Assessment and treatment of bipolar II postpartum depression: a review.
OBJECTIVE
This paper critically reviews the current literature on the detection, diagnosis, and treatment of bipolar II postpartum depression.


METHODS
A Pub-Med search (1998-2009), using the search terms 'postpartum depression', 'postpartum depression AND screening/detection/diagnosis/treatment', 'bipolar I AND postpartum depression', 'bipolar II AND postpartum depression', 'postpartum hypomania', and 'postpartum hypomania AND screening', was carried out. The reference lists of articles identified were also searched to select other relevant publications.


RESULTS
Brief hypomanic symptoms occur in the early puerperium in approximately 15% of women. Despite preliminary evidence that postpartum depression in some patients may be a manifestation of bipolar II disorder or bipolar disorder NOS, there are no screening instruments to differentiate unipolar from bipolar depression arising in pregnancy or the postpartum. Also lacking are evidence-based treatment options specifically targeted to treat bipolar II postpartum depression.


CONCLUSIONS
Research into postpartum mood disorders has focused primarily on major depressive disorder, bipolar I disorder, and puerperal psychosis, and has largely ignored the study of bipolarity beyond bipolar I disorder. The clinical and research implications of the misdiagnosis of bipolar II depression as major depressive disorder in the postpartum period are discussed.
Sharma
Verinder
V
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada. vsharma@uwo.ca
Burt
Vivien K
VK
Ritchie
Hendrica L
HL
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008094:Lithium / Q000009:adverse effects / Q000627:therapeutic use; D008403:Mass Screening; D011247:Pregnancy; D011613:Psychotherapy; D012008:Recurrence
D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D008094:Lithium