Can Pregnancy Hormones Trigger Bipolar Disorder?
Woman holding up baby in diaper on bed

Can Pregnancy Hormones Trigger Bipolar Disorder?

We’ve all heard of postpartum depression, and we may even be familiar with postpartum psychosis and even postpartum PTSD. But postpartum mania?

It’s a real thing. In a blunt, nothing-off-limits new book by Dyane Harwood, Birth of a New Brain describes one woman’s harrowing battle with mental illness after the birth of her second child. The book, published by Post Hill Press, will release in October.

While Harwood’s book most certainly describes the hell one sometimes goes through in finally finding the help they need, her story ends on an upbeat note regarding recovery.

“I’m not leading a Pollyanna life now either, but things are a whole lot better,” said Harwood in an exclusive interview with MentalHealthTreatment.net.

She said all the signs were there — her dad was bipolar and a drinker. Yet until a crisis situation emerged, nobody noticed the signs that maybe Harwood had a mental disorder or at least was at elevated risk.

Birth of a New Brain is brilliantly titled. When a woman becomes pregnant, her brain does actually change. Pregnancy can set off a host of underlying mental disorders. In Harwood’s case, what happened after delivery was particularly unusual. Not only did she become manic, but she also became obsessed with furiously writing on her computer — morning, noon and night.

“In my clinical experience, it has been difficult for healthcare professionals to recognize hypomania or mania in a woman who has recently given birth,” said Dr. Carol Henshaw, co-author of The Modern Management of Perinatal Psychiatry in the forward of Harwood’s book.1

“In Dyane’s case, no one at the maternity hospital recognized her emerging mania before she was discharged. Many perinatal psychiatrists rarely address the possibility that postpartum hypomania or mania may signify a first episode of bipolar disorder.”

Missed Cues Before and During Pregnancy

Harwood said there were many clues along the way that she might suffer, at least mildly, from mental illness.

Her dad was bipolar, and her doctor knew that, Harwood said. Once, in her twenties, she exhibited mania during a special event she attended in Silicon Valley. It was so extreme, she knew deep inside something was wrong. “I didn’t think to say, ‘Call a doctor, I’m feeling weird,'” she said.

Later, she became depressed, and she did seek treatment for that. Yet between her dad’s diagnosis and her own experience, including some peaks and valleys, she never received a bipolar diagnosis until after she had a baby.

That’s not to say people with a mental disorder cannot or should not have children. But recent research has shown that going off your medications while pregnant can be more dangerous for you than the meds are for the baby. Another option is to taper down medications during pregnancy.

When she had the baby, her second child, she displayed intense elation. But nobody considered that odd for a mother, especially since she calmed down for a short while before she was released from the hospital. Harwood’s official diagnosis is bipolar disorder, peripartum onset, as classified by DSM-5, the officially accepted manual of mental disorders. She also was diagnosed with a rare co-occurring disorder called hypergraphia, a behavioral condition characterized by the intense desire to write.

“My husband would hide the computer so I would spend time with the baby,” Harwood explained. “I couldn’t stop writing for a moment, even as I breastfed my precious newborn or while answering the call of nature. I was caught in a whirl of racing, obsessive thoughts, which is how many people describe their bouts of mania.”

Harwood wasn’t the only one to document these experiences in a book; her doula, Salle Webber, did too. In her book The Gentle Art of Newborn Family Care: A Guide for Postpartum Doulas and Caregivers, she describes Harwood’s behavior from her own perspective. Harwood says Webber told her story using the pseudonym “Elaine.”

“She and her husband often fought bitterly, especially on weekends when there was no outside help,” Webber wrote. “I found that my devoted attention to Elaine kept her generally calm, and she trusted and confided in me. However, outbursts frequently occurred in my absence, coloring the mood of the home the next day.”

There’s more, and these vivid descriptions would potentially be insulting or embarrassing to any mother. But, writes Harwood, “I knew her book would educate doulas and help mothers suffering from postpartum bipolar disorder.”

She said she valued Webber’s “clearheaded perspective, adding she is “indebted to Salle for being there for my family in such a chaotic setting.”

Pregnant woman lying down with hand on her stomach

 

Years of Struggle

What followed were many years of struggle for Harwood, her husband and her daughter. She tried to get better, but like so many people with bipolar disorder, it took many, many years to get the medications right.

There was a bad reaction to amitriptyline. “I wanted to hang myself, and I thought, I am really scared. I never would want to hang myself. In fact, I used to judge people who did that. Now I understand how our brains turn on us, and the way that happened to me was through chemicals.”

Many people go off their meds due to side effects such as weight gain, gas, bloating, inability to think and many other problems. However, those who do sometimes find out that, as bad as the side effects may be, not being medicated is worse.

“I was looking for any excuse to stop my meds,” Harwood said.

It is important for a woman who is pregnant to discuss her mental health with her doctor and and bring up any previous bouts of depression or mania. Postpartum depression is rather common. It can leave new moms debilitated at a time they need to be chasing after their tots. In Texas, the Senate recently passed a bill that would provide funding to help identify new mothers with postpartum depression and get them into treatment.2

Not Anti-Big Pharma

Despite having problems with many medications before finding the right combination, Harwood stressed she is not “anti-Pharma” and today takes two medications for her bipolar disorder. “I am not anti-big pharma because some of those medications can save your life.”

However, Harwood said she found relief in electroconvulsive therapy. “It is very controversial but for me it was totally life-saving,” she told MentalHealthTreatment.net. “But friends have had terrible responses.”

Today, Harwood said she takes two medications: Lithium and one “very old school antidepressant” from a class of drugs called MAOIs. She notes that a doctor told her that Marilyn Monroe was prescribed Parnate, an MAOI, six weeks before she died.

When severe episodes of mental illness occur in a hospital setting, they can be treated in a safe place where changes in medication can be monitored very closely. There is no denying it can take time to find the right combination of medications.

The brain is our body’s most complex organ, and its changes during pregnancy leave many scientists awestruck.

In her book The Dolphin Parent: A Parent’s Guide to Raising Healthy, Happy and Motivated Kids — Without Turning into a Tiger, Dr. Shimi Kang wrote, “Human neuroscience has shown that a mother’s brain changes dramatically during her first pregnancy. The brain’s neurons are wired and rewired at a comparable rate to that which occurs during puberty … One can say that a new mother has a different brain than before delivering her child.”


Sources

1. Harwood, Dyane. (2017) Birth of a New Brain. Post Hill Press: New York. Personal interview with author, book to be released October 2017.
2. Collins Walsh, Sean. (2017, May 23). Texas Senate approves bill aimed at identifying post-partum depression. Austin American Statesman. Retrieved May 25, 2017, from http://www.statesman.com/news/state–regional-govt–politics/texas-senate-approves-bill-aimed-identifying-postpartum-depression/ONlgcyTAn6zun8iAVQS7xH/

Written by David Heitz