Bipolar Women - Important Information

How does the condition of bipolar women differ from that of men with bipolar disorder? Is the prevalence of the ailment similar, or different, among the two genders?

The prevalence of bipolar disorder has actually been shown to be about equally distributed between men and women. However, the illness’ course, risks, and possible treatment options vary greatly between the sexes.

This fact becomes especially true during conception and pregnancy, which affects not only the progression of the illness, but the treatment options available. Conception and pregnancy aside, women experience some marked differences in exhibiting some the disorder’s main symptoms.

For instance, bipolar women tend to cycle between episodes of mania and depression more rapidly and more prevalently than bipolar men. Approximately three times as many women as men experience rapid cycling. Rapid cycling can be defined as demonstrating four or more episodes of mania, hypomania and depression in the span of one year.

The exact causes of this specific difference between bipolar women and men remain unknown; however, experts theorize that it may be attributed to a higher incidence of hypothyroidism among women, the specific use of anti-depressant medications (more often prescribed to women than men), and hormonal differences (gonadal steroid effects), such as the presence of estrogen and progesterone.

These hormones fluctuate a great deal during the premenstrual or menstrual phase of the cycles, which sets women up to be highly susceptible to mood changes, including irritability and outbursts of anger. Increased estrogen may make women more susceptible to hypercortisolism, which can lead to depression, as high cortisol can change stress levels.

Sixty six percent of bipolar type I women experience mood cycling during their menstrual phases. Rapid cycling can be challenging to treat, and standard prescription antidepressants seem to worsen manic episodes. If taken alone, anti-depressant medications such as selective serotonin re-uptake inhibitors (SSRI), tricyclics and monoamine oxidase inhibitors (MAOI), may increase the severity of manic episodes. Serotonin reuptake inhibitors and monoamine oxidase inhibitors appear less likely to cause mania side effects, as compared to tricyclic antidepressants.

Some experts believe that manic episodes caused by antidepressants will be more moderate compared to those caused spontaneously, yet caution patients against taking antidepressants when other trigger factors may be present. In addition, manic episodes caused by monoamine oxidase inhibitors are much milder than those caused by tricyclics or fluoxetine, also known as Prozac antidepressant.

Mood stabilizing agents can be used in place of antidepressants to prevent mood episodes or to treat manic, hypomanic or mixed episodes. However, individuals (especially women) who rely only on mood stabilizing agents may experience extremely deep or severe depressive periods.

Another difference between bipolar women and men is that women will be more likely to develop type II bipolar disorder, in which severe mania does not develop, but milder episodes of hypomania alternate with frequent or prolonged depression.

Mood stabilizing drugs have been linked to reproductive issues in women, such as polycystic ovarian syndrome, which can put women at risk for infertility, as well as diabetes, heart disease and uterine cancer.

Prior to conception and during pregnancy and breastfeeding, bipolar women should cease taking lithium and similar bipolar medications. For some bipolar women, pregnancy has a stabilizing effect on their disorder, although post partum depression can be a concern. For others, they must take extra measures to continue to treat their condition, albeit without the use of medications which can cause birth defects and other side effects in pregnancy. Electro-convulsive therapy (ECT) has been suggested as a safe alternative to medications.

The onset of menopause, with its fluctuating hormone levels and mood disturbances, can be a difficult time for any woman, but especially for bipolar women. Symptoms such as anger, irritability or rage can increase during this time.

During perimenopause, the estrogen levels decline, causing a special vulnerability to depression. Natural hormone therapies such as various creams, in place of hormone replacement, can be used to regulate hormone levels and decrease mood swings.

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