We Need to Talk About Postpartum Bipolar Disorder
by Dyane Harwood
for the PSI Blog
January 30 2018
This blog originally appeared in Self Magazine on July 25, 2017.
My manic symptoms were mistaken for a mother’s joy—I needed help.
Within 24 hours of giving birth to my daughter Marilla in 2007, I was hypomanic, a mood state that literally means “less than mania”—that is, just shy of the clinical definition of mania. I became excessively talkative, energetic, and elated. My episode was undetected by the hospital staff because it was perceived as a mother’s joy at having a healthy newborn.
When I returned home from the maternity hospital, I also had hypergraphia, a rare compulsion to write. I wrote hundreds of pages while I breastfed my baby. I typed so much that I could barely move my writing arm, and I had muscle spasms in my back and neck.
As the weeks passed, Marilla didn’t gain enough weight because I was writing too much instead of breastfeeding her sufficiently. Meanwhile, my hypomania persisted and became mania.
I knew what mania looked like—I’d witnessed it in my dad, who was diagnosed with bipolar I disorder when he was a teenager. But fear kept me from admitting I was manic—I didn’t want to be considered an inept mother. However, as my mania intensified, I could no longer keep it a secret.
During Marilla’s six-week checkup, her observant pediatrician heard my racing, pressured speech (a hallmark symptom of bipolar) and blurted out “Dyane, I think you’re manic!” I burst into tears. I felt ashamed, yet relieved after he assured me I’d get help and feel better.
It was clear I needed hospitalization, but leaving Marilla, my toddler, and my husband Craig was the last thing I wanted to do. In a heartbreaking decision, I admitted myself into the local hospital’s psychiatric unit where I was diagnosed with postpartum bipolar disorder.
Postpartum bipolar disorder, described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as “bipolar disorder, peripartum onset,” is characterized by mood episodes—mania, hypomania or depression—that can begin during pregnancy or in the weeks after childbirth. In addition to the logorrhea and compulsive writing I experienced (which is not itself a specific marker of the disorder), hypomania may include inflated self-esteem or grandiosity, irritability, racing thoughts, distractibility, decreased need for sleep, and risky behaviors. The counterpart to postpartum bipolar mania, postpartum bipolar depression can look like a very severe depression, or might be experienced as anxiety. (Postpartum mood disorders do not have their own diagnostic definitions in the DSM-V; if disorders present during or shortly after pregnancy, they are given a “peripartum onset” modifier.)
While awareness about postpartum depression is growing, little is said of postpartum bipolar disorder.
Over the last few years, postpartum depression and postpartum psychosis—psychotic features include delusions and hallucinations and are a risk factor for infanticide—have made notable appearances in the media. In 2017, the postpartum depression and postpartum psychosis documentary When the Bough Breaks, narrated by Brooke Shields, became a bestseller on iTunes. In the previous year, the hit British television show EastEnders featured the character Stacey Branning who suffered from postpartum psychosis.
The greater public perception of postpartum depression and postpartum psychosis is promising. However, there is scant awareness of postpartum bipolar disorder, and it is often overlooked or misunderstood by medical professionals.
According to Dr. Verinder Sharma, a perinatal psychiatrist who specializes in studying mothers with bipolar disorder, there are no statistics that measure the incidence of postpartum bipolar disorder. Dr. Sharma says, “Unfortunately we don’t have the data. There are studies on the rates of recurrence during and after pregnancy, but data on the new-onset of bipolar mood episodes are lacking.”
It’s imperative that doctors and other caregivers assess women not only for postpartum depression but also hypomanic or manic symptoms immediately following childbirth.
“The risk of developing new-onset severe mental illness is higher in early post-childbirth period than any other time in women’s life. Family history, pre-existing mental health conditions, traumatic birth experience, and sleep deprivation could be potential risk factors,” obstetrician Dr. Raja Gangopadhyay of the West Hertfordshire Hospitals NHS Trust, U.K., tells SELF, “Bipolar illness can present for the first time during this period. Accurate diagnosis is the key to the recovery.”
That’s why moms need comprehensive mental health screening during and after pregnancy, and why in January 2016, the U.S. Preventive Services Task Force made a landmark decision calling for depression screening in pregnant and postpartum women. This needs to include ample attention to the signs of bipolar. A family history of mental illness is known to increase a person’s risk of developing depression, and a history of depression increases a woman’s chances of postpartum depression, according to the USPSTF guidelines. When I was pregnant, my obstetrician didn’t question me about my mental health or my family’s mental health history.
Ever since my postpartum bipolar disorder diagnosis 10 years ago, I’ve had multiple hospitalizations and medication trials. Now I’m incredibly grateful to be stable and doing well. While mood disorders ravage many relationships, my husband and I have stayed together with the help of counselors, psychiatrists, and effective medication. My life with this chronic illness will always be a challenge, but my two daughters inspire me to take care of myself.
If pregnancy and motherhood are taking a toll on your mood and mental health, you’re not alone—there are resources that can help you cope.
If you suspect you might have postpartum bipolar disorder, see a medical professional immediately, whether it’s your general physician, at a hospital emergency room, or a perinatal psychiatrist. Let them know your symptoms.
Everyone who lives with a mental illness deserves the chance to find support and empathy from others who understand her experience. Through connecting with those who can relate to our mood disorder, whether it’s in person or online, we may not find a magic cure, but we can benefit greatly from encouragement, empathy, and hope.
The Postpartum Support International Warmline—1-800-944-4773(4PPD)—is a toll-free telephone number for basic information, support, and resources in Spanish and English. Warmline messages are returned every day of the week. The volunteer will give you information, encouragement, and names of resources near you. Postpartum Support International also offers online support groups in English and Spanish led by trained facilitators.
If you feel suicidal or know someone who needs help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.
Dyane Leshin-Harwood holds a B.A. in English Literature from the University of California at Santa Cruz. A freelance writer for over two decades, she has interviewed luminaries including Madeleine L’Engle, Dr. Kay Redfield Jamison, and SARK. Dyane was diagnosed with postpartum bipolar disorder (bipolar, peripartum onset) in 2007. Dyane was selected as an International Bipolar Foundation Story of Hope and Recovery, and a PsychCentral Mental Health Hero. She’s raising her daughters Avonlea and Marilla with her husband Craig and serves as a women’s postpartum mental health advocate. Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA) and facilitates free support groups for moms with mood disorders. She’s a member of the International Society for Bipolar Disorders and Postpartum Support International. Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder will be published by Post Hill Press in 2017. Dyane is a Huffington Post blogger. Her own blog Birth of a New Brain is at: www.proudlybipolar.wordpress.com and Twitter: @birthofnewbrain