The condition typically begins in young adulthood, often between the teenage years and the 30s. It tends to last for life.
Why it occurs is not clear, but there may be genetic factors as it can run in families.
Bipolar disorder affects men and women equally, but there is evidence that it presents differently in women than it does in men.
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Differences in symptoms between men and women
Some symptoms of bipolar disorder are the same in men and women while others may be gender-specific.
Women with bipolar disorder are more likely to experience depression than mania.
Symptoms that appear in both men and women include:
- High or irritated mood
- More energy and greater goal-driven activity
- Elevated self-esteem or grandiosity
- Reduced sleep
- Much more talking than usual
- Rapid speech flow and flights of ideas or racing thoughts
- Being easily distracted
- Impulse for risky pleasures, such as shopping or sex, without understanding the consequences
The typical symptom of depression in both men and women with bipolar disorder is a severe form of feeling "low" or "down." Some people may lose interest in things, including eating, while others may be unable to undertake everyday activities.
Other symptoms of depression include feeling guilty without good reason, and difficulty concentrating. Some people have trouble sleeping or wake up unusually early.
The way that episodes of depression and mania alternate varies between people. Some may have mostly depressive symptoms, while others experience more mania.
Research has suggested that women with bipolar disorder are more likely to have mainly depressive episodes. Men are more likely to experience a "mixed state" with depression and mania both occurring.
As women are more likely to go to their doctors with depression, they are more likely to be wrongly diagnosed with depression. If a woman is diagnosed with bipolar disorder, it is likely to be bipolar II, which means they have experienced depression with some hypomanic episodes.
According to the new edition of Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, a woman with bipolar disorder II is more likely to alternate rapidly between episodes.
DSM-5 also notes that women with bipolar disorder are more likely to have a higher lifetime risk of alcohol use disorder and a higher rate of lifetime eating disorders.
Suicide risk in women with bipolar disorder
An article published in PLOS One in 2014 reviewed the risk of attempted suicide in people who have bipolar disorder.
The authors found differences between men and women with the condition. A predictor of suicide risk in men was substance use.
Women's predictors were different. They included:
- Many mixed episodes, or having symptoms of depression and mania at the same time, over a lifetime
- Psychiatric problems starting earlier in life
- A personality disorder alongside the bipolar disorder
- Having social problems
A review of the evidence published in the Indian Journal of Psychiatry in 2015 said that women with bipolar disorder attempted suicide more often than men with the same condition, and 2 to 3 times more often than men in the general population.
Effects of pregnancy and sex hormones
Childbirth can be a trigger of severe episodes for women with bipolar disorder. These are known as postpartum episodes.
A woman with bipolar disorder has a higher chance of mood swings after giving birth.
One study published in the journal JAMA found childbirth strongly raised the risk of a severe episode.
Women who have given birth are 23 times more likely to be hospitalized for severe mental illness, including bipolar disorder, than other women.
The same study noted that becoming a new father did not have higher risks for severe mental illness.
It is not known exactly how childbirth triggers a bipolar episode. Possible causes include hormonal changes, sleep disturbances, and other changes that follow childbirth.
A woman with bipolar disorder should speak to their doctor about the impact of pregnancy and the effects of any medication.
Hormones may play a role in triggering a bipolar episode after childbirth, and mood symptoms may be worsened by the menstrual cycle. However, evidence of a link is less strong than it is for childbirth.
The hormones present around the time of menstruation may slightly alter the effect of lithium, a treatment for bipolar treatment disorder, and this may affect the drug's influence.
Hormonal and other changes around the time of menopause mean that women between the ages of 45 and 55 years are more likely to experience depressive episodes.
Treatment differences for women
Women who have bipolar disorder may receive different treatment from men, according to the findings of a study of 7,000 patients.
The 2015 study, published in the Journal of Affective Disorders, found significant gender differences in the routine clinical treatment of bipolar disorders in Sweden.
Women with bipolar disorder were more likely to receive antidepressant treatment than men, but men were more likely than women to be treated with lithium.
Women were also more likely than men to receive treatment for bipolar disorder in the form of electroconvulsive therapy (ECT), lamotrigine, benzodiazepines, and psychotherapy.
Since there was no clinical reason to use different treatments by gender, the authors concluded that doctors showed gender biases.
The article notes that women in general, not just those with bipolar disorder, are more likely to get antidepressants and combination treatments than men.
Bipolar treatment risks for pregnant women
Pregnancy itself does not appear to affect bipolar disorder, but some of the treatments for bipolar disorder can present a risk to the unborn baby.
These medications include:
In severe cases, ECT can be used, but this is generally considered a "last resort" treatment.
Women with bipolar disorder who are considering pregnancy should discuss their treatment plans with their doctor. Some women may prefer to stop their medications for pregnancy, but any change in medication must also be discussed with a doctor.