Postpartum Episodes

All mood disorders tend to recur during pregnancy or the postpartum period, but does the frequency and timing of recurrences vary by type of disorder? To find out, U.K. investigators examined reports of affective episodes during and after pregnancy in 980 women with bipolar I disorder (BDI), 232 with bipolar II disorder (BDII), and 573 with recurrent major depression (RMD).

A similar proportion of women in each diagnostic group (71%–74%) reported an affective episode in pregnancy or within 6 months of delivery sometime during their lives. The risk for a mood episode within 6 weeks of delivery was significantly higher with BDI than with BDII or RMD; more than 20% of pregnancies or postpartum periods in the BDI group were accompanied by mania or psychosis, and 25% were accompanied by depression. Within 4 weeks of delivery, women in the BDI and RMD groups were significantly more likely to experience an episode than those in the BDII group; mania and psychotic depression were most common in the BDI group. In all diagnostic groups, mood episodes were significantly more common during the first month postpartum than during pregnancy. Depression during pregnancy was more common in the RMD group than in either bipolar group.

Comment: These results confirm previous findings that affective episodes are common during pregnancy and the postpartum period and that BDI, in particular, carries a high risk for early postpartum mania, depression, and psychosis. Why BDII disorder is associated with a lower risk for immediate postpartum episodes is unknown. But women with any mood disorder, especially those with BDI, clearly need close postpartum follow-up (JW Psychiatry May 14 2012).

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry March 18, 2013