25th June 2021
A Voices blog on Bipolar Disorder by Dr Clare Dolman, who is co-chairing the Bipolar Commission, launched to improve healthcare for people living with the condition.
Over a million people are living with bipolar in the UK. It’s a condition of extreme highs and lows but also of long periods of being well, especially if you can get the right treatment and learn to manage your lifestyle. This means learning about your particular ‘triggers’ – what provokes your mood to start escalating towards a dangerous mania (when you’re likely to behave ‘out of character’ by, for example, behaving recklessly; offending people; spending crazily and not sleeping enough). Or sometimes it’s not as extreme as crashing cars and walking out of your job swearing at the boss: the less extreme hypomania is characterised by heightened energy and enthusiasm. Or you might be triggered into a deep depression. If you have any clients with this condition, direct them to Bipolar UK where they can find information and peer support, especially women-and-bipolar, (also @bipolaruk).
As a Health Visitor, it’s particularly important to understand how bipolar affects women. Most women are affected by hormonal changes and when this interacts with bipolar it can trigger an episode of illness. This makes us vulnerable in pregnancy but especially after childbirth: the hormonal upheaval at this time triggers an episode of illness in around 50% of new mums with bipolar. Most of those will be depressive in nature but about 20% of them will be more manic or mixed, termed a postpartum psychosis. This is a psychiatric emergency (there is a risk of suicide) and usually requires hospitalisation. So, if you visit a Mum who’s ‘manically’ cleaning and baking – or talking very fast in a distracted way – do take notice. She’s probably barely slept since the birth, but her behaviour should not be put down to just tiredness. If she or her family think she’s ‘not quite right’ or ‘not her normal self’, do take notice and get a second opinion.
I, myself, have Bipolar (Bipolar 1 which carries a greater risk of postpartum illness than Bipolar 2) and I had a 6-week stay in hospital after the birth of my first child. It’s very frightening – women are very confused and often hallucinating. But thankfully, medication and good care – preferably in an MBU – are highly effective and, once stable again, most women with bipolar make brilliant mums (so my daughter says – and she’s a Health Visitor!)
For women with a diagnosis of bipolar, it’s essential they are referred to a perinatal team and, if you visit a mum with bipolar who’s thinking of having another child, they need to get referred to the local specialist team for preconception advice as there are many decisions around medication and pre and postnatal care which they need specialist advice to help them think through. Another issue might be breastfeeding, as women who are taking some medications for bipolar, for example, lithium will need to bottle-feed. But interviewing many women for my PhD on this subject taught me how important it is to remind all perinatal professionals to support women, rather than make them feel guilty. Even if they’re taking medication that allows them to breastfeed, some women have to bottle-feed to stay well as sleep is so critical to bipolar.
About 50% of women who have postpartum psychosis report no history of mental health issues before, so it may take longer to recognise and get them the urgent help they need. If you care for a family going through this, do direct them to Action on Postpartum Psychosis (APP) which has a wonderful e-forum where women and their families can find support, via email and face-to-face help.
Dr Clare Dolman