Review articleGender differences in bipolar disorder
Section snippets
Age of onset
Women appear to have a later age of onset of bipolar disorder than men [1]. In a study of 69 euthymic outpatients with bipolar disorder, women experienced onset of episodes of depression (27.2 years±1.3 versus 22.4 years±1.2) and mania (25.9±1.0 versus 21.8±1.0) at a significantly later age than men [2]. Another more recent study of 360 outpatients with bipolar disorder also found that women had a significantly later age of onset of bipolar disorder than men, with women experiencing onset of
Bipolar II disorder
Bipolar I disorder, characterized by manic and major depressive episodes, occurs equally in women and men [114]. Bipolar II disorder, characterized by episodes of hypomania and depression, appears to be more common in women with a female-to-male ratio of 2.3 in one recent study [115]. A longitudinal study found more depressive episodes in bipolar II patients compared with bipolar I patients [116]. Furthermore, compared with bipolar I patients, those with bipolar II disorder have more frequent
Gender differences in the treatment of bipolar disorder
There is no evidence that gender affects treatment response to mood stabilizers. For example, gender did not impact overall morbidity in a retrospective study of lithium prophylaxis in bipolar disorder [126]. Additionally, response to lithium and the effects of lithium discontinuation did not differ between women and men [127]. More recent studies have also found no sex differences in the response to lithium for bipolar disorder [3], [128]. Notably, women required or tolerated slightly but
Menstrual cycle
Symptoms of bipolar disorder worsen in many women during the premenstrual phase of the menstrual cycle (see references [70], [146], [147]). For example, approximately 66% of a sample of bipolar women reported menstrual or premenstrual exacerbation of mood symptoms [70], and premenstrual depression was reported to occur in one fourth of women with bipolar disorder [148]. Anxiety symptoms are also elevated in the premenstrual phase in many female bipolar patients [148]. However, a consistent
Evaluation of women with bipolar disorder
A complete assessment of women with bipolar disorder includes a psychiatric and medical history, family and social history, and mental status exam with a focus on mood, psychotic, anxiety, substance use, and eating disorder signs and symptoms. Because women with bipolar disorder, particularly bipolar II disorder, frequently present with depression, it is important to probe carefully for a history of hypomanic or manic symptoms, which may not be recognized as problematic by the patient. Using
Summary
The presentation and course of bipolar disorder differs between women and men. The onset of bipolar disorder tends to occur later in women than men, and women more often have a seasonal pattern of the mood disturbance. Women experience depressive episodes, mixed mania, and rapid cycling more often than men. Bipolar II disorder, which is predominated by depressive episodes, also appears to be more common in women than men. Comorbidity of medical and psychiatric disorders is more common in women
References (220)
Issues in the treatment of women with bipolar illness
J Clin Psychiatry
(1997)- et al.
Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores
J Affect Disord
(1998) - et al.
Response to lithium maintenance treatment in bipolar disorders: comparison of women and men
Bipolar Disord
(2001) - et al.
Seasonal mood disorders: patterns of seasonal recurrence in mania and depression
Arch Gen Psychiatry
(1993) - et al.
Seasons and bipolar disorder
Ann Clin Psychiatry
(1995) Women with bipolar illness: clinical and research issues
Am J Psychiatry
(1996)- et al.
Manic depressive illness
(1990) - et al.
Sex and depression in the National Comorbidity SurveyI: lifetime prevalence, chronicity and recurrence
J Affect Disord
(1993) The course and prognosis of depression on the basis of 652 patients deceased
The course of affective disordersII. Typology of bipolar manic-depressive illness
Arch Psychiatr Nervenkr
(1978)
The relative prophylactic efficacy of lithium against manic and depressive recurrences in bipolar patients
Int Pharmacopsychiatry
The longitudinal course of recurrent affective illness: life chart data from research patients at NIMH
Acta Psychiatr Scand
Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients
Acta Psychiatr Scand
Gender and Bipolar Illness
J Clin Psychiatry
Diagnostic and statistical manual of mental disorders
Rapidly cycling affective disorder: demographics, diagnosis, family history and course
Arch Gen Psychiatry
Course of the manic-depressive cycle and changes caused by treatments
Pharmakopsychiatr Neuropsychopharmakol
Validity of rapid cycling as a modifier for bipolar disorder in DSM-IV
Depression
Multisite data reanalysis of the validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV
Am J Psychiatry
Validity of rapid cycling as a course specifier for bipolar disorder
Am J Psychiatry
The phenomenon of rapid cycling in bipolar mood disorders: a review
Can J Psychiatry
Lithium maintenance treatment of depression and mania in bipolar I and bipolar II disorders
Am J Psychiatry
Effects of rapid cycling on response to lithium maintenance treatment in 360 bipolar I and II disorder patients
J Affect Disord
Bipolar rapid cycling: focus on depression as its hallmark
J Clin Psychiatry
Rapid cycling in manic depression induced by tricyclic antidepressants
Arch Gen Psychiatry
Can antidepressants cause mania and worsen the course of affective illness?
Am J Psychiatry
Clinical factors in lithium carbonate prophylaxis failure
Arch Gen Psychiatry
Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic
Am J Psychiatry
Predictors of valproate response in bipolar rapid cycling
J Clin Psychopharmacol
Rapid-cycling depressive patients
Compr Psychiatry
Clinical aspects and treatment of rapid cycling mood disorders
Can J Psychiatry
Effects of carbamazepine and lithium on affective disorders
Neuropsychobiology
Current research on rapid cycling bipolar disorder and its treatment
J Affect Disord
Lithium and anticonvulsants in bipolar disorder
The efficacy of lamotrigine in rapid cycling and non-rapid cycling patients with bipolar disorder
Biol Psychiatry
A double-blind, placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression
J Clin Psychiatry
Spectrum of activity of lamotrigine in treatment-refractory bipolar disorder
Am J Psychiatry
A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders
J Clin Psychopharmacol
Clozapine prophylaxis in rapid cycling bipolar disorder
J Clin Psychopharmacol
Treatment of refractory rapid cycling bipolar disorder with risperidone
J Clin Psychopharmacol
Quetiapine in the treatment of rapid cycling bipolar disorder
Bipolar Disord
Olanzapine in the acute treatment of bipolar I disorder with a history of rapid cycling
J Affect Disord
Abnormal cortisol suppression in bipolar patients with simultaneous manic and depressive symptoms
Am J Psychiatry
Diagnosis and treatment of mixed mania
Am J Psychiatry
Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania
Am J Psychiatry
The role of gender in mixed mania
Compr Psychiatry
Diagnostic and statistical manual of mental disorders
The clinical epidemiology of pure and mixed manic episodes
Bipolar Disord
The dexamethasone suppression test in mixed bipolar disorder
Am J Psychiatry
Hypothalamic-pituitary-adrenocortical function in mixed and pure mania
Acta Psychiatr Scand
Cited by (212)
Sex differences in bipolar disorder: The dorsolateral prefrontal cortex as an etiopathogenic region
2024, Frontiers in NeuroendocrinologySex effects on differentiating patients with major depressive disorder from bipolar disorder in depressive state: A fMRI study with follow-up
2023, Journal of Affective DisordersNeuroanatomical and functional substrates of the hypomanic personality trait and its prediction on aggression
2023, International Journal of Clinical and Health PsychologyNeuropsychological functioning of patients with major depression or bipolar disorder comorbid to substance use disorders: A systematic review
2023, European Neuropsychopharmacology