Gender differences in the course of bipolar have been known about for many years, yet the full effects during puberty, menstruation, pregnancy, menopause, use of HRT and use of oral contraception have yet to be fully evaluated. In 1996, Ellen Leibenluft, M.D. published a literature review on this very issue. It remains one of the most frequently cited scholarly works on the subject and forms the basis of this brief summary.
The incidence of bipolar disorder in men and women is similar. What stands out is the much higher risk of rapid-cycling in women. Women with bipolar may also be at higher risk for depressive episodes and mixed episodes and appear more likely to experience mixed mania. In her paper, Leibenluft suggests three potential risk factors that may predispose women to rapid-cycling. These are: hypothyroidism, gonadal steroid effects, and antidepressant medication.
Various lines of research have attempted to establish whether hypothyroidism is more common in women with rapid-cycling than other people with bipolar. Results show that while hypothyroidism is common in people with bipolar, no clear evidence exists to suggest a significantly higher rate in women with rapid-cycling bipolar. Discovering the mechanism causing hypothyroidism in rapid-cycling bipolar is as important as determining whether its presence puts women more at risk of rapid-cycling.
The idea that fluctuations in gonadal steroids throughout the menstrual cycle predisposes women with bipolar to frequent mood cycles is not supported. Rapid-cycling occurs in both men and women, but even if we factor out males, there appears to be no substantive relationship between mood and phase of menstrual cycle. Leibenluft gives greater support to theory of gonadal steroids disrupting sleep. This, she argues, could indirectly affect moods because of the effect on circadian rhythms. Disrupted sleep is a feature of mania and can also cause mood cycling. Comparatively little is known about the effects of gonadal steroids on sleep. However, in people with rapid-cycling bipolar, the timing of melatonin secretion shifts earlier as the cycle moves towards hypomania. This could point to a situation where gonadal steroids play an important role in mood cycling and hormone cycles could predispose some women to rapid mood cycles.
Next: Antidepressants & Special Considerations in the Treatment of Women
Leibenluft, E. (1996) Women With Bipolar Illness: Clinical and Research Issues. American Journal of Psychiatry. 153: 2. 163-173
Dr. Leibenluft is Senior Investigator and Chief of the Section on Bipolar Spectrum Disorders in the Emotion and Development Branch, Mood and Anxiety Program, National Institute of Mental Health, and Clinical Associate Professor of Psychiatry at Georgetown University School of Medicine.
Published On: July 19, 2009
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