Bipolar II Postpartum Depression
Many postpartum mood disorders are depressive episodes of bipolar disorder, rather than unipolar major depression. Sharma et al. (p. 1217) recommend that clinicians ask all pregnant women about personal and family history of bipolar disorder. This history can help identify postpartum bipolar episodes, as can assessment of manic and hypomanic symptoms in women with postpartum depression. Research provides few guidelines for pharmacotherapy specific to the postpartum period. Carbamazepine and valproate are considered compatible with breastfeeding, but nighttime breastfeeding may lead to sleep deprivation, a possible trigger for bipolar episodes. Antidepressant monotherapy should be avoided. Genetic and clinical aspects of postpartum mood disorders are examined further by Dr. Susan Hatters Friedman in an editorial on p. 1201.