Psychology

Bipolar disorder is among the earliest known ill health conditions and has a notable developmental history. There is a mention of the related symptoms in the early medical records. Bipolar disorder was first noticed in the second century when Aretaeus of Cappadocia in ancient Turkey, identified symptoms of mania and depression, and expressed an opinion that there could be a link between the two. German psychiatrist Karl Leonhard in the early 1950s with his associates developed a classification system, which used the term bipolar emphasizing the difference between unipolar and bipolar depression. With regard to medications in the treatment of bipolar disorder, the Australian physician John Cade deserves a special mention. In 1949, he introduced lithium in psychiatry after he accidentally observed that lithium urate calmed down guinea pigs. Since then, lithium has been one of the most effective medications in treating mood disorders.

Bipolar disorder may be described as a type of depression where an individual exhibits extreme temperaments. Also known as maniac-depressive illness, the mood swings corresponds to a high peak and a lowest low. Although bipolar disorder affects both men and women, it is women who are greatly affected by it and require special care. Research has also shown that women are more likely to develop bipolar II, in which there is no severe mania, and where depression is alternated with mild hypomania. Women with bipolar disorder, experience maniac or depressive episodes just before their periods or after childbirth. It has been observed that over sixty six percent of women suffering from bipolar I, which is severe and involves extreme maniac episodes, experience regular mood changes, during menstrual or premenstrual periods. However symptoms of bipolar disorders in women are difficult to be identified as most of these are perceived as hormonal change based mood swings.

When women elate to a maniac state, they become abnormally cheerful and outgoing. The National Institute of Mental Health points out that maniac mood changes can also get women easily agitated and erratic which might well be perceived as premenstrual syndrome (PMS). When experiencing maniac episodes women exhibit illogical behaviors like for instance wipe out an entire credit card in one binge shopping. Women might also engage in sudden sexual encounters with strangers or be unusually interested in sex. Women in maniac state would not easily get sleep too (Rutherford, 2010). Compared to maniac mood changes, the depressive mood changes are easy to be recognized in women. They become abnormally anxious, coping with a feeling of emptiness and seek a meaning for their lives. There is a sense of withdrawal, losing interests in most things they do, like rejecting the sexual advances of their partners. The depressive behavior of women includes regular complaints of being tired, unable to think or concentrate, changes in eating or sleeping patterns. An important aspect of bipolar disorder in women is that the disorder is exhibited in several ways. While some women experience long periods of mania or depression, some others may shuttle briefly between the two. They would feel very normal for most of the time.

Women in their childbearing age are at a risk for bipolar disorder, as this disorder is evident in their early adulthood, and persist throughout their life. Pregnancy and childbirth considerably affect the symptoms of bipolar disorder. Among women affected by bipolar disorder, it has been observed that pregnant women and women who have just delivered are about seven times more likely to be hospitalized compared to women who are not pregnant or delivered recently.  Also the risk of recurring is twice in this category of pregnant and new mothers. Another important aspect of bipolar disorder is the rapid cycling. The American Psychiatric Association (APA) manual states that rapid cycling is when a person experiences four or more episodes of mood swings in a year. Each episode or swing can include depression, mania or mixed condition. Researchers have not been able to conclusively point out as to why women, succumb to rapid cycling. It is however suspected to be associated with changes in hormone levels and thyroid activity. It must be noted here that women receiving anti-depressant therapy are susceptible to mania too. When antidepressants are used in the treatment of bipolar disorder, they need to be always accompanied by a mood stabilizer (Croft, 2010).

Lithium is vital in the treatment of bipolar disorder. Taking lithium during pregnancy can at times be life saving for the mother. Lithium also has fewer risks to the developing fetus than most other medications. Women should ensure sufficient hydration when taking lithium to prevent lithium toxicity in themselves and in the fetus. Lithium levels also need to be carefully monitored particularly during delivery and its aftermath. This would prevent occurrence of relapse in mother and also indicate high levels in infants. Women who breastfeed their infants should realize that lithium is also secreted in their milk. Therefore mothers taking lithium should have their breast fed infants monitored for lithium in their blood. However, bipolar medications including that of lithium are not recommended during pregnancy as it might lead to birth defects or other complications. Electroconvulsive therapy (ECT) is recommended in such cases as an alternative and safe procedure (Miller, 1994).

The mood stabilizing drugs taken for bipolar disorder in women are associated with reproductive problems like polycystic ovary syndrome. This condition is associated with female hormones and bears the risk of infertility, diabetes and even heart disease and uterus cancer.  Clinical psychiatrist Michael Anonson MD, of WebMD suggests that women should not take lithium or other medications of bipolar disorder, either prior or during pregnancy. According to him, pregnancy itself can stabilize bipolar condition while it can destabilize at other times (WebMD, 2010). ECT is recommended for pregnant women. The symptoms associated with bipolar disorder considerably worsen during perimenopause and menopause. This normally happen about five to ten years before menopause the period also described as perimenopause. Extreme mood swings prevail during these periods. The hormone fluctuations associated with perimenopause and menopause is known to induce mood disorders in women. When women already have anxiety disorders, bipolar disorder etc, there is an increase of symptoms during these periods. In perimenopause, estrogen levels fall and women become susceptible to depressive symptoms. Rapid and dramatic mood swings are associated with menopause although the maniac and depression observed would be less intense compared to that in bipolar disorder. Mood studies during menopause have shown an increased risk of depression during perimenopause and a lesser risk in the postmenopausal years.

Although bipolar disorder is an equal opportunity condition striking both men and women similarly, there is an over representation of women seeking treatment. The development and course of bipolar disorder is different in men and women. The disorder tends to occur later in women compared to men, but has a pronounced seasonal pattern of mood disturbance. The episodes of depression, mania and rapid cycling are more experienced by women than men. Bipolar II, which is characteristic of depressive episodes, is also very common in women than in men. Comorbidity of disorders is also more evident in women and impairs recovery from bipolar disorder. Comorbidity associated with thyroid, obesity and anxiety disorders are frequent and common in women while substance-based disorders are evident in men. Most often bipolar disorder in men is wrongly perceived as depression or other mental illnesses and treated appropriately, only to further devastate the mans work and social life. Men take to substance abuse to ride over their uncomfortable symptoms of depression or mania.
Alcohol and drug abuse not only mask the symptoms in men but may also interfere with the treatment and medications prescribed. Although there is no evidence that gender is relevant to mood stabilizer treatment, the clinical features of bipolar disorders are different in men and women.

A major study of the gender differences in the diagnosis and treatment of bipolar disorder was carried out recently which was published in the Australian and New Zealand Journal of Psychiatry. The study touched over hundred references including case studies from 1966 and databases of Medlife, Psychinfo and Pubmed. The notable findings of the study include

Bipolar I is equally seen in men and women, but bipolar II, which has milder hypomania but increased depression is more prevalent in women.

Women are three times more likely to develop cormorbid conditions. Alcoholism and anxiety disorders are prominent and common cormorbid conditions.

Women are more likely to experience rapid cycling.

Although bipolar disorder is known to develop across gender lines, its effects on women are predominant. The exact cause of bipolar disorder is not yet clear, although experts have established that the condition develops as a consequence of multiple factors. A genetic aspect has also been correlated to the disorder, with an individual being at risk when a family member has the disorder. Among identical twins too, when one develops bipolar disorder, the other is at high risk for developing the same. The treatment for bipolar disorder has come a long way, but at least with regard to women, much remain to be done.