Assessment and treatment of bipolar II postpartum depression: A review

• Published in: Journal of affective disorders Vol. 125; no. 1; pp. 18 - 26
• Main Authors: Sharma, Verinder, Burt, Vivien K, Ritchie, Hendrica L
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01-09-2010; Elsevier
• Subjects: Adult and adolescent clinical studies; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Antimanic Agents - adverse effects; Antimanic Agents - therapeutic use; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Assessment; Biological and medical sciences; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - psychology; Bipolar Disorder - therapy; Bipolar disorders; Combined Modality Therapy; Depression; Depression, Postpartum - diagnosis; Depression, Postpartum - psychology; Depression, Postpartum - therapy; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Diagnosis; Diagnosis, Differential; Drug Therapy, Combination; Evidence-Based Medicine; Female; Humans; Hypomania; Lithium - adverse effects; Lithium - therapeutic use; Mass Screening; Medical sciences; Mood disorders; Postnatal depression; Postpartum depression; Postpartum hypomania; Postpartum women; Pregnancy; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Recurrence; Screening; Treatment; Bipolar disorder; Postpartum hypomania; Postpartum depression; Treatment; Assessment; Human; Mood disorder; Evaluation; Depression; Review; Maternal diseases; Puerperium; Woman
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2009.09.014

Abstract Objective This paper critically reviews the current literature on the detection, diagnosis, and treatment of bipolar II postpartum depression. Method A Pub-Med search (1998–2009), using the search terms ‘postpartum depression’, ‘postpartum depression AND screening/detection/diagnosis/treatment’, ‘bipolar I AND postpartum depression’, ‘bipolar II AND postpartum depression’, ‘postpartum hypomania’, and ‘postpartum hypomania AND screening’, was carried out. The reference lists of articles identified were also searched to select other relevant publications. Results Brief hypomanic symptoms occur in the early puerperium in approximately 15% of women. Despite preliminary evidence that postpartum depression in some patients may be a manifestation of bipolar II disorder or bipolar disorder NOS, there are no screening instruments to differentiate unipolar from bipolar depression arising in pregnancy or the postpartum. Also lacking are evidence-based treatment options specifically targeted to treat bipolar II postpartum depression. Conclusions Research into postpartum mood disorders has focused primarily on major depressive disorder, bipolar I disorder, and puerperal psychosis, and has largely ignored the study of bipolarity beyond bipolar I disorder. The clinical and research implications of the misdiagnosis of bipolar II depression as major depressive disorder in the postpartum period are discussed.