Bipolar Manic After Delivery

rn/writer, RN · Oct 15, 2007

I'd venture to guess that most of these patients have chosen to go off their meds while pregnant. In that case, whatever would be happening to them if they were not BP would be exaggerated. The natural high of having a baby would overreach into mania. And you're correct in thinking that the normal "baby blues" could extend as well into severe postpartum depression.

We strongly encourage our patients with psych history to see their psych caregivers ASAP after the birth and caution them and their family members to be on the lookout for warning signs. We remind them that hormonal changes can affect mood, perspective and behavior and that it is very important that they build a supportive framework of people they trust who can monitor them for changes in affect and behavior and take action if they see questionable or disturbing things.

Patient teaching can and should address known psych issues--the needs for meds, danger signs, information on shaken baby syndrome, how to ask for help, and anything else that seems pertinent. All moms should be told about pp depression and how to seek out assistance, but this is absolutely critical in patients who have a history of psych issues. I make special notation of this kind of teaching on our regular teaching sheets and document that they were encouraged to set up an appointment (with their psychologist or NP or whomever they have seen in the past regarding meds) before they are discharged. If they don't have anyone or they weren't happy with their previous provider, they are much more like to follow through on getting care if we can provide a referral while they are still in the hospital.

This is an extremely important concern. Thank you for bringing it up.

Elvish, BSN, DNP, RN, NP · Oct 15, 2007

I have noticed this too, and do teach moms (and their families) how to recognize sx of either end of the spectrum. A big part of it is that I struggled with PP depression myself and do not want anyone else to go as long as I did without help.

It's so easy for moms to be wrapped up in resting and/or caring for their new baby that they don't recognize the sx in themselves that they are desperately ill and need tx. My son's PNP pointed it out to me 4-5 months out, and said point-blank, "You have postpartum depression, and you need to get help NOW." I am forever grateful to her.

Very good thread.

Jolie, BSN · Oct 16, 2007

I can recall 2 patients who were taken off their bipolar meds during pregnancy who exhibited obvious symptoms of mania during their post-partum stays. Both had healthy term babies and were motivated to "get well" so that they could take care of their babies at home. Both voluntarily signed themselves into psych upon their PP discharge. What left the greatest impression on me regarding these women was that despite significant manic episodes, they were able and willing to recognize their need for treatment, an insight your "average" manic patient will often not have. I don't know if it has anything to do with a "maternal" instinct, but it was gratifying to see them accept treatment and go home able to care for themselves and their children.

magz53 · Oct 16, 2007

I have seen mania in a pt. with NO previous history. We need to remember that bi-polar disorder is a BIOLOGICALLY based illness that is affected by stress, hormones and other physical factors.

My daughter recently had a very traumatic delivery....long story but the final straw was the spinal wore off during her repair. I was very impressed when her baby's pediatrician told her that because of her traumatic delivery, she was at high risk for postpartum depression and that SHE ( the pediatrician ) would be watching her for signs and symptoms as she would be seeing her more frequently than her OB. Thankfully, she is ok. It was nice to know that professionals are more aware of these problems today than when I had my children.

allnurses Guide · Oct 16, 2007

I didn't actually have this woman as a patient but she is bi-polar and was on her meds for her pregnancy. Then was told to go off her meds if she wanted to breastfeed or else don't breastfeed.

Her husband called me in a panic when they went home. His wife was very upset, had gone off her meds so she could breastfeed. He said if she didn't get to breastfeed, it would kill her and yet, she needed her meds.

I emailed Dr. Thomas Hale ("Medications and Mother's Milk) and he actually called me back in a short period of time. He said it was ok for her to go on her psych meds and breastfeed. Sent me the research. He is a nice man with a slight Texas twang.

I called the patient's ob/gyn . . an old cowboy sort. He initially was mad at me but he coudn't refute the evidence and this poor woman was likely to hurt herself or even the baby if she didn't get to breastfeed and go on her meds.

So, back on her meds she went. Breastfed for a year or so. I see her son often, who is about 5 now. Cute kid. She and her husband (especially her husband) are grateful.

steph

Jo Dirt · Oct 24, 2008

I have noticed over the years that women diagnosed with bipolar disorder are manic the first couple of days after delivery. These pts are on the light all night despite sending baby to the nursery and dad asleep at bedside. benadryl, vistaril, ambien....nothing seems to affect them. have any of you seen this trend too?? everything online i've read is about the increased risk for depression and postpartum psychosis i guess thats when they cycle through.

Well, I have been diagnosed as bipolar and with my last baby the nurse kept saying she wished all her patients were like me. I never used the call light and the only time I got a pain med was when it was offered, and several times they offered and I turned it down.

I guess I'm tooting my own horn, but I was a pretty good patient.

elizabells, BSN, RN · Oct 28, 2008

I had a pt on my psych rotation in nursing school who had voluntarily committed herself during her pregnancy after her OB told her she had to go off her meds. She was very pleasant, if clearly hypomanic. I was told that lithium is the only bipolar med that can be taken during pregnancy, and if a pt can't tolerate it, they're kind of SOL. We also have a woman on our high-risk AP floor right now for PPROM who is schizophrenic but still on her meds. I don't know if those are okay to take, or if it was determined that the risk of going off them was too great.