Today, we look at how often postpartum depression converts to bipolar and what that means for treatment.

Welcome to the Carlyte Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chrisaken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Postpartum depression begins within four to six weeks of delivery.

It's four weeks in DSM-5 and six weeks in ICD-11, and some argue for an even longer time span. But regardless of where

we draw that line, we know that the onset peaks around two weeks after delivery. Until recently,

postpartum depression was approached much like any other major depressive episode, typically managed

with psychotherapy and antidepressants,

with Certraline, often the preferred one, due to its relative safety for breastfeeding mothers.

But two developments are changing that.

First is the growing awareness that many cases of postpartum depression are due to bipolar disorder, where antidepressants

would not be a good idea. If a woman is in her first episode of a depression, it is three

times more likely to be a bipolar type if the episode comes on postpartum than if it comes on

at other times.

The other development that is challenging Certraline's dominance is Xeranolone,

Zerzuvie, a neurosteroid approved for postpartum depression that we covered last week.

Today, I'm going to look at the bipolar piece.

Zeranelone is not a treatment for bipolar depression, although Sage Therapeutics is exploring it there, but from everything we know about this drug, which

imitates the neurohormone allopregnitalone and has gabbergic benzodiazepine-like effects,

serenolone is unlikely to trigger mania. And that is a meaningful advance,

because if you give an SSRI like CERCline to a woman with postpartum depression, there's a good

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