I've often wondered if I had something more than postpartum depression and anxiety.
I had extreme mood disturbances following the birth of my first daughter. First, I was severely depressed. I was crying all the time and I thought life was over. I'd pick fights with my husband daily and I was convinced he didn't love me anymore.
Then the mood would pass and I'd feel so high and wonderful and on top of the world and I'd have all these amazing ideas that I had to constantly write down. It's like my brain couldn't stop. I had so many thoughts coming in all at once and I would speak quickly and make all these impulsive decisions. I quit my job, wrote a book and a one-woman musical in one month's time. I wore revealing clothing and wore lots of make-up and dyed my hair bleach blond. I rented out a theatre in Toronto and invited all my friends to come watch my performance. I created a new, better version of me.
Or so I thought.
I reached the pinnacle of my elation and then sunk into a deep depression which lasted for months. Then, one day, I perked up again suddenly and dropped thousands of dollars on courses to turn me into this and that.
The extreme ups and downs cleared up after my hormones went back to normal but not before emptying my bank account and leaving me looking at pictures of myself during those manic episodes wondering what the hell had happened.
I'm still trying to get my book off amazon.
The second time around after the birth of my second daughter, I didn't fool around. As soon as I felt the same thing happening, I sought help right away and went on medication.
For postpartum depression.
But was postpartum bipolar disorder I was experiencing? Does it make a difference?
All I did was answer questions on the Edinburgh Postpartum Depression Scale with my doctor that doesn't include any questions about bipolar symptoms.
"Mood is on a spectrum ranging from severely depressed at one pole, and floridly manic at the other pole, with average/normal mood in the middle," explains Dr. Marla Wald, Assistant Professor of Psychiatry and Behavioral Sciences at Duke University in North Carolina. "People who have 'unipolar' depression oscillate between an average/normal mood and just the depressive pole. People who have 'bipolar' illness have moods that oscillate between the two poles, i.e. sometimes depressed, sometimes manic. 'Bipolar depression' refers to the depressed phase that someone will experience even though at other times they experience mania."
According to the Diagnostic Statistical Manual on Mental Health Disorders, symptoms of mania can include:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Attention is easily drawn to unimportant or irrelevant items
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Dr. Wald co-authored a 2016 study on Bipolar Depression in the Pregnancy, Postpartum and Lactation period and I contacted her to learn more about this often overlooked condition.
"The goal was to review and summarize the data and to make the broader point that treatment must be individualized and tailored to each woman's needs," says Dr. Wald. "There is a growing recognition among primary care providers of Postpartum Depression- which is a very good thing- but there is insufficient awareness that it may be either unipolar or bipolar depression. If bipolar depression is misidentified and treated as unipolar depression, the patient's situation and symptoms will worsen."
A study revealed that 23% of women with bipolar disorder had a mood episode during pregnancy and 52% of women with bipolar disorder in the study had an episode during the postpartum period.
But you don't have to have bipolar disorder prior to pregnancy to have a bipolar episode postpartum. Studies also show that women with bad PMS and premenstrual dysphoric disorder are a higher risk for a bipolar event during pregnancy and postpartum.
I've never been diagnosed with bipolar disorder but I did have anxiety and depression growing up. And who knows? Maybe I am bipolar too and should have been flagged. Maybe if there were more psychiatrists around to help us make a diagnosis, I would have known sooner and taken preventative steps and not have my postpartum episodes be such a surprise to me and my doctor.
Dr. Wald is surprised bipolar illness isn't considered just as much as postpartum depression.
"Most clinicians who talk about postpartum depression are only thinking about unipolar depression," says Dr. Marla Wald. "While that is an important issue to understand and be prepared for, bipolar depression must be identified quickly to be treated accurately."
It's important to identify the difference between postpartum depression and postpartum bipolar disorder because the medication used to treat each one can be different. In fact, sometimes the wrong treatment can actually increase symptoms of mania.
There are also many wellness practices like yoga, nutrition and meditation that can help but that requires access to a practitioner, money and time.
To help with that, I'm creating an affordable online wellness program with yoga routines, meditation downloads and nutritious tips to help moms with any variety of postpartum depression get better.
"Bipolar illness is not necessarily a contraindication to pregnancy and motherhood," says Dr. Wald. "Informed decision making can empower women and families to have control over their futures."
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