Postnatal euphoria: are 'the highs' an indicator of bipolarity?

Research into postnatal mood disorders to date has concentrated on depressive syndromes of varying severity and full-blown acute puerperal mania. However, clinical experience, backed up by a review of the literature, indicates that milder hypomanic symptoms also occur in the early puerperium. Although these symptoms may often be regarded as clinically insignificant, there is evidence that the experience of minor puerperal elation may be a predictor of later postpartum depression. In addition, studying mild puerperal high mood may provide insights into the pathophysiology of more severe puerperal mania and psychosis. This paper critically reviews the literature on milder forms of high mood occurring in the puerperium and discusses the potential clinical and research significance of 'the highs'.