What is Postnatal/Postpartum Depression?
Postnatal depression, often misdiagnosed as chronic stress or bipolar depression, is one of the most common forms of depression encountered by women all across the world. Women go through mild to extreme depressive disorder after giving birth. The depression starts immediately after the delivery and it may last from 3 months to 1 year, if treated properly (Cohen et al., 2010). In case of wrong treatment or misdiagnosis, the depression may last for several years. A woman in a depressive state can develop suicidal tendencies or can harm her child. Therefore, timely diagnosis and right treatment is very important.
Misdiagnosis of Postnatal Depression
The postnatal period is characterized by extreme mood swings. According to a research article by Ritchie et al. (2010), the bipolar depression encountered by women during the postnatal period is often misdiagnosed as major chronic depressive disorder. According to this research, it is true that initial symptoms of bipolar II in postpartum depression are very much similar to those of unipolar major depressive disorder. However, the treatment, medication and therapies for both of these disorders are different from each other. Misdiagnosis of postnatal depression not only delays the treatment, but wrong therapies and medication also worsen the situation. According to Cohen, delayed treatment of postnatal depression can cause severe psychological disorders.
Differences between Postnatal and Bipolar I Depression
Contrary to the normal perception that only bipolar I is included in bipolar disorder spectrum, bipolar II is also a type of major bipolar disorder. However, the treatment and symptoms of both bipolar disorders are different. In postnatal period, women show signs of bipolar II disorder which is characterized by frequent episodes of mild to extreme hypomania and depression. On the other hand, the main symptoms of bipolar I are extreme mania and depression. From the modern researches the depressive state during postpartum period is declared as the psychological order closest to bipolar II. The symptoms of postnatal depression do not meet the criteria defined for bipolar II in DSM (Diagnostic and Statistical Manual of Mental Disorders) IV (Hirschfield, 2000).
According to a research conducted by Merikangas et al. (2007), postpartum depression is considered as the combination of major depressive disorder, puerperal psychosis, bipolar II and mania. The symptoms of hypomania shown by women during postnatal period can be misunderstood as mania or chronic stress and this is the reason that 54% of the women suffering from postnatal depression are often misdiagnosed with other common depressive disorders (Sharma et al., 2010).
Negative Effects of Misdiagnosis
According to the research conducted by Burt et al. (2009), women suffering from postnatal depression often recover wrong treatment. This is because the hypomania during postnatal period is mostly mistaken as major depressive disorder. Wrong diagnosis is followed by wrong medications and therapies, thus causing severe damage to mental stability. Here are some of the negative effects of misdiagnosis, discussed in the research study by Burt and colleagues:
Use of Antidepressants- Major depressive disorder is treated with antidepressants. However, in postnatal depression a women that shows the signs of hypomania and antidepressants cannot control hypomania. Hypomania or frequent mood swings can be effectively controlled by mood stabilizers. Extreme hypomania can cause other health problems like irregular blood pressure.
Blood Consistency- Antidepressants are blood thinners, and after delivery, thinning the consistency of blood can result in a prolonged or abrupt menstrual cycle.
Brain Hemorrhage- Severe hypomania can also cause brain hemorrhage or severe stress on the heart. If diagnosed at the initial stages, hypomania can be controlled by mood stabilizers and therapies, but misdiagnosis increases the probability of other psychological disorders like paranoid personality disorder.
For the right treatment of postnatal depression, timey diagnosis is important. According to Sharma et al. (2006), the treatment mainly involves therapies and counseling. Psychologists also rely on the use of mood stabilizers to control the frequency of hypomania episodes. According to psychologists, it is easier to control postnatal depression during early stages. Women go through postnatal depression period during the first year after delivery. Psychologists suggest that the first three months are most crucial and woman suffering from depression or frequent mood swings should immediately opt for screening test for postnatal depression.
Cohen LS, Wang B, Nonacs R, et al. (2003). Treatment of mood disorders during pregnancy and postpartum. Psychiatry Clinic North Am .33(2):273-93.
Hirst KP, Moutier CY. Postpartum major depression. Am Fam Physician . (2010). Oct 15;82(8):926-33.
Hirschfield RMA, Williams JBW, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr., Lew is L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J. (2000). Development and validation of a screening Instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.
Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Co-morbidity Survey Replication. Arch Gen Psychiatry 2007; 64:543–552.
Ritchie HL., Sharma V, Burt VK, (2009). Bipolar II postpartum depression: detection, diagnosis, and treatment. Am J Psychiatry; 166:1217-1221.
Sharma V, Smith A, Mazmanian D. (2006). The prevention of postpartum psychosis and mood episodes in bipolar disorder. Bipolar Disorder 2006; 8:400–404.
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Christie Hunter is registered clinical counselor in British Columbia and co-founder of Theravive. She is a certified management accountant. She has a masters of arts in counseling psychology from Liberty University with specialty in marriage and family and a post-graduate specialty in trauma resolution. In 2007 she started Theravive with her husband in order to help make mental health care easily attainable and nonthreatening. She has a passion for gifted children and their education. You can reach Christie at 360-350-8627 or write her at christie - at - theravive.com.