Post-Partum Manic Episode
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Q:  Post-Partum Manic Episode

I was diagnosed with OCD at age 22 and have have prolonged depressive periods.  Now at age 39, 2 months after my father died (I was hospitalized for suicidal intentions), my first child was born prematurely at 28 weeks of gestation, probably due to the stress I was under.  A week after she was born I was extremely joyful that God was keeping her alive and answering everyone's prayers for the baby.  This turned into a manic episode with childlike behavior, giddiness, not sleeping, too much energy etc and a couple of possible hallucinations.  My question is, what is the likelihood that I will have a repeat episode of mania.  My psychiatrist of 17 years has rediagnosed me with Bipolar type 2. Since this manic episode was so tied in with pregnancy and hormones etc., will it be repeated?

Dear Susan - 
There's an obvious and important question -- and one which we don't really have the information we need to answer (or at least I don't from what I know from the psych' literature).  We know, for example, that in bipolar disorder, 50% of women will have a post-partum depression; and that post-partum psychosis is commonly associated with bipolar disorder, as much as 80% of the time.  But we don't have that kind of information "in reverse": for a person who has not had mania before onset after childbirth, what is the prognosis?  

Certainly there are patients who have manic symptoms when given an antidepressant, who won't have them again if they're not given an antidepressant again, at least over the kinds of periods of observation we generally get with patients, like on the order of 10 years or so (before they move or we do, that is).  And the hormonal shifts of pregnancy and delivery are certainly capable of inducing mood symptoms, so if you didn't go through that again (not knowing your plans there), it seems by extension of the antidepressant story that you might not have this again either.  You can see how rickety this "inferring our way to an answer" is.  

A mood and pregnancy expert like Lee Cohen at Harvard; or even a psychiatrist with extensive experience treating women through deliveries, could certainly have more "clinical experience" (as opposed to research data) to help answer your question.  My guess, very much a guess, but based on your previous symptoms ("OCD" and repeated depressions -- for which you were treated, I would guess, with antidepressants?), is that over time you'll see some "manic" symptoms that may merit treatment with mood stabilizers, and caution with antidepressants -- but I hope in any case that things go a lot smoother an that you are able to enjoy your new baby as much as every other new mother. 

Dr. Phelps

Published September, 2001


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