Postpartum Bipolar Disorder: Signs, Symptoms, & Treatments

What Is Postpartum Bipolar Disorder?

Postpartum bipolar disorder occurs when a woman develops symptoms of bipolar disorder shortly after giving birth. People with postpartum bipolar disorder experience episodes of mania or hypomania, and sometimes depression. Signs of mania and hypomania include an elevated or irritable mood, increased energy, difficulty focusing, and racing thoughts.² Signs of depression include sad mood, low energy, and changes in sleep and eating patterns. It can also be accompanied by postpartum rage or bipolar anger.

To receive a postpartum bipolar disorder diagnosis, someone must either be experiencing a manic, hypomanic, or mixed episode, or have a current depressive episode but have experienced mania or hypomania in the past. Someone with only a current or past history of depression would be diagnosed with postpartum depression instead. A person can be diagnosed with bipolar disorder with peripartum onset if they start showing symptoms within four weeks of giving birth.² However, many professionals believe this window is too restrictive and that someone may develop this condition in the months following childbirth.

Symptoms of Postpartum Bipolar Disorder

Postpartum bipolar disorder is more than just mild mood changes that many women experience during the “baby blues.” Women with postpartum bipolar disorder experience episodes of mania, hypomania, and/or depression.² These symptoms can affect many areas of a woman’s life, including their relationships and ability to connect with their baby.

Symptoms of Mania & Hypomania

Mania and hypomania cause similar symptoms, but manic symptoms are much more severe than hypomanic symptoms, and often lead to hospitalization.³

Signs and symptoms of postpartum bipolar mania or hypomania include:²

• Elevated, expansive, or irritable mood that lasts for at least one week
• Inflated self-esteem
• Feeling energized with little to no sleep
• Excessive talking
• Racing thoughts
• Lack of focus
• Increased productivity
• Restlessness
• Participation in activities that could lead to negative consequences (e.g., going on shopping sprees, having risky sex, or using drugs)

Symptoms of Postpartum Depression

Women with postpartum bipolar disorder may also show these signs and symptoms of depression:²

• Sad mood that lasts at least two weeks
• Loss of interest in things that were once enjoyed
• Changes in appetite or weight
• Changes in sleeping patterns
• Low energy
• Slowing down of thoughts or movement
• Excessive feelings of guilt or worthlessness
• Poor concentration or indecisiveness
• Suicidal thoughts

Symptoms of Bipolar Psychosis

Psychosis is an occurrence that happens when individuals are psychologically removed from their reality. For example, someone may experience delusions (false beliefs) or hallucinations (sensory perceptions in the absence of external stimuli).

Like mania, psychosis is a symptom of bipolar disorder and it’s important to be aware of the full set of symptoms, including:

• Poor work/school performance
• Limited social contact
• Flat affect
• Poor personal hygiene
• Difficulties with communication and concentration
• Anxiety and depression
• Auditory and visual hallucinations and delusions

Bipolar I & Bipolar II

Bipolar disorder is sometimes referred to as a spectrum because the severity of symptoms varies.¹ There are two types of bipolar disorder: bipolar I and bipolar II.² Bipolar I causes more severe symptoms because it involves having at least one manic episode. Women may experience symptoms of bipolar I or II during the postpartum period.¹ In some cases it may be harder to diagnose bipolar II disorder because symptoms of depression and hypomania may be confused with the “baby blues,” which are normal mood changes that occur in the days after giving birth.⁴

Postpartum Bipolar vs. Postpartum Depression

Postpartum depression (PPD) is another mood disorder that can affect women after giving birth.⁴
During PPD, someone experiences symptoms like feelings of sadness, emptiness, or numbness for at least two weeks. Around one in nine people experience postpartum depression after giving birth. The primary difference is that people with postpartum bipolar disorder have had at least one manic or hypomanic episode in their lifetimes, while people with PPD have not.²

Here are the similarities and differences between postpartum bipolar disorder and postpartum depression:

Postpartum bipolar disorder:

• The person has had at least one manic episode or a hypomanic and depressive episode
• May experience symptoms of depression like sad mood, hopelessness, low energy, and loss of interest or pleasure
• Often involves changes in sleep and eating patterns (e.g., during a manic or hypomanic episode, a women usually sleeps very little)
• May include psychotic symptoms like hallucinations, delusions, and disorganized thinking

Postpartum depression:

• No experience of manic or hypomanic episode
• May experience symptoms of depression like sad mood, hopelessness, low energy, and loss of interest or pleasure
• Often involves changes in sleep and eating patterns (e.g., may sleep longer than usual or experience insomnia)
• No psychotic symptoms

Postpartum Bipolar vs. Postpartum Psychosis

Postpartum psychosis is a rare but serious condition that can develop within the first month of giving birth.⁵ During postpartum psychosis, someone might experience hallucinations, delusions, paranoia, disorganized and bizarre thinking, and display odd behaviors. There’s also an increased risk of suicide and infanticide, so securing professional help for someone experiencing postpartum psychosis is imperative.

Many people who develop postpartum psychosis have bipolar disorder.⁵ In fact, having a diagnosis of bipolar disorder significantly increases the risk that a woman may develop postpartum bipolar psychosis. Though postpartum psychosis can be a part of bipolar disorder, some people may display symptoms of depression, mania, or hypomania without psychotic features during the postpartum period.

How Can Pregnancy & Postpartum Affect an Existing Bipolar Disorder?

People who have a previous diagnosis of bipolar disorder have a 25%-40% higher risk of experiencing mood symptoms after giving birth.¹ Those who experience perinatal mood and anxiety disorders like depression or mania during pregnancy are at high risk of having another episode after birth.

During pregnancy and the postpartum period, people experience shifts in hormone levels, sleep deprivation, and increased stress as they navigate caring for a newborn. All these factors can make a person with a pre-existing bipolar condition vulnerable to a relapse. However, treatment can help reduce this risk.

What Causes Postpartum Bipolar Disorder?

No one knows exactly what causes bipolar disorder, but researchers and professionals believe it’s a combination of biological, psychological, and environmental factors. People are particularly prone to developing mood symptoms during the postpartum period due to a combination of hormonal changes, sleep deprivation, and stress related to caring for a newborn.¹

Common causes of postpartum bipolar include:¹

• Genetics
• Hormonal changes that occur after giving birth
• Sleep deprivation
• High levels of stress

Risk Factors for Postpartum Bipolar Disorder

Certain risk factors increase the likelihood that a person may develop postpartum bipolar disorder. The more risk factors you have, the higher the likelihood that you could develop postpartum bipolar disorder. Taking steps to care for yourself may help reduce your risk.

Risk factors of postpartum bipolar disorder are:^6,7

• Having a past history of bipolar disorder
• Having had more than one manic episode in the past
• Family history of bipolar disorder
• Shorter time since last depressive episode
• Having an unplanned pregnancy
• Not taking medication during pregnancy

How Is Postpartum Bipolar Disorder Diagnosed?

Medical and psychological professionals can diagnose postpartum bipolar disorder. Diagnosing postpartum bipolar disorder can be tough as the period of time it takes to diagnose can vary based on the woman and her symptoms. It can also be challenging as there are other postpartum issues that can come up, and differentiating these can take time to unpack.

Current best practice is to screen women twice in the 4-6 weeks post-delivery. Screening can be ongoing as well, and using different screen methods to identify what postpartum issues someone could be facing is also recommended.

Treatments for Postpartum Bipolar

Treatment for bipolar disorder usually involves a combination of therapy, medication, and self-care. If postpartum psychosis develops, then hospitalization is necessary to stabilize the woman before she can return to outpatient care. Because bipolar disorder is complex and serious, people benefit from continuing treatment even after their symptoms improve.

Medication

Bipolar medications like mood stabilizers, antidepressants, and anti-anxiety medications may be prescribed depending on someone’s symptoms.¹ These medications can help reduce mood changes, decrease manic, hypomanic, and depressive symptoms, and improve a person’s ability to function.

Some people have concerns about the risks of taking medication while breastfeeding. While certain medications used to treat bipolar disorder do pose risks, other medications are considered safe during breastfeeding.⁸

Professionals recommend evaluating the risks and benefits of medication and considering that untreated mental health issues can have a negative impact on parent and baby. It is therefore important to speak with a psychiatrist that has experience working with postpartum mood disorders to determine what medication options are best for you.

Therapy

While medication is often necessary to treat bipolar disorder, therapy plays an important role, too.¹ It can help improve a mother’s mood stability, relationships, and quality of life, and help reduce other emotional symptoms like anxiety. Many types of therapies that are effective for the treatment of traditional bipolar disorder can be effective during the postpartum period.

Therapy that can help with postpartum bipolar include:

• Cognitive behavioral therapy (CBT): CBT for bipolar looks at how a person’s thoughts, feelings, and behaviors affect one another.⁹ CBT helps you change negative thoughts and beliefs and teaches skills to manage negative emotions.
• Mindfulness-based cognitive therapy (MBCBT): MBCBT combines elements of CBT with mindfulness-based practices.¹⁰ This form of therapy helps people learn to cope with their emotions by accepting rather than resisting them.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT was developed for people with bipolar disorder.¹¹ It focuses on helping people work with their circadian rhythms to create healthy habits, routines, and sleeping patterns. It also utilizes techniques from CBT and interpersonal therapy to help people maintain positive changes and improve their relationships.

Self-Care

Forming healthy habits and taking steps to care for yourself are important when recovering from postpartum bipolar disorder.¹² Eating a healthy diet and exercising a few days per week can help you manage your mood. Getting enough sleep is also important for managing symptoms. Aim for seven to eight hours per night and reach out to your treatment team if you’re sleeping too much or too little.

Try to find healthy outlets for your stress like playing sports, meditating, and connecting with your support system. Also avoid alcohol and drugs, which can negatively affect your mood and may also interfere with your medication.

How to Get Help for Postpartum Bipolar Disorder

Bipolar disorder is a serious, chronic condition that can affect many areas of someone’s life and hinder the ability to function.¹ Getting help sooner rather than later is highly recommended when it comes to postpartum bipolar disorder. Symptoms are unlikely to resolve on their own and can get worse, which can have devastating effects.

These symptoms can affect a parent’s relationships and ability to care for and bond with the baby. This is especially important if someone shows signs of postpartum psychosis. Someone experiencing postpartum psychosis is unable to understand what’s happening, so family and friends play an important role—getting emergency support is crucial. Postpartum psychosis is a psychiatric emergency that requires hospitalization.

Who to Talk to

If you suspect that you’re showing signs of postpartum bipolar disorder, start by contacting your OB-GYN. They will assess your symptoms and talk to you about your treatment options. You may also choose to look for a psychiatrist right away. Medication and therapy are strongly recommended for anyone dealing with bipolar disorder.

To find a provider who can prescribe medication, search for a psychiatrist with experience treating postpartum mood disorders. A great place to start is to search for a psychologist, social worker, therapist, or counselor on an online therapist directory, or you can ask for a referral from your OB-GYN or your primary care physician.

Can Postpartum Bipolar Disorder Be Prevented?

There’s no way to guarantee that you won’t develop postpartum bipolar disorder. However, if you have a history of bipolar disorder or are at high risk, there are steps you can take to help reduce the chances of having a manic, hypomanic, or depressive episode after giving birth. It’s important to talk about your personal or family history of bipolar disorder with your OB-GYN and treatment team and to develop a plan to help support you during the postpartum period.

To help prevent a mood episode, be sure to get enough rest.¹ If you’re having trouble sleeping, consider talking to your support system about ways to get more sleep. Speak with your healthcare provider if you’re unable to sleep while the baby sleeps. If you’re already in therapy when you get pregnant, it’s helpful to continue even if you feel OK.

Having the additional support can help you cope with any mood shifts that may occur. If you’re already on medication, your provider may want to keep you on the same medication if it’s working well for you. If you have any concerns or questions about taking medication while pregnant, contact your provider.

Final Thoughts

Postpartum bipolar disorder is a mood disorder that can have serious consequences for parents and their families. With proper treatment, including therapy, medication, and lifestyle changes, recovery is possible. If you or someone you know is showing signs of postpartum bipolar disorder, do not hesitate to seek help today.