Postpartum Despair: Unipolar or Bipolar?




About 15% of ladies will expertise postpartum melancholy after the beginning of a kid.  Whereas most of these ladies may have unipolar melancholy, a sure variety of ladies may have bipolar melancholy.  At this juncture, making the right prognosis is important, because the remedy of bipolar melancholy differs from the remedies usually used for unipolar melancholy is that this setting.  Moreover, the usage of antidepressants in a girl with bipolar dysfunction will not be efficient and may very well make the signs worse.   

Step one in making this distinction rests upon a cautious assessment of previous psychiatric signs.  Is there a historical past of mania or hypomania?   However for a lot of ladies with bipolar dysfunction, depressive episodes predominate.  It’s thus pretty frequent that the primary episode, and probably subsequent episodes, are depressive in nature and happen previous to the onset of a hypomanic or manic episode.

In ladies who current with postpartum melancholy, is it attainable to tell apart unipolar melancholy for bipolar dysfunction when the primary onset of sickness is a depressive episode?  Utilizing a multicenter cohort of sufferers with bipolar dysfunction, researchers tried to establish medical and demographic options which distinguish bipolar from unipolar melancholy.  

Utilizing knowledge from the FACE-BD (FondaMental Educational Facilities of Experience for Bipolar Issues), a French multicenter cohort of sufferers with bipolar dysfunction, researchers recognized all ladies who had onset of bipolar dysfunction with a serious depressive episode and who had a minimum of one baby.  They in contrast two teams of ladies, relying whether or not the onset of bipolar sickness occurred throughout or exterior of the postpartum interval.

Among the many 759 ladies on this cohort, 93 (12.2%) skilled a postpartum onset of sickness, and 666 (87.8%) skilled onset exterior of the postpartum interval.   Girls who had postpartum onset of bipolar dysfunction had a extra secure household life, extra youngsters, and had been older at age at sickness onset.  They had been extra more likely to have Bipolar Dysfunction Sort 2, much less likelty to hav e historical past of suicide makes an attempt, and had fewer depressive episodes.  

Whereas this is among the few research trying on the options which can assist clinicians to tell apart unipolar from bipolar postpartum melancholy, the knowledge is of restricted medical utility.  It could present some reassurance in that the onset of bipolar dysfunction (with melancholy) through the postpartum interval is much less frequent than non-postpartum onset.  Moreover, it seems that ladies who current with bipolar melancholy through the postpartum interval have much less extreme sickness (fewer depressive episodes, fewer suicide makes an attempt, decrease danger for mania) and have larger ranges of household assist.

Nonetheless, vigilance is required in screening ladies who current with postpartum melancholy for bipolar dysfunction.  Whereas earlier research have proven that ladies with elevated scores on the Edinburgh Postnatal Despair Scale (EPDS) may very well have bipolar dysfunction, different instruments just like the Temper Issues Questionnaire (MDQ) might assist clinicians to establish ladies with bipolar dysfunction.  

 

Ruta Nonacs, MD PhD

 

Reference:

Tebeka S, Godin O, Mazer N, Bellivier F, Courtet P, Etain B, Gard S, Leboyer M, Llorca PM, Loftus J, Olié E, Passerieux C, Polosan M, Schwan R, Belzeaux R, Dubertret C; FondaMental Superior Facilities of Experience in Bipolar Issues (FACE-BD) Collaborators.  Medical traits of bipolar problems with postpartum depressive onset.  Prog Neuropsychopharmacol Biol Psychiatry. 2020 Dec 18.

 

Associated Posts:

Utilizing the EPDS Throughout Being pregnant: What Precisely are We Screening For?

What Screening Instruments Establish Postpartum Girls with Bipolar Dysfunction?

Screening for Despair Throughout Being pregnant Might Result in Misdiagnosis for Girls with Bipolar Dysfunction

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