What’s My Diagnosis? Karen Kleiman Explains the Connection between Postpartum Depression and Bipolar Illness

Karen Kleiman, MSW, LCSW is the author of several books and articles on postpartum depression, and has over 25 years of experience treating prenatal and postpartum mood and anxiety disorders in her practice, the Postpartum Stress Center. Her work has been featured in numerous magazines, and on many radio and television shows. To read her original article entitled “Postpartum Depression and Bipolar Illness: What’s the Connection?” click here. To learn more about postpartum depression, check out her blog on psychologytoday.com, “This Isn’t What I Expected.” To learn more about her work and the Postpartum Stress Center, check out their website here. Take a look!

You’re the Founder and Executive Director of the Postpartum Stress Center, and you’re recognized as an international expert on postpartum depression (PPD). How did you get into this field of study, and what makes you passionate about it?

“When my children were born over 30 years ago, I noticed how many women weren’t feeling good after they had their baby. I started researching this phenomenon, since so little was known about it. I did not have postpartum depression, but I was in contact with new mothers and soon realized that the needs of many postpartum women were falling through the medical cracks.”

A recent study that you cite in your article “Postpartum Depression and Bipolar Illness: What’s the Connection?” states that bipolar disorder is often misdiagnosed as major depressive disorder during the postpartum period. Do you think there are many individuals in the postpartum period for whom their diagnosis has been incorrect?

“A study by Sharma and colleagues (Sharma, Khan, Corpse, Sharma. Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disorder 2008;10:742-747) found that 54% (N=56) who had diagnosed with postpartum depression were later found to have bipolar disorder. That’s a high number! So it’s important that people are informed and make sure they are disclosing the nature of their symptoms and the extent to which they are suffering, to their healthcare providers.”

Can you explain some of the subtler differences between symptoms of bipolar illness in the postpartum period and PPD?

“All postpartum patients should be screened for symptoms of mania and hypomania. At The Postpartum Stress Center, we use the MDQ (Mood Disorder Questionnaire). One of the diagnostic

challenges is that it can be difficult to distinguish between hypomanic symptoms and the euphoria that can accompany new motherhood. This is why screening and a comprehensive assessment is essential. It is important to rule out hypomania, especially during the very early postpartum days and weeks. Symptoms may include extreme talkativeness, racing thoughts, a decreased need for sleep, extreme distractibility. Individuals should also be asked about a family history of bipolar disorder.”

How can individuals in the postpartum period advocate for their own best healthcare?

“Be informed. Find the names of reputable experts in the field and follow their work. Do not settle for healthcare providers who may dismiss your reports of distress or who may patronize you with platitudes. It is not okay for you to suffer because of someone else’s misguided information. If you think something isn’t right, find someone you trust and let them know. If you don’t like the way they respond, find someone else who has specialized training in the treatment of maternal mental health.”

Your first book, This Isn’t What I Expected: Overcoming Postpartum Depression, co-authored by Dr. Valerie Davis Raskin, was groundbreaking in the market of self-help books on postpartum depression. What advice can you give to new parents who’ve been diagnosed with PPD? How is that advice different for new parents who’ve been diagnosed with bipolar illness?

“The advice is the same. Accept the diagnosis as something real and treatable. Try not to let feelings of shame or guilt complicate the clinical picture. Perinatal mood and anxiety disorders are real and they respond well to treatment. Ways to help augment your treatment include: rest, proper nutrition, gentle exercise, sunshine, avoid alcohol, avoid caffeine, avoid people or things that make you feel bad right now, fortify your support network, ask for help, accept the help when offered.”

Buy This Isn’t What I Expected: Overcoming Postpartum Depression here.

Find her booklist here.

Research on the relationship between postpartum depression and bipolar illness is ongoing; what do you hope to see in the coming years in this field of study in terms of understanding and awareness?

“My hope is that both patients and members of the medical community continue to be educated in symptoms and presentations that make perinatal (pregnant and postpartum) disorders unique. The nuances that manifest during this challenging time in a person’s life, can be hard to recognize for the untrained professional, because there are so many emotional and physical changes during pregnancy and the postpartum period. Individuals are suffering longer than they have to. Differential diagnosis is needed to insure that proper treatment is received. Early and appropriate intervention will augment recovery and healing.”

On behalf of Psych2Go, I’d like to thank Karen Kleiman for this informative interview! Definitely check out her blog and her website for more information!