Review article
Gender differences in bipolar disorder

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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

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