Postpartum Bipolar Disorder: Symptoms, Diagnosis, and Treatment

Just like bipolar disorders that occur in other contexts, postpartum bipolar disorder includes both depressive and manic symptoms, and sometimes psychosis, which can occur at separate times or at the same time. Either symptom type can show up first in postpartum bipolar disorder.

Depressive Symptoms

Postpartum bipolar 1 and 2 disorders have a major depressive episode embedded, says Misty Richards, MD, a reproductive psychiatrist at UCLA Health in Los Angeles. According to Cleveland Clinic, symptoms of major depressive episodes that are part of bipolar disorder include:

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Feeling sad, empty, hopeless, tearful, or down
Loss of interest or pleasure in most activities
Unintended changes in weight or appetite
Changes in sleep patterns, including insomnia and oversleeping
Acting restless or super slow
Not having energy or feeling tired
Feeling worthless or guilty
Difficulty thinking, focusing, or making decisions
Having thoughts of hurting yourself (including suicidal ideation)

Telling the difference between typical postpartum experiences and signs of a depressive episode of postpartum bipolar disorder can be difficult, says Dr. Richards. For example, she notes that some degree of fatigue is normal when someone is building or supporting a baby.

But there may be features that set the depression of postpartum bipolar disorder apart from stand-alone postpartum depression, research suggests. Agitation may be one aspect, which Richards describes as a “carbonated depression.”

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Manic and Hypomanic Symptoms

“Bipolar 1 has manic episodes that are really hard to miss,” says Richards. But the hypomanic symptoms of bipolar 2 are more subtle and easier to overlook, she notes.

Per Mayo Clinic, signs of both manic and hypomanic episodes include:

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Feeling unusually upbeat, jumpy, or wired
Increased activity, energy, or agitation
Feeling euphoric, like everything is great and you’re great
Not sleeping, and not feeling like you need to
Abnormal talkativeness
Racing thoughts
Distractable
Acting recklessly or impulsively

As with depressive symptoms, it can sometimes be difficult to tell the signs of mania and hypomania apart from healthy excitement at welcoming a new life into your home. But the increased energy and activity characteristic of bipolar disorder isn’t just about having a productive Target trip where you knock five items off your list, clarifies Richards. “It’s like, ‘I’m going to go to six different Targets and get 70 different things,’” she says.

Psychosis

Postpartum bipolar disorder is also linked with postpartum psychosis, a serious condition impacting around 5 in 1000 women, according to a review of the research.

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Postpartum psychosis can be freestanding, but in the majority of cases, it is part of a postpartum bipolar disorder episode, says Osborne.

When someone experiences postpartum psychosis, they may have intense symptoms like hearing voices, hallucinations, and extreme paranoia or suspicion, per the APA.

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While normal postpartum sleep deprivation can lead to odd experiences, such as occasionally thinking you hear your baby crying when they’re fast asleep, psychosis is a step beyond the ordinary. It may include false beliefs and unusual behavior, says Osborne. For example, if you’re repeatedly hearing your baby’s cries, and you go check on the baby and the baby’s not crying, but you can’t quite believe that’s true, that’s a problem, she says.

Likewise, Osborne says that if you hear something else that isn’t related to what you would expect, such as a voice telling you to do something, that would be a sign of psychosis.

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