A reader who commented on my entry about sleep and depression asked about the relationship between mood, sleep loss, and the postpartum period, the first few months following childbirth.
For women, the postpartum period is a stressful time, even when there is ample help from family members. Symptoms ranging from sadness to severe depression are common. No doubt, rapid hormonal changes contribute to the depressive symptoms. Sleep disruption is almost inevitable, as newborns usually do not develop a pattern of sleeping mostly at night for several months.
During this time, it is important to be aware of the increased risk for depression, which sometimes can lead to extremely distorted and delusional thinking, occasionally with tragic results. A pregnant or postpartum woman with a history of depressive episodes, especially past postpartum depressions, should confer with a psychiatrist about preventive treatment. Others who recognize that depression is becoming a problem may wish to confer with their OB/GYN or primary care doctor, and then perhaps be referred to a specialist.
In people with a tendency to develop bipolar disorder, sleep loss has the potential to induce a manic or hypomanic episode, whether or not they have had a previous episode. Lack of adequate sleep is common with a newborn at home. A helpful father who's also losing lots of sleep can share the risk of a mood disorder triggered by chronic sleep disturbances.
A 19-year-old woman was admitted to our psychiatric unit after family members brought her to the emergency room because she was behaving in a disorganized manner and was not making any sense. While she had never had psychiatric problems before this episode, both of her parents had been treated for bipolar disorder. This family history certainly increased the likelihood that she eventually would develop symptoms of bipolar disorder. I suspect the fact that she had given birth just three weeks previously had a lot to do with the timing of this first episode.
Clearly, the relationship between sleep and mood is a two-way street. Episodes of mania or depression almost always affect sleep and, in people who are vulnerable to a mood disorder, sleep patterns can directly influence the course of their psychiatric illness. I'm pleased to see the positive attention given to these risks during the postpartum period in the recent book and interviews by Brooke Shields. She is one example of a celebrity sharing her own experiences so others can benefit.
