Drs. Sharma, Burt, and Ritchie Reply

To the Editor: We thank Drs. Bergink and Koorengevel for their interest in our article. We agree that the presence of psychotic symptoms is an important clue for the bipolar nature of postpartum depression (1). Psychotic depression is also a useful predictor of bipolar disorder in patients with nonpostpartum depression (2). Preliminary findings of a prospective study at our center also support the clinical observations of Drs. Bergink and Koorengevel that compared with women with major depressive disorder, women with a bipolar diathesis are more likely to have an early onset (within 4 weeks after delivery) rather than a later onset (between 4–12 weeks after delivery). Therefore, the treatment of women who have depression with psychotic features and an acute onset of the postpartum episode should follow the same guidelines as treatment for bipolar II postpartum depression.