Q: Bipolar Symptoms Developing after Birth of a Child?
I was wondering if you had ever seen bipolar symptoms develop after birth of a
child? My mother was dx w/bipolar in the early 70's after my birth.
Her previous birth of my brother created postpartum depression. My family is
concerned about me having children, and developing bipolar. I would ask my
mother but she died last year. Plus my parents divorced and they did not get
along at all, so I partially question her diagnosis as correct. My father says
she was fine before birth. I have a masters in counseling and in my work had
never seen, heard of this. Although I no longer practice I wondered if you had
some information for me.
Thank You for your time.
Dear Rachel --
Post-partum onset of mood symptoms is actually quite common, as you know,
namely "post-partum depression." However, it is not so widely recognized that
postpartum depression is a marker for bipolar disorder. Not everyone with
postpartum depression has bipolar disorder of course; but that timing of onset
raises the probability that a person's depression is actually "bipolar". Since
plain old "unipolar" depression is more common than bipolar depression, this
shift is a moderate statistical change. Technically, using the most recent
epidemiologic study in the United States, the shift in probability is roughly
from a one in four chance that a depression is "bipolar depression", to
something more like a one in three chance. Obviously these figures are very
rough, but that gives you an idea of the ballpark we are in here.
In my experience, developing bipolar symptoms "out of the blue", after
delivering a child, is not very common. Much more frequently, women have had
some degree of symptoms before giving birth, and then find a symptoms are more
prominent afterward. I have a working hunch (i.e. preceding your note) here
that this is more likely after the second child than after the first; as though
each pregnancy is a kind of sensitization experience (but it does not seem to
get worse after the second, just after the first. This is just my clinical
observation, I have never seen anything about this in print).
The main point in that last paragraph: if you have no mood symptoms now, no
sense of "mood swings", I think that lowers the likelihood that pregnancy is
going to have some impact on your mood stability. On the other hand, if you
already have a fairly noticeable capacity to have mood swings, then your risk is
probably somewhat greater that these will be worse after pregnancy.
Unfortunately, nothing in my business comes with a guarantee or a firm
You have a certain degree of risk based on your mother's diagnosis of bipolar
disorder. I have never seen anyone publish a statistical assessment of a
persons risk, given a first-degree bipolar relative, based on his or her gender
-- let alone based on how many pregnancies you have had or are contemplating
having. The point there is that if there was a really substantial change in the
risk of having symptoms, for a person who is symptom free now and contemplating
pregnancy, I think someone would have written something about that. So, not
seeing such an opinion anywhere is perhaps a slight reassurance for you.
Conversely, I have definitely seen people write that it is a mistake, even
unethical in a sense, to encourage women who have bipolar disorder not to have
children. Usually this is a warning that the potential risk to the child of
developing bipolar disorder, because of the genetic risk, is not high enough to
warrant discouraging the parent. Again, in such discussions, I've never seen
anyone raise the issue of the risk to the mother of worsening her
already-diagnosed bipolar disorders.
I hope this makes sense. I'm trying to reassure you as much as possible
without offering any degree of false reassurance. The problem is, we just don't
have enough data on all this. I suppose you could wonder out loud with your
father and your partner/husband: suppose someone could give you a 100%
probability that you would develop bipolar symptoms if you become pregnant.
Would you choose not to? Suppose that probability was 80%? Or 50%? Does it
really make any difference what the probability is? If you find that sure
enough, the percentage really does matter, then you might want to get even more
specific than this informal question-and-answer exchange we are having here.
The extreme in that respect would be to contact the "reproductive psychiatry"
clinic at Massachusetts General Hospital, led by Dr. Lee Cohen and his wife (he
is a psychiatrist; she is an obstetrician/gynecologist) and ask for a
consultation, bringing this question. If you have the means for such a
consultation, see if you can find out in advance whether they really have much
of an answer for you, before you commit to it.
Good luck with all that --
Published November, 2008