Can bipolar depression get worse after pregnancy?

Question

Hello doctor,

My 28-year-old daughter has been struggling with bipolar depression for four years, and nothing seems to work long-term. She tried lithium, which gave her terrible tremors and caused her thyroid to stop working, and then Depakote, which made her gain 40 pounds in six months. Now she is on Lamotrigine 200 mg twice daily and Quetiapine for sleep, but she still has depressive episodes that last for weeks.

The manic episodes are less frequent, but when they occur, she spends all her money and makes terrible decisions. She was doing okay until she had her baby eight months ago, but postpartum depression triggered the worst bipolar depressive episode she has ever had. She cannot take care of the baby on her bad days, and I am worried about her safety because she sometimes talks about not wanting to be here anymore.

Her psychiatrist recently added sertraline, but I am afraid it might trigger mania. She stopped breastfeeding because of all the medications, but feels very guilty about it. Can bipolar depression get worse after pregnancy? Is electroconvulsive therapy a safe option for her?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

As a parent, it must have been difficult for you, and I can understand it. Bipolar disorder is a disorder that has a high recurrence rate, which makes it challenging to manage.

Pregnancy is a big risk factor for many psychiatric illnesses, and bipolar disorder is one of them. Postpartum is the highest risk period for bipolar disorder recurrence.

ECT (electroconvulsive therapy) is a good, safe, and effective option in bipolar depression. There is a stigma associated with it; otherwise, it is very safe. Mild amnesia can occur after ECT, typically resolving within a day.

She should also be screened for rapid cycling disorder, which is a type of bipolar disorder in which four or more episodes occur in a year, and the management protocol is different. Therefore, keep an eye on the number of episodes per year.

Suicide is also a big red flag in bipolar disorder and must be continuously monitored. Please consider CBT (cognitive behavioral therapy) as it is very effective, long-term, and safe. Remember, we can not manage psychiatric illnesses just by adding more and more medicines. We need to address stressors, develop effective coping strategies, and engage in family therapy.

Psychosocial stressors are often the maintaining factors and cause relapse. Sleep is another important biological component that can cause a relapse. Therefore, strict sleep-wake cycles are important. Thyroid profile should be repeated and kept a strict eye as its fluctuations can cause depressive and manic symptoms.

Highly expressed emotions shown by the family are also a big risk factor for relapse. Therefore, identify these, e.g., harsh comments or overprotectiveness. Therefore, the role of family therapy is vital. I will advise ECT, continue the same medications, Thyroid profile, identify stressors, maintain factors, work on stressors, family therapy, and CBT.

CBT will be a very good option to work on her guilt, dysfunctional thoughts, and dysfunctional behaviors, and it can reduce the risk of relapse many times.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.