left untreated.
To have bipolar I, a person must have manic episodes. In order for an event to be considered a manic episode, it must:
include shifts in mood or behaviors that are unlike the person’s usual behavior
be present most of the day, nearly every day during the episode
last at least one week, or be so extreme that the person needs immediate hospital care
People with bipolar I typically have depressive episodes as well, but a depressive episode isn’t required to make the bipolar I diagnosis
Bipolar II is considered more common than bipolar I. It also involves depressive symptoms, but its manic symptoms are much less severe and are called hypomanic symptoms. Hypomania often becomes worse without treatment, and the person can become severely manic or depressed.
Bipolar II is harder for people to see in themselves, and it’s often up to friends or loved ones to encourage someone with this type to get help.
What causes Bipolar Disorder?
Bipolar disorder is a common mental health illness, but it’s not yet clear what causes some people to develop the condition and not others.
Possible causes of bipolar disorder include:
If your parent or sibling has bipolar disorder, you’re more likely than other people to develop the condition (see below). However, it’s important to keep in mind that most people who have bipolar disorder in their family history don’t develop it.
Your brain structure may impact your risk for the disease. Abnormalities in the structure or functions of your brain may increase your risk.
It’s not just what’s in your body that can make you more likely to develop bipolar disorder. Outside factors may contribute, too. These factors can include:
Each of these factors may influence who develops the bipolar disorder. However, a combination of factors contributes to the development of the illness.
How common is Bipolar Disorder?
Bipolar disorder isn’t a rare brain disorder. In fact, 2.8 percent of U.S. adults — or about 5 million people — have been diagnosed with it. The average age when people with the bipolar disorder begin to show symptoms is 25 years old.
About 1 in 5 women with bipolar disorder develop a severe case of postpartum psychosis quickly in the first few weeks after having a baby.
Signs that you may be experiencing Bipolar Disorder
The signs and symptoms of bipolar disorder are varied. Many of these symptoms can also be caused by other conditions, making this condition hard to diagnose.
The signs of bipolar disorder can generally be divided into those for mania, and those for depression.
Signs of mania
During an episode of mania, the person may feel very happy and energetic. They can become so overexcited that they're not able to control what they're doing. They may also feel much more confident than usual and take risks that they wouldn't normally take. The person often doesn't realize that they're ill during an episode of mania.
Mania can cause other symptoms as well, but seven of the key signs of this phase of bipolar disorder are:
feeling overly happy or “high” for long periods of time
having a decreased need for sleep
talking very fast, often with racing thoughts
feeling extremely restless or impulsive
becoming easily distracted
having overconfidence in your abilities
engaging in risky behavior, such as having impulsive sex, gambling with life savings, or going on big spending sprees
Signs of depression
During an episode of depression, the person feels very 'low' and stops enjoying things they used to like doing. They may not feel like spending time with family and friends and feel very alone and isolated. They may also feel tired all the time and sometimes think about harming themselves or suicide.
Like mania, depression can cause other symptoms as well, but here are seven of the key signs of depression from bipolar disorder:
feeling sad or hopeless for long periods of time
withdrawing from friends and family
losing interest in activities that you once enjoyed
having a significant change in appetite
feeling severe fatigue or lack of energy
having problems with memory, concentration, and decision making
thinking about or attempting suicide, or having a preoccupation with death
If you have bipolar disorder it’s best to talk to your doctor and psychiatrist (if you have one) before you become pregnant. Each woman’s situation is different, but it is best practice to consult before pregnancy and to have a treatment plan in place.
Do not stop taking medication for mental health problems before talking to your doctor. This can lead to withdrawal symptoms. It could also make your symptoms come back or get worse.
Some medications used to treat bipolar disorder carry risks when you are pregnant or breastfeeding. But some women will still need to take their medication because the benefits of managing their bipolar outweigh any risk to their pregnancy.
Your mental health specialist will talk to you about what may be best for you, but it is your decision. You may be advised to:
stay on the medication you are on now
switch to another medication
stop or reduce the dose of your medication
Make sure you understand the risks and benefits of all your options before you decide.
Where To Get Help
Don’t be afraid to reach out if you or someone you know needs help. Learning all you can about mental health is an important first step.
Reach out to your health insurance, primary care doctor, or state/country mental health authority for more resources.
Contact the PPSC SupportLine to find out what services and supports are available in your community.
If you or someone you know needs help now, you should immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911.