The prevalence of bipolar I disorder is about the same in men and women, whereas multiple studies have shown that women have a higher incidence of bipolar II. In clinical terms, there are distinctive differences between bipolar in men and women, especially the course of illness, perception of quality of life and psychosocial functioning.1 Women are more likely to experience rapid cycling, which is characterized by four or more episodes of depression and mania in one year, and appears to be relatively more resistant to treatment. Men are less likely to voluntarily seek help for psychological conditions (e.g. bipolar disorder), which increases their risk of suicide.
Types of Bipolar Disorder
Bipolar I disorder: This is characterized by one or more manic episodes or mixed episodes (symptoms of both mania and depression) that last at least seven days. Typically, a person will also experience periods of depression with episodes lasting at least two weeks. It is common for episodes to be so severe that immediate hospitalization is warranted.2
Bipolar II disorder: This is characterized by a pattern of one or more major depressive episodes and at least one hypomanic episode. Patients do not experience the full-blown manic episodes that are indicative of bipolar 1. This type is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported.2
Cyclothymic disorder: This is a milder type defined by numerous alternating periods of hypomanic and depressive symptoms. The episodes generally have a duration of at least two years in adults and one year in children and adolescents. The severity of this type may change over time.2
Bipolar Symptoms in Men
- Earlier onset than women
- More severe than women
- Higher incidence of manic episodes
- More prone to aggressive behavior during manic episodes
- Comorbid drug or alcohol abuse more common
Bipolar Symptoms in Women
- Later onset than men
- Higher incidence of depressive episodes
- Higher probability of experiencing simultaneous or overlapping symptoms of mania and depression (mixed episodes)
- Greater comorbidity of physical pathology (thyroid disease in particular)
- More likely to experience seasonal episodes
- Greater incidence of comorbid conditions such as eating and anxiety disorders
Estrogen is thought to play a role in bipolar disorder in women because symptoms often worsen during perimenopause and menopause. During perimenopause, women may be especially at risk for depressive episodes due to declining estrogen levels.3 Studies on the relationship of bipolar disorder and worsening premenstrual syndrome (PMS) symptoms have yielded contradictory findings. A 2007 study showed that PMS symptoms were experienced by twice as many women diagnosed with mood disorders (mixture of bipolar disorder and major depressive) than women without psychiatric disorders. Other studies have shown different results, including a 2004 study that showed that bipolar women treated with lithium had fewer PMS symptoms than women without bipolar disorder.4
Managing bipolar disorder during and after pregnancy is a challenge for many women. Research suggests that some anticonvulsants used to treat bipolar disorder can be harmful to fetuses, potentially contributing to birth defects. Lithium can increase the risk of cardiovascular malformations in fetuses exposed to it. Breast-feeding during lithium therapy is discouraged because it is excreted in breast milk. Additional scientific studies are needed to fully understand the impact of these medications on the nursing infant.3
Postpartum Bipolar Disorder
The largest postpartum depression study done to date involved 10,000 women and found that one in seven experienced symptoms of depression after childbirth. The results, published in JAMA Psychiatry, showed that an estimated 20% of the mothers with depressive symptoms had suicidal thoughts. Among those who were followed for a full year, 22% experienced severe depression. Symptoms began prior to pregnancy for 27% and during pregnancy for 33% of the women, respectively. Follow-up evaluations resulted most commonly in a diagnosis of depression with a co-occurring anxiety disorder. In addition, 22.6% of the women were diagnosed with bipolar disorder.4
The differences in bipolar disorder in men and women necessitates an individualized approach to treatment. Close attention needs to be paid in particular to pregnant women and those who have recently given birth due to medication risks and the high propensity of depression.
- Bipolar Disorder Differences Between Genders: Special Considerations for Women: Gender Differences in Bipolar Disorder. Medscape website. http://www.medscape.org/viewarticle/751888_3 Published Oct. 31, 2011. Accessed June 20, 2016.
- Types of Bipolar Disorder. Depression and Bipolar Support Alliance website. http://www.dbsalliance.org/site/PageServer?pagename=education_bipolar_types Accessed June 20, 2016.
- Bipolar Disorder and Gender Differences. Everyday Health website. http://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-and-gender-differences.aspx Updated Nov. 10, 2008. Accessed June 20, 2016.
- MGH Center for Women’s Mental Health website. Bipolar Disorder and PMS. https://womensmentalhealth.org/posts/bipolar-disorder-and-pms/ Published Dec.15, 2008. Accessed June 21, 2016.
- Wisner KL, Sit DK, McShea MC, et al. Onset Timing, Thoughts of Self-Harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry. 2013;70(5):490-498. doi:10.1001/jamapsychiatry.2013.87.