Postpartum diagnostic switches likely in depressed women

By Eleanor McDermid, Senior medwireNews Reporter

Women with major depression should be monitored for emerging symptoms of hypomania during the postpartum period, say researchers.

The team led by Verinder Sharma (Western University, London, Ontario, Canada) found that rates of switching to a bipolar II disorder at this time were around 11- to 18-fold higher than reported in nonpostpartum women.

“Given the relatively high rates of diagnostic switching, it is important that women with a prior history of depression should be assessed for emerging symptoms of postpartum hypomania,” they write in Bipolar Disorders.

“As women are in frequent contact with healthcare professionals at this time, the early postpartum period should serve as an opportune time for the early diagnosis of, and initiation of optimal treatment for, bipolar disorder.”

However, Sharma et al warn that bipolar II disorder often goes unrecognized in women after childbirth. They also highlight the risks associated with antidepressant use in patients with bipolar disorder and advise that all women be screened for hypomanic symptoms before starting on antidepressants.

There were 92 women with major depression in the study. None converted to a bipolar II diagnosis during pregnancy, but six (6.5%) did so within 6 months of giving birth. Five (5.4%) of these conversions occurred within the first 3 months.

Annual conversion rates among men and nonpregnant women are reportedly around 1%, so the 3- and 6-month postpartum rates in the current study are markedly higher, says the team.

The only factor that differed between women who did and did not convert was family history of bipolar disorder, which was present in 66.7% of women who converted compared with 22.1% of those who did not.

About 20% of the women were taking antidepressants at the time of delivery, but this was not associated with the likelihood for converting.

“This means that childbirth-related biological processes rather than external factors are causally linked to the diagnostic conversion in the immediate postpartum period,” suggest the researchers.

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