Bipolar disorder in the postnatal period

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What is bipolar disorder in the postnatal period?

Find local help and support for bipolar disorder in the postnatal period

Download Bipolar Disorder in the Postnatal Period Fact Sheet

What is bipolar disorder?

Bipolar disorder, which used to be called manic depression, is a serious mental health condition that affects between one to three percent of women. If you have already had a diagnosis of bipolar disorder, you are at greater risk of experiencing these symptoms (known as a relapse) of bipolar disorder in the postnatal period.

Bipolar disorder after birth

Some women may not have been diagnosed with bipolar disorder in the past, and may experience their first bipolar symptoms (called an episode) for the first time in the postnatal period (the first 12 months after the baby has been born). This is more likely if you have a history of the condition in your family.

Recognising the signs of bipolar disorder and getting help as early as possible is very important. Sometimes it may be difficult to observe these symptoms in yourself when they start – so both parents learning about the symptoms and knowing what to do is very important for you, your partner, your baby and other children.

Symptoms of bipolar disorder in the postnatal period

Bipolar disorder, as the name suggests, involves experiencing quite extreme, opposite symptoms (bipolar) over time. Bipolar disorder can result in periods (called episodes) of depression, which leaves you feeling low and lacking energy, as well as mania (feeling on a high, with elevated mood and lots of energy).

Depression symptoms

Like depression at other times (including during pregnancy or postnatal depression), if you experience bipolar disorder you may find yourself looking at things in a negative way and worry that things are worse than they really are. For example, a women with bipolar disorder who has recently had a baby may worry about whether she is a good mother, whether she deserves to have children or worry a lot about the baby’s health – fearing that something is wrong and needing to constantly take the baby to the doctor for reassurance.

Manic symptoms

At the other end of the spectrum, the periods of mania are likely to give you excessive energy, making you overactive (for example, rushing around, doing lots of activity). You may strong feelings of confidence and self-worth that are out of character and/or believe that ‘you can do anything’. High energy levels also mean that you don’t sleep much, or even feel the need for sleep – even with a new baby. Women may also behave in a way that is unusual, like speaking and/or thinking very quickly (racing thoughts). In some cases, behaviours like being unusually flamboyant or going out on spending sprees can also be associated with the mania side of bipolar disorder.

A person experiencing bipolar disorder may therefore show some unusual changes in the way they are thinking and behaving. When the condition is severe, a woman may experience the following type of problems in thinking style:

Grandiose ideas – such as being famous, or highly knowledgable about everything
Hallucinations – seeing or hearing things that are not there
Delusions – having beliefs that are not based on reality
Paranoia – feeling that everyone is against you.

These and various other symptoms of depression and mania are outlined below.

Common behaviour associated with depression	Common behaviour associated with mania
Moodiness that is out of character	Increased energy
Increased irritability and frustration	Irritability
Finding it hard to make minor personal criticisms	Over-activity
Spending less time with friends and family	Increased spending
Loss of interest in food, sex, exercise or other pleasurable activities	Being reckless or taking unnecessary risks (e.g. driving fast or dangerously)
Being awake throughout the night	Increased sex drive
Increased alcohol and drug use	Racing thoughts
Staying home from work or school	Rapid speech
Increased physical symptoms (e.g. fatigue or pain)	Decreased sleep
Slowing down of thoughts and actions	Grandiose ideas
Hallucinations and/ or delusions (psychosis)	Hallucinations and/ or delusions (psychosis)
Suicidal thoughts or thoughts of harming baby

Download Bipolar Disorder in the Postnatal Period Fact Sheet

Seeking help for bipolar disorder in the postnatal period

Whether a woman is experiencing the symptoms of depression or mania, it is very important to seek help as early as possible.

Bipolar disorder significantly impacts a woman’s ability to care for her baby. She may also be at risk of suicide or harming herself or the baby, so urgent assistance from your general practitioner, mental health service or a hospital emergency department is recommended.

Often the woman will not recognise the symptoms in herself, so partners and family members play a critical role in observing changes in character and taking the lead to ensure she gets help early.

Seeking help as early as possible can ensure the mother is safe, and that steps can be made to ensure she receives effective treatment as soon as possible.

Managing bipolar disorder with a new baby

Hospital care

In most cases, the management of an acute episode of bipolar disorder in the postnatal period will require that women go to hospital – usually a psychiatric hospital – to allow time for treatment to be provided in a setting where she and the baby are safe, and she can be monitored by health professionals.

Some psychiatric hospital settings have a mother and baby unit where a woman can stay with her baby as she stabilises. This is generally available to those with private healthcare, while easy access for those in the public system varies across Australian states and territories.

With time and effective treatment, the symptoms of bipolar disorder will begin to settle down and stabilise – at which time the health professional will determine when she can be discharged from hospital.

Following discharge, the woman will need to receive ongoing support and monitoring by a specialist mental health professional.

Bipolar disorder will not ‘settle down’ or go away on its own without medical treatment. As such, it is important to seek help as early as possible to help prevent the condition from getting worse and having a negative impact on your family.

Medical Treatment

The National Perinatal Mental Health Guideline recommends that bipolar disorder is managed and treated using medications. These medications work to stabilise the symptoms by reducing the impacts of the ‘highs’ and ‘lows’ of bipolar disorder.

Different types of medication are used to treat the depression, mania or both depression and mania. There are a variety of medications that may be prescribed.

Types of medication for bipolar disorder in the postnatal period

Mood stabilisers

Mood stabilisers work to stabilise mood and help reduce the likelihood of the symptoms recurring (relapse). The most common mood stabiliser is lithium. Other types of mood stabilisers (which are also used to manage epilepsy) that may be used are sodium valporate, carbamazapine and lamotrigine.

Antidepressants

Antidepressants are used to treat the symptoms of depression that are part of the ‘depression’ part of the disorder.

Antipsychotics

Antipsychotics assist with both manic and psychotic symptoms such as delusions or hallucinations.

Medical treatment for bipolar disorder needs careful, specialist attention and management. Before medications are prescribed, changed or stopped, it is vital that advice is sought from a psychiatrist who will consider the best choice of medical treatment to manage the condition for each individual.

If prescribed one of these treatments for bipolar disorder, it is important that you do not alter or stop your medications suddenly.

It is also important to speak to your mental health specialist if you are, or want to breastfeed and have been prescribed sodium valporate or clozapine. If you are prescribed lithium, again your health professional needs to know that you are, or are intending to breastfeed, as your baby will also require monitoring.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) is a specialist treatment that may be used to treat the symptoms of mania and severe depression. ECT involves stimulating the neurones in the brain via an electric current. While ECT can lead to short-term memory loss, for many women it plays a crucial role in treating bipolar disorder and making steps towards management and recovery.

There are safe and effective treatments for bipolar disorder. Getting help early for bipolar disorder is vital to reduce the impact of the condition on the mother, partner, infant and other members of the family.

Talking therapies

Talking therapies can be very helpful in treating symptoms of depression and anxiety, which are common in people with bipolar disorder.

They can help you recognise and change the negative thinking and feelings that depression brings. They also give you useful tools to stop anxiety coming back.

Talking therapies include:

Cognitive-behavioural therapy (CBT)

The cognitive (or thinking) part of this therapy teaches you to think logically and challenge negative thoughts. The behaviour part helps you change the way you react in situations and can help you to get involved in activities that you have been avoiding or have stopped doing.

Interpersonal therapy (IPT)

Interpersonal therapy helps you to find new ways to connect with others, and overcome losses, challenges and conflicts that you may have. Registered practitioners with appropriate training and experience provide talking therapies for individuals or groups.