January 29, 2023

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Prevalence of Bipolar Disorder and Bipolar-Spectrum Mood Episodes During Pregnancy and the Postpartum Period in Perinatal Women

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Prevalence of Bipolar Disorder and Bipolar-Spectrum Mood Episodes During Pregnancy and the Postpartum Period in Perinatal Women

The perinatal time period is a critical time to screen and address psychiatric illness among reproductive-aged women of all ages. The consequences of untreated psychological health issues in the perinatal time period are profound and large-reaching, ranging from the reduction of interpersonal and fiscal methods to maternal and infant mortality and morbidity. Growing awareness has been compensated to perinatal mood and anxiety diseases (PMADs), these as postpartum melancholy and postpartum anxiousness however, it may perhaps be time for clinicians to turn towards more nuanced ways to perinatal mental wellness treatment that incorporate screening for bipolar condition and bipolar-spectrum mood episodes alongside with major depressive ailment (MDD). In reality, evaluating for postpartum melancholy devoid of also screening for (hypo)mania may possibly outcome in misidentification of postpartum mental health issues. 

Preceding scientific tests have demonstrated that between women with bipolar ailment (BD), there is a greater threat for postpartum psychosis. Nevertheless, considerably less is identified with regards to unipolar despair vs . bipolar condition in gals presenting with depressive indications. A latest assessment and meta-assessment is a critical appear into the prevalence of bipolar dysfunction in the perinatal period of time. For this assessment, the authors recognized posts in English that provided populations of perinatal gals (pregnant or in the to start with calendar year postpartum) who had been 18 yrs or older and who had done a screening or diagnostic device for bipolar problem.  The evaluation included 22 research as part of the qualitative evaluate and 12 for the meta-examination. 

The review identified that upwards of 20% of women with no heritage of psychiatric ailment knowledge their 1st bipolar-spectrum temper episode (which include despair, hypomania/mania, or mixed temper) through the perinatal time period.  In ladies with no regarded psychiatric ailment in advance of being pregnant, the pooled prevalence of BD was 2.6%. Conversely, for females with earlier diagnosed BD, 54.9% had been found to have at the very least 1 bipolar-spectrum mood episode throughout the perinatal period.

The authors highlight a number of inquiries these putting conclusions raise: “Does this then mean that the peripartum period confers about a 7-fold increased threat for precipitating a initial life time presentation of bipolar disorder? Or, that an astonishingly large 1 in 5 depressed pregnant or postpartum women might truly manifest signs of bipolar disorder? Or, that the wide vast majority of ladies with preexisting bipolar dysfunction may well have long gone unrecognized or completely undiagnosed prior to being pregnant and delivery?” 

We do not however have answers to individuals inquiries having said that, this vital overview sheds light-weight on the substantial prevalence of mood episodes in the generally vulnerable and sophisticated peripartum time period. Furthermore, this work highlights the will need for further more investigation into the existing screening and therapy pathways and choices for determining underrecognized perinatal mood ailments like BD. For women of all ages with earlier identified BD, proof-based scientific care that consists of ongoing treatment with medicines and treatment is usually critical. There continues to be analysis on temper stabilizers taken all through the perinatal period these kinds of as lamotrigine and lithium. Having said that, there has not been posted literature analyzing the longitudinal program and therapy of perinatal patients with depressive symptoms who may in fact have BD. 

Amidst this vital critique about the prevalence of BD, it is significant to think about the diagnostic confusion of MDD as opposed to BD specially supplied the DSM-5 construct of MDD with blended functions. Alternatively than the distinct and opposite poles of melancholy and mania, it may be beneficial to change towards a scientific continuum that displays the spectrum inside of mood conditions. On top of that, it is vital to dissect how substantially the prevalence of BD from this overview represents treated compared to untreated ailments and the class of medicine clients may possibly be having. In the end, this assessment really should warn clinicians to the prevalence of despair together with (hypo)mania in peripartum mental overall health screening and therapy – even though highlighting caveats linked to the accuracy of diagnosing perinatal temper conditions and the important want for more exploration to realize the phenomenology of psychiatric problems in the peripartum.

Margaret Gaw

Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N. Prevalence of Bipolar Disorder in Perinatal Women of all ages: A Systematic Overview and Meta-Examination. J Clin Psychiatry. 2022 Jul 1383(5):21r14045. doi: 10.4088/JCP.21r14045. PMID: 35830616. https://pubmed.ncbi.nlm.nih.gov/35830616/

Freeman MP, Goldberg JF. The Pursuit to Understand Bipolar Condition in Pregnant and Postpartum Girls. J Clin Psychiatry. 2022 Jul 1383(5):22ed14399. doi: 10.4088/JCP.22ed14399. PMID: 35830617. https://pubmed.ncbi.nlm.nih.gov/35830617/

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