Skip to main content
SpringerLink
Log in

Mania and depression in the perinatal period among women with a history of major depressive disorders

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Women with a history of major depressive disorder (MDD) have increased risks for postpartum depression, but less is known about postpartum mania in this population. The objectives of this study were to prospectively determine the frequency with which mania occurs in the postpartum among women who have a history of MDD and to explore temporal relationships between onset of mania/hypomania and depression. We administered the Structured Clinical Interview for DSM IV disorders (SCID) to pregnant women with a self-reported history of MDD to confirm diagnosis and exclude women with any history of mania/hypomania. Participants completed the Edinburgh Postnatal Depression Scale and Altman Self-Rating Mania Scale (ASRM) once during the pregnancy (∼26 weeks) and 1 week, 1 month, and 3 months postpartum. Among women (n = 107) with a SCID-confirmed diagnosis of MDD, 34.6 % (n = 37) experienced mania/hypomania (defined by an ASRM score of ≥6) at ≥1 time point during the postpartum, and for just over half (20/37, 54 %), onset was during the postpartum. The highest frequency of mania/hypomania (26.4 %, n = 26) was at 1 week postpartum. Women who experienced mania/hypomania at 1 week postpartum had significantly more symptoms of mania/hypomania later in the postpartum. A substantive proportion of women with a history of MDD may experience first onset of mania/hypomania symptoms in the early postpartum, others may experience first onset during pregnancy. Taken with other recent data, these findings suggest a possible rationale for screening women with a history of MDD for mania/hypomania during the early postpartum period, but issues with screening instruments are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Altman EG, Hedeker D, Peterson JL, Davis JM (1997) The Altman Self-Rating Mania Scale. Biol Psychiatry 42(10):948–955

    Article  CAS  PubMed  Google Scholar 

  • Azorin J-M, Angst J, Gamma A, Bowden CL, Perugi G, Vieta E, Young A (2012) Identifying features of bipolarity in patients with first-episode postpartum depression: findings from the International BRIDGE Study. J Affect Disord 136(3):710–715

    Article  PubMed  Google Scholar 

  • Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N and Jones I (2013) “Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis”. Bipolar Disorders

  • Bostwick JM, Pankratz VS (2000) Affective disorders and suicide risk: a reexamination. Am J Psychiatry 157(12):1925–1932

    Article  CAS  PubMed  Google Scholar 

  • Breedlove G, Fryzelka D (2011) Depression screening during pregnancy. J Midwifery Women’s Health 56(1):18–25

    Article  Google Scholar 

  • Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  CAS  PubMed  Google Scholar 

  • Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I (2012) Perinatal episodes across the mood disorder spectrum. Arch Gen Psychiatry 17:1–8

    Google Scholar 

  • Dubovsky SL, Leonard K, Griswold K, Daurignac E, Hewitt B, Fox C, Seymour D, Dubovsky AN, DeGruy F (2011) Bipolar disorder is common in depressed primary care patients. Postgrad Med 123(5):129–133

    Article  PubMed  Google Scholar 

  • First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P)

  • Glover V, Liddle P, Tayler A, Adams D (1994) Mild hypomania (the Highs) can be a feature of the first postpartum week: association with later depression. Br J Psychiatry 164:517–521

    Article  CAS  PubMed  Google Scholar 

  • Goldberg JF, Harrow M, Whiteside JE (2001) Risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry 158(8):1265–1270

    Article  CAS  PubMed  Google Scholar 

  • Hannah P, Cody D, Glover V, Adams D, Kumar R, Sandler M (1993) The tyramine test is not a marker for postnatal depression: early postpartum euphoria may be. J Psychosom Obstet Gynaecol 14(4):295–304

    Article  CAS  PubMed  Google Scholar 

  • Hasegawa M (2000) Mild hypomania phenomenon in Japanese puerperal women. Nurs Health Sci 2:231–235

    Article  Google Scholar 

  • Heron J, Haque S, Oyebode F, Craddock N, Jones I (2009) A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period. Bipolar Disord 11(4):410–417

    Article  PubMed  Google Scholar 

  • Hirschfeld RMA, Lewis L, Vornik LA (2003) Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 Survey of Individuals with Bipolar Disorder. J Clin Psychiatry 64(2):161–174

    Article  PubMed  Google Scholar 

  • Howard LM, Boath E, Henshaw C (2006) Antidepressant prevention of postnatal depression. PLoS Med 3(10):e389

    Article  PubMed Central  PubMed  Google Scholar 

  • Jones I, Craddock N (2001) Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatr 158(6):913

    Article  CAS  PubMed  Google Scholar 

  • Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstetricia Et Gynecologica Scandinavica 80(3):251–255

    Article  CAS  PubMed  Google Scholar 

  • Kaminsky LM, Carlo J, Muench MV, Nath C, Harrigan JT, Canterino J (2008) Screening for postpartum depression with the Edinburgh Postnatal Depression Scale in an indigent population: does a directed interview improve detection rates compared with the standard self-completed questionnaire? J Matern-Fetal Neonatal Med: Off J Eur Assoc Perinatal Med, Fed Asia Ocea Perinatal Soc, Int Soc Perinat Obstetricians 21(5):321–325

    Article  Google Scholar 

  • Kim B, Wang HR, Son JI, Kim CY, Joo YH (2008) Bipolarity in depressive patients without histories of diagnosis of bipolar disorder and the use of the mood disorder questionnaire for detecting bipolarity. Compr Psychiatry 49(5):469–475

    Article  PubMed  Google Scholar 

  • Lane A, Keville R, Morris M, Kinsella A, Turner M, Barry S (1997) Postnatal depression and elation among mothers and their partners: prevalence and predictors. Br J Psychiatry : J Mental Sci 171:550–555

    Article  CAS  Google Scholar 

  • Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale–implications for clinical and research practice. Arch Women’s Mental Health 9(6):309–315

    Article  CAS  Google Scholar 

  • Murray D, Cox JL (1990) Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). J Reprod Infant Psychol 8(2):99–107

    Article  Google Scholar 

  • Payne JL, Roy PS, Murphy-Eberenz K, Weismann MM, Swartz KL, McInnis MG, Nwulia E, Mondimore FM, MacKinnon DF, Miller EB, Nurnberger JI, Levinson DF, DePaulo JR Jr, Potash JB (2007) Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Disord 99(1–3):221–229

    Article  PubMed  Google Scholar 

  • Proudfoot J, Doran J, Manicavasagar V, Parker G (2011) The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review. J Affect Disord 133(3):381–387

    Article  PubMed  Google Scholar 

  • Sharma V, Khan M (2005) A closer look at treatment resistant depression: is it due to a bipolar diathesis? J Affect Disord 84(2–3):251–257

    Article  PubMed  Google Scholar 

  • Sharma V, Khan M (2008) Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disord 10(6):742–747

    Article  PubMed  Google Scholar 

  • Sharma V, Khan M (2010) Identification of bipolar disorder in women with postpartum depression. Bipolar Disord 12(3):335–340

    Article  PubMed  Google Scholar 

  • Sharma R, Markar HR (1994) Mortality in affective disorder. J Affect Disord 31(2):91–96

    Article  CAS  PubMed  Google Scholar 

  • SharmaVB, Xie MK, Campbell D, Penava E, HampsonD, Mazmanian and Pope CJ (2013) “A prospective study of diagnostic conversion of major depressive disorder to bipolar disorder in pregnancy and postpartum”. Bipolar Disorders

  • Smith S, Heron J, Haque S, Clarke P, Oyebode F, Jones I (2009) Measuring hypomania in the postpartum: a comparison of the highs scale and the Altman Mania Rating Scale. Arch Women’s Mental Health 12(5):323–327

    Article  CAS  Google Scholar 

  • Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG, Boyken L, Keller MB (2010) Longitudinal course of bipolar I disorder: duration of mood episodes. Arch Gen Psychiatry 67(4):339–347

    Article  PubMed Central  PubMed  Google Scholar 

  • Webster J, Pritchard MA, Creedy D, East C (2003) A simplified predictive index for the detection of women at risk for postnatal depression. Birth (Berkeley, Calif) 30(2):101–108

    Article  Google Scholar 

  • Wisner KL, Perel JM, Peindl KS, Hanusa BH, Findling RL, Rapport D (2001) Prevention of recurrent postpartum depression: a randomized clinical trial. J Clin Psychiatry 62(2):82–86

    Article  CAS  PubMed  Google Scholar 

  • Wisner KL, Perel JM, Peindl KS, Hanusa BH, Findling RL, Rapport D (2004) Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry 161(7):1290–1292

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to the participants, the physicians and staff at the BC Reproductive Mental Health Program, the volunteers who assisted with the data entry for this study, Wayne Su M.A., MSc. for the IT support, and Boris Kuzeljevic M.A. for his help with the statistical analyses.

Sources of financial support

This study was funded by the Canadian Institutes of Health Research. JA was supported by the Canada Research Chairs Program, the Michael Smith Foundation for Health Research, and BC Mental Health and Addictions Services.

Author information

Authors and Affiliations

  1. Department of Medical Genetics, University of British Columbia, Vancouver, Canada

    Angela J. Inglis & Jehannine C. Austin

  2. Department of Psychiatry, University of British Columbia, Vancouver, Canada

    Catriona L. Hippman, Prescilla B. Carrion, William G. Honer & Jehannine C. Austin

  3. Women’s Health Research Institute, BC Women’s Hospital & Health Centre, Vancouver, Canada

    Catriona L. Hippman

  4. Rm A3-112 3rd Floor, CFRI Translational Lab Building, 938 West 28th Avenue, V5Z 4H4, Vancouver, BC, Canada

    Jehannine C. Austin

Authors
  1. Angela J. Inglis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catriona L. Hippman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prescilla B. Carrion
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William G. Honer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jehannine C. Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jehannine C. Austin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Inglis, A.J., Hippman, C.L., Carrion, P.B. et al. Mania and depression in the perinatal period among women with a history of major depressive disorders. Arch Womens Ment Health 17, 137–143 (2014). https://doi.org/10.1007/s00737-013-0408-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-013-0408-1

Keywords

Search

Navigation