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Bipolar Disorder and Women's Health

There have been many claims in the scientific literature that Bipolar Disorder presents differently in women than in men [ref], but many of these claims have been based on small studies and remain inconclusive. There is good evidence that women tend to be diagnosed with Bipolar II Disorder more often than men, but otherwise there is no clear proof of any other important gender differences in Bipolar Disorder [ref].

However, it does appear that women with Bipolar Disorder will experience more symptoms during times of hormonal changes, such as in their pre-menstrual periods, following the birth of a child, and during menopause [ref].

Bipolar Disorder and Pregnancy

Among women with Bipolar Disorder, pregnancy seems to be a sensitive period when moods can destabilize. As many as 70% of expecting mothers with Bipolar Disorder will experience a mood episode (Hypomanic, Manic, Mixed or Depressive Episode) during pregnancy, and this will often begin in the first trimester [ref].

The risk of an episode happening is twice as high among those women who discontinue their medications during pregnancy, and in these cases the Bipolar mood episode will occur earlier in the pregnancy and will tend to last five times longer compared with women who continue to take their medications [ref].

However, even among those women who continue their medications during pregnancy, about 25% will experience a relapse of their Bipolar Disorder during the pregnancy [ref].

Besides stopping one's medications, other factors that put women with Bipolar Disorder at risk for having a relapse during pregnancy include [ref]:

Having a Bipolar mood episode (Hypomanic, Manic, Mixed or Depressive Episode) during pregnancy brings a 60% chance of further mood instability in the postpartum period [ref].

Postpartum Bipolar Episodes and Postpartum Psychosis

As many as half of all women with Bipolar Disorder will experience a Bipolar mood episode (Hypomanic, Manic, Mixed or Depressive Episode) within the three or four weeks following delivery, and this will be more likely if they are not taking any medication [ref, ref].

Of special concern is something called Postpartum Psychosis, which is a Manic, Mixed or Depressive Episode that occurs shortly after delivery and that includes very pronounced psychotic features.  This can be dangerous because it can cause the mother to lose touch with reality and behave in unpredictable and potentially dangerous ways towards both herself and her infant. Postpartum Psychosis is quite common, and occurs most frquently among women with Bipolar Disorder when any of these situations are present [ref, ref]:

  • The woman had a Postpartum Psychosis in a previous pregnancy (in this case, there is a 50% chance that she will have a Postpartum Psychosis with each subsequent pregnancy)
  • She had a mood episode (Hypomanic, Manic, Mixed or Depressive Episode) during pregnancy [ref]
  • She experienced sleep deprivation after delivery
  • She had a markedly elevated or euphoric mood, or other manic symptoms, shortly after delivery
  • She was on Lithium but then abruptly discontinued it
  • She was in her first pregnancy [ref]
  • She experienced delivery complications [ref]

Fortunately, there are effective treatments for this condition, but the important point is that mothers who are at risk for a Postpartum Psychosis be monitored closely during the four weeks after delivery so that they can receive treatment immediately if the condition develops. Pregnant women who experienced episodes of Postpartum Psychosis following previous pregnancies should also be started on a treatment immediately after delivery, as explained here.

 

Bipolar Disorder in the Elderly

Overview of Treatments