Managing bipolar disorder in the postnatal period

In most cases, the management of an acute episode of bipolar disorder in the postnatal period will require that women go to hospital, usually a psychiatric hospital to allow time for treatment to be provided in a setting where she and the baby are safe, and she can be monitored by health professionals.

Some psychiatric hospital settings have a mother and baby unit where a woman can stay with her baby as she stabilises. This is generally available to those with private healthcare, whilst easy access for those in the public system varies across Australian states and territories.

With time and effective treatment, the symptoms of bipolar disorder will begin to settle down and stabilise – at which time the health professional will determine when she can be discharged from hospital.

Following discharge, the woman will need to receive ongoing support and monitoring by a specialist mental health professional.

Bipolar disorder will not ‘settle down’ or go away on it’s own without medical treatment – so it’s important to seek help as early as possible.  By getting help early you can help prevent the condition from getting worse and having a negative impact on your family.

Medical Treatment 

The National Perinatal Mental Health Guidelines recommend that bipolar disorder is managed and treated using medications. These medications work to stabilise the symptoms by reducing the impacts of the ‘highs’ and ‘lows’ of bipolar disorder.

Different types of medication are used to treat the depression, mania or both depression and mania. There are a variety of different types of medication that may be prescribed, and these include:

• Mood stabilisers – Work to stabilise mood and help reduce the likelihood of the symptoms reoccurring (relapse). The most common mood stabiliser is lithium. Other types of mood stabilisers (which are also used to manage epilepsy) that may be used are sodium valporate, carbamazapine and lamotrigine.
• Antidepressants – Are used to treat the symptoms of depression that are part of the ‘depression’ part of the disorder.
• Antipsychotics – Asist with both manic and psychotic symptoms such as delusions or hallucinations.

Medical treatment for bipolar disorder needs careful, specialist attention and management. Before medications are prescribed, changed or stopped, it is vital that advice is sought from a psychiatrist who will consider the best choice of medical treatment to manage the condition for each individual.

If prescribed one of these treatments for bipolar disorder, it is important that you do not alter or stop your medications suddenly.

It is also important to speak to your mental health specialist if you are, or want to breastfeed and have been prescribed sodium valporate or clozapine.  If you are prescribed lithium, again your health professional needs to know that you are, or intending to breastfeed, as baby will also require monitoring.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) is a specialist treatment that may be used to treat the symptoms of mania and severe depression.  ECT involves stimulating the neurones in the brain via an electric current.  Whilst ECT can lead to short-term memory loss, for many women it plays a crucial role in treating bipolar disorder and making steps towards management and recovery.

There are safe and effective treatments for bipolar disorder. Getting help early for bipolar disorder is vital to reduce the impact of the condition on the mother, partner, infant and other members of the family.