Be honest.

When you think about maternal mental health, does bipolar disorder even come to mind?

The focus tends to be on postpartum depression, and maybe even anxiety. Postpartum OCD is only just recently starting to be talked about, but even that is still shrouded in stereotypes and shame. Any awareness of postpartum psychosis tends to be tainted by fear and sensationalism.

Even the commonly used acronym in Australia - PNDA, short for perinatal depression and anxiety - excludes mention of other diagnoses.

It’s no wonder that bipolar disorder doesn’t immediately come to mind. But it should.

Pregnancy and postpartum include an increased vulnerability to the onset (or recurrence) of bipolar disorder.

So why don’t we screen for bipolar?

Screening in antenatal and postnatal settings tends to only focus on depression, meaning bipolar disorder remains underdetected and under-treated in the perinatal period. This is a missed opportunity.

As many as twenty percent (20%) of mothers with bipolar disorder are actually misdiagnosed as having depression. This is unsurprising, given the main symptom of Bipolar II is actually depression, although this misdiagnosis can be problematic.

Treatments for depression aren’t always effective for bipolar disorder, and may even be counterproductive, as two of my podcast guests learnt the hard way.

Lived experiences.

Shortly after the birth of her son, Jade was misdiagnosed as having postpartum depression. In episode 09 of the podcast, she discusses how none of the standard treatments (talk therapy, medication etc.) seemed to help. It took three (3) years before she was finally diagnosed with Bipolar II.

In Jade’s own words:

“Receiving the diagnosis came as a huge relief, but it was also accompanied with overwhelming frustration and grief. If only the right questions had been asked, if they had just dug a little deeper…I wouldn’t have had to struggle so much for so long.”

Another guest of the podcast, Taegan, only discovered she had bipolar disorder when the anti-depressants she’d been prescribed for depression actually induced a manic episode. Antidepressants do not always induce mania, although the experience Taegan recounts in episode 15 shows the importance of digging deeper.

What needs to change?

We need to focus on more than just postpartum depression when it comes to maternal mental ill health.

Better screening of bipolar disorder is needed to support the care and prompt treatment of pregnant and postpartum women. At the bare minimum, health care providers should be asking about whether there is a history of bipolar disorder in the family.

As Jade says:

“Screening for bipolar disorder should be part of the process… just a few extra minutes could potentially save years of suffering.”

Hear more about Jade and Taegan's experiences with bipolar disorder and motherhood in episodes 09 and 15 of the Perinatal Stories Australia podcast.

Please contact your health care provider or visit the Centre of Perinatal Excellence (COPE) to find more information or to access specialised support.

Reference

Bhat, Amritha et al. “Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They Are.” Psychiatric services 69.12 (2018): 1207-1209. doi:10.1176/appi.ps.201800133 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382604/)