Academic journal article Indian Journal of Psychiatry

Bipolar Disorder in Women

Academic journal article Indian Journal of Psychiatry

Bipolar Disorder in Women

Article excerpt

Byline: Sonia. Parial

Bipolar affective disorder in women is a challenging disorder to treat. It is unique in its presentation in women and characterized by later age of onset, seasonality, atypical presentation, and a higher degree of mixed episodes. Medical and psychiatric co-morbidity adversely affects recovery from the bipolar disorder (BD) more often in women. Co-morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders occur more frequently in women while substance use disorders are more common in men. Treatment of women during pregnancy and lactation is challenging. Pregnancy neither protects nor exacerbates BD, and many women require continuation of medication during the pregnancy. The postpartum period is a time of high risk for onset and recurrence of BD in women. Prophylaxis with mood stabilizers might be needed. Individualized risk/benefits assessments of pregnant and postpartum women with BD are required to promote the health of the women and to avoid or limit exposure of the fetus or infant to potential adverse effects of medication.


Bipolar disorder (BD) in women needs unique consideration as it differs from its male counterparts in various aspects. The gender difference in phenomenology, course and outcome of the disorder is reviewed. BD affects the most important period of life that is reproductive period of life in women. Most women in Indian scenario experience many life stressors during this period. [sup][1] The significant impact of the reproductive cycle on disease and the issues posed to the clinician to treat this disorder in preconception, conception, and postconception and lactation period are discussed in detail.


There is not much difference in the life time prevalence of bipolar affective disorder amongst the genders. There are few clinical characteristics that differentiate men and women with BD. Women experience more depressive episodes in BD as they do in major depressive disorder (MDD) Bipolar I is equally distributed between men and women. The national co-morbidity survey, an American Epidemiological study involving 8098 respondents, found life time prevalence rates of BD in men (0.42%) and women (0.47%). The Bipolar II Epidemiological Catchment Area study using Diagnostic and Statistical Manual of Mental Disorder-III (DSM-III) criteria did not find any difference in gender distribution of Bipolar II (life time prevalence 0.5% vs. 0.4% in women vs. men). Another prevalence study of DSM-III mental disorders indicated the similar rate of hypomania, Bipolar I in females and males (1.7% vs. 1.4%; 1.7% vs. 1.1%). Bipolar II was significantly more common in females as compared to males. [sup][2]

Hendrick et al . reviewed the medical charts of 131 bipolar patients seen at a specialized mood disorder clinic in Los Angeles, and found 48% of their clinic population were women, but women accounted for 60% of Bipolar type II. [sup][3]

Khess et al . in a study of first-episode mania found no difference in prevalence among male and female among Indian patients. [sup][4] Most of the hospital-based Indian studies of BD found that the male patients outnumbered female patients, but in Western studies it has been recorded that women with mania require more hospitalization. [sup][5]

Clinical Presentation

Age of onset

Women appear to have a later age of onset of BD than men in a study of 69 euthymic outpatients with BD. [sup][6] Women experienced onset of episodes of depression (27.2 years = 1.3 vs. 22.4 years = 1.2) and mania (25.9 = 1.0 vs. 21.8 = 1.0) at a significantly later age than men. [sup][7]

Another more recent study of 360 outpatients with BD also found that women had a significantly later age of onset of BD than men, with women experiencing the onset of illness approximately 3.2 years later than men. The onset of BD during the fifth decade of life is also more common in women than men. …

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