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Is it postpartum depression or something more?

Chaunie Brusie is writer, speaker, and labor and delivery nurse. Her first book, Tiny Blue Lines, a guide to young motherhood, was released in May 2014. She writes about life as a young mom of three.

A startlingly high number of PPD cases are actually bipolar disorder

When it comes to treating mental disorders in the postpartum period, doctors may be missing one important diagnosis.

After I missed my own diagnosis of having postpartum depression with my first daughter, I've been cautiously evaluating myself with each subsequent pregnancy and birth. How am I feeling? Am I overwhelmed? Do I need a valid excuse to hire a housekeeper yet? (Darn, the answer is still no.) 

I'm embarrassed to say that even after working in OB, going through four years of nursing school and carefully instructing many other new mothers on the signs and symptoms of postpartum depression, I still missed it when it happened to me. There's just so much about depression that can be masked in the life of a new mom and as it would turn out, even postpartum depression itself is often misdiagnosed.

Pec Indman, Ed.D., M.F.T. and counselor with over 25 years of experience in women's mental health issues with a special passion for postpartum depression says that up to 22 percent of women diagnosed with postpartum depression may actually have bipolar disorder instead. "Most people go over 10 years, undiagnosed, or with a missed diagnosis usually of depression," she explains. "Bipolar disorder occurs along a spectrum — the depressions are severe, but the level of highs vary. People tend to seek help for depression, the low mood, rather than high mood, so without asking questions, practitioners treat the depression."

The hormonal changes that can occur during pregnancy may trigger the disorder in a woman who is already susceptible. "For women who are sensitive to hormonal changes, this can certainly be a trigger," Indman notes. "We also think sleep deprivation or interrupted sleep is a big trigger."

Not only is missing a diagnosis of bipolar disorder a huge medical mistake, but Indman cautions that treating only for the "low points" of depression instead of the high/low mood swings that mark bipolar disorder can actually be even more dangerous. "Treating only the depression in someone who is actually bipolar can push them into a manic episode," she warns.

So how can you differentiate between postpartum depression and bipolar disorder? "Depression is considered 'uni-polar,'" explains Indman. "It goes one direction — down. Mood is normal, and then becomes low." Bipolar disorder, on the other hand, has cycles of depression and "highs," known as mania.

Symptoms of mania can include:

  • Euphoria
  • Poor judgment
  • Rapid speech
  • Racing thoughts
  • Aggressive behavior
  • Agitation or irritation
  • Risky behavior
  • Spending sprees or unwise financial choices
  • Easily distracted
While depressive symptoms are more likely to manifest in feelings of:
  • Sadness
  • Hopelessness
  • Suicidal thoughts or behavior
  • Anxiety
  • Guilt
  • Low appetite or increased appetite
  • Fatigue
  • Loss of interest in activities once considered enjoyable
  • Problems concentrating
  • Irritability
  • Chronic pain without a known cause

As with any mental health issue, Indman is adamant that women understand that mood disorders during and after pregnancy are very real, clinical conditions that warrant medical treatment. "Women cannot just 'think' themselves out of a mood or anxiety disorder," she stresses. "You would never tell or expect someone with a thyroid disorder, or diabetes, to just 'think' their hormones back to normal levels. The brain is no different than another part of the body."

The bottom line, says Indman is that for the average woman and mother, it's not so important to worry about exactly what your diagnosis is if you're experiencing a mental or mood disorder during or after pregnancy, as it is to find someone who will get you a diagnosis. "Perinatal mood and anxiety disorders are real, and have a long-term impact on moms and families," she says.

Because many general OB-GYNs and other pregnancy care providers don't receive specific training in mental health and mood disorders, she also recommends finding a trained specialist for your mental health care. Treatment can range from talk therapy, yoga, infant massage, mindfulness, social support and medication.

More on postpartum depression

Symptoms of postpartum depression
Is it postpartum depression?
Postpartum work-home choice affects happiness

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