If you have bipolar disorder, it may get worse after you have a baby, and you may experience postpartum bipolar disorder symptoms. Psychotherapy, medications, and lifestyle strategies can help.

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Bipolar disorder is a mental health condition that causes unusual shifts in energy, activity levels, and mood. Periods of elevated, agitated energy are known as mania or hypomania, while periods of low mood and energy are called depressive episodes.

Several types of bipolar disorder exist, including bipolar I disorder, bipolar II disorder, and cyclothymia. The type of type of bipolar disorder diagnosis you receive will depend on which mood episodes you experience and how severe they are.

If you receive a bipolar disorder diagnosis during the recovery period after giving birth, it’s known as postpartum bipolar disorder.

Learn more about bipolar disorder.

According to diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), “postpartum bipolar disorder” is not a formal diagnosis. Postpartum bipolar disorder is bipolar disorder — it just occurs during the postpartum period.

Your official diagnosis according to the DSM-5-TR would be bipolar disorder (type I, type II, or cyclothymia) with a specifier of “with peripartum onset.”

Specifiers are unique diagnostic labels that help add insight into a diagnosis. “Peripartum” refers to the prenatal (before birth) and postpartum (after birth) time frames.

Postpartum bipolar disorder features the same primary symptoms related to mood and energy as other types of bipolar disorder.

Symptoms of manic episodes can include:

  • a decreased need for sleep
  • restlessness or increased activity levels
  • rapid speech
  • racing and swiftly changing thoughts
  • impulsivity
  • increased risk-taking
  • agitation or irritability
  • feelings of euphoria or self-importance
  • a tendency to indulge in pleasurable activities

Hypomania features less severe manic symptoms over a shorter period of time.

Symptoms of a depressive episode can include:

  • intense feelings of sadness or despair
  • inappropriate guilt
  • loss of interest in almost all self-motivated activities
  • sleep disturbances
  • appetite changes
  • low energy or fatigue
  • lack of concentration
  • slowed speech or movement
  • difficulty concentrating
  • suicidal ideation

Are there unique symptoms in postpartum bipolar disorder?

Time of onset isn’t the only distinguishing feature in postpartum bipolar disorder.

According to Amy Braun, a licensed clinical professional counselor and certified perinatal mental health therapist from Naperville, Illinois, the relapse rate and symptom presentation can be unique as well.

“Bipolar disorder has a very high relapse rate during the postpartum period,” she explained. “[It’s also] often called the ‘postpartum depression impostor,’ as it mostly presents with depressive symptoms first rather than mania or hypomania.”

One research review from 2022 found that the overall risk of postpartum bipolar disorder relapse was 36.77% among women who had previously received a bipolar disorder diagnosis.

Additionally, in a small 2007 study of 89 pregnant women who had bipolar disorder, about 70% of the participants experienced a recurrence of symptoms at some point during pregnancy. The risk of recurrence was higher in those who stopped taking medications for bipolar disorder during pregnancy.

“Most importantly, healthcare providers should be aware that psychosis occurs in 20–30% of women with known bipolar disorder during the postpartum period, which poses a huge risk,” Braun added.

A 2018 research review notes that women who have a previous diagnosis of bipolar disorder have a higher risk for postpartum psychosis and postpartum depression after giving birth.

Language matters

You’ll notice we use the binary term “women” in this article. While we realize this term may not match your gender experience, this is the term used by the researchers whose data was cited. We try to be as specific as possible when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data for or may not have had participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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The exact causes of bipolar disorder aren’t fully understood, but pregnancy isn’t the only cause. Changes in the brain’s function and structure, genetics, and environmental factors are all thought to play a role in the development of bipolar disorder.

“Pregnancy itself does not cause bipolar disorder,” said Braun. “However, pregnancy and the postpartum period can trigger the onset or reoccurrence of bipolar symptoms in those who are predisposed to the disorder. Predisposing factors include hormonal changes, sleep disruptions, stress, genetics, lack of support, and other environmental stressors.”

Postpartum bipolar disorder treatment involves psychotherapy, medication, and lifestyle strategies that promote overall well-being.

Psychotherapy, also known as “talk therapy,” uses different frameworks to help you identify and change unhelpful thought patterns while building beneficial coping strategies. Cognitive behavioral therapy and interpersonal therapy are two common psychotherapy approaches used for bipolar disorder.

Medications such as mood stabilizers or antipsychotics can help relieve symptoms related to mania and depression, though special consideration is needed when bipolar disorder occurs in the postpartum period.

“The majority of women with postpartum bipolar disorder are misdiagnosed with unipolar depression, which causes long delays to getting proper treatment,” said Braun. “Misdiagnosis can also be dangerous because prescribing an SSRI [a type of antidepressant] alone can induce cycling into mania.”

She added that postpartum bipolar disorder medications may also vary depending on whether a person is nursing.

A previous diagnosis of bipolar disorder increases your risk of experiencing a bipolar disorder relapse during the postpartum period.

Other risk factors that increase your chances of developing bipolar disorder in general include:

  • childhood trauma
  • occurrence of bipolar disorder in a first-degree relative
  • major life changes or extreme stress
  • substance misuse
  • the presence of another mental health condition

It might not be possible to completely prevent postpartum bipolar disorder, but you may be able to reduce your individual risk by:

  • going over your risk factors with your doctor
  • participating in preconception counseling and counseling during pregnancy
  • keeping up with your current bipolar disorder treatments and medications
  • visiting a doctor regularly to monitor your mental and physical health
  • having a support system in place for after birth to help ease your stress load
  • starting beneficial lifestyle changes before pregnancy

Bipolar disorder is a chronic, lifelong condition, regardless of when symptoms first emerge. But with treatment and effective management strategies, you can experience periods of remission — weeks, months, or even years when you’re fully or partially free of symptoms.

Overall, bipolar disorder is considered a highly recurrent condition, although estimates of the recurrence rate vary.

One 2023 study involving 2,649 people with bipolar disorder in the United Kingdom found that 25% of the participants had a relapse of symptoms in a 5-year period. Older studies cited in a 2017 review suggested that up to 75% of people experience a relapse within 5 years and that 90% may experience one in their lifetime.

Finding help if you have postpartum bipolar disorder

If you think you or a loved one may be experiencing postpartum bipolar disorder, you can learn more or find local resources in your area by contacting:

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At what age does bipolar disorder start in females?

Regardless of gender or sex, the average age of onset for people with bipolar disorder is their mid-20s.

What is postpartum mania?

Postpartum mania is a period of extremely elevated energy and mood. This is a common indication of the onset of bipolar disorder.

What does untreated bipolar look like?

Untreated bipolar disorder can appear as severe periods of mood instability and changing energy levels. In addition to depressive and manic episodes, it can feature symptoms of psychosis, substance misuse, and a decline in physical health. These changes can cause difficulties in functioning at work, in school, or in relationships.

Postpartum bipolar disorder is bipolar disorder that relapses or begins soon after you give birth. It often causes depressive symptoms first and is sometimes misdiagnosed as postpartum depression.

While you may not be able to completely prevent postpartum bipolar disorder, you can manage your risk by working closely with a doctor and being proactive about your mental and physical well-being.