depressed african american woman sitting on bed

Depression and Mania: Two Different Sides of Bipolar Disorder

Bipolar disorder is a mental illness resulting in significant, often sudden shifts in a person’s mood, energy and ability to think clearly. High and low moods, called mania and depression, can severely impact a person’s quality of life and ability to function.

Rapid cycling is defined as four or more episodes of illness within a 12-month period. This form of bipolar disorder tends to be more treatment resistant than non-rapid-cycling bipolar disorder.

The average age of bipolar onset is 25, although the disorder can affect adolescents and even children, although far less commonly. The condition affects an estimated 5.7 million adult Americans or 2.6% of the U.S. population, with 83% of diagnosed cases considered severe.

Distinctive gender differences in bipolar disorder have been documented, although these findings are inconsistent. An equal gender ratio has been reported for bipolar I disorders, although some studies indicate males are more likely to develop the disorder, while others suggest females have a higher risk.

Bipolar Disorders in Men

  • Excessive co-occurring use of alcohol, cannabis and nicotine is likely much higher in men.
  • Men are more likely to experience mania during their first episode.
  • Bipolar disorder may be more common in males ages 16-25 than females in the same age demographic.
  • Men with bipolar disorder are more likely to have conduct problems or antisocial behaviors in childhood, which may increase the risk of violence and problems with the law.

Bipolar Disorders in Women

  • About three times as many women as men experience rapid cycling.
  • Women may have more depressive episodes, severe depressive symptoms and more mixed episodes than men.
  • Women may have more psychotic symptoms such as paranoid delusions.
  • More women with acute mania tend to live independently or with a partner.
  • Bipolar disorder may be more common in females aged 25 and older than males.

Gender Differences in Bipolar Disorder

A 2013 study published in BMC Psychiatry found 74.6% of males and 42.6% of females were using substances; much higher rates than in the general population. While men were more likely to use cannabis than females, no gender differences were noted in alcohol or polysubstance use.

During treatment, men were more likely than women to decrease or stop substance use. Men who fell ill during a first episode of psychosis were more likely than women to receive understanding and support from family members. Women were seven times more likely to have experienced sexual abuse than men. The female incidence rate in the study group was significantly higher than in the general population (30% versus 19.7%).

A study published in the Journal of Affective Disorders analyzed 461 men and 629 women with bipolar I disorder. Depressive symptoms were more dominant in women with the condition, while manic symptoms were more common in men.

Women were more likely to suffer from metabolic disorders, while men had more neurologic conditions and cancer. Lead researcher Dr. Jean-Michel Azorin suggested “the differences in psychiatric comorbidity may to a certain extent account for the differences found in medical comorbidity.”

A 2017 study published in the Indian Journal of Psychological Medicine uncovered no significant gender differences with respect to medications prescribed (mood stabilizer vs. antipsychotic), adverse effects, compliance and number of follow-up visits. During the five-year follow-up period, the total number of mood episodes, hypomanic, depressive and manic episodes in the two groups were comparable.

Differences in brain maturation, psychosocial development and changes in the female reproductive cycle are thought to be factors in bipolar gender differences. Gender-specific bipolar treatment addresses both gender and individual differences.

Women’s mental health treatment takes into account symptoms such as more severe mood swings and hormonal factors. Men’s mental health treatment may focus on symptoms like risk-taking, impulsivity and anger.

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