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Women and Bi-polar (manic-bepressive) Disorders
What are they?
Bi-polar disorders are a set of mood disorders that involve periods
of depression alternating with periods of mania. Mania is much
more than being "up" or "hyper". It can be an irritable mood as well
as elevated mood. However, it must last at least a week and it
must disrupt social or job functions or require hospitalization to be
considered true mania. Mania can be accompanied by
grandiosity, lack of sleep, and excessive activity. Hypomania can
also be a feature of some sub-types. It is characterized by
elevated mood lasting less than one week and is not disruptive to
one's life. Bi-polar disorders occur in about 1% of the general
population.
The Different Kinds of Bi-polar Disorders
The three major types of bi-polar disorders are differentiated by
the degree of mania or depression and which of them
predominates. Bi-polar I is marked by at least one full-blown manic
episode combined with some or all of the additional symptoms
listed above. Bi-polar II is when a woman's depressive episodes
are full-blown, but she has hypomanic episodes as opposed to
full-blown mania. Cyclothymia is the third type of bi-polar disorder
and is identified by an alteration between hypomania and mild
depression.
Differences in Women
Unlike depression alone, which is predominate in women, bi-polar
disorders effect both genders equally. However, there are still
gender differences in the course and treatment of the disease.
Women are more likely to rapidly cycle between high and low
moods. The reasons for this are unclear. It may due to women's
higher rates of hypothyroidism. This in turn may be due to women's
greater susceptibility to lithium-induced hypothyroidism (lithium is a
common treatment for bi-polar disorders). Any woman on lithium
who experiences a return of depressive symptoms on lithium
should be tested for hypothyroidism, which can cause depression
in and of itself. Rapid cycling may also be due to the use of
antidepressants to control the disease. This in turn is used in
women more often because women express the depressive
aspects of the disease more. Women are also more likely to have
Bi-polar II disorder.
Women with bi-polar disorders are at a high risk of relapse in the
post-partum period. Treatment is a challenge, in this situation, as
the use of medications during pregnancy and nursing is difficult.
Several drugs used to treat bi-polar women can interfere with oral
contraceptives, most notably carbamazapine. Spotting between
periods is a sign that the drug is interfering with the pill. An oral
contraceptive with a higher dose of estrogen or a different birth
control method all together, is in order. This is crucial as
carbamazapine, lithium and valproic acid can cause birth defects.
Valproic Acid also causes menstrual irregularities, including
halting menstruation, in the vast majority of women who take it.
Gender differences that are still being researched and are not yet
proven include studying whether or not women's expression of the
disease is altered by female hormonal states other than during the
post-partum period. Pre-menstrual and menopausal states are
factors that may increase vulnerability. There is some evidence
that menopause triggers a shift from depression to a bi-polar
mood disorder, particularly to the rapid cycling type.
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