Women with Bipolar Disorder

Bipolar disorder is a mood disorder with distinct periods of extreme euphoria and energy (mania) and sadness or hopelessness (depression). It's also known as manic depression or manic depressive disorder.

Bipolar disorder occurs with similar frequency in men and women. But there are some differences between the sexes in the way the condition is experienced.

For example, a woman is likely to have more symptoms of depression than mania. And female hormones and reproductive factors may influence the condition and its treatment.

Research suggests that in women, hormones may play a role in the development and severity of bipolar disorder. One study suggests that late-onset bipolar disorder may be associated with menopause. Among women who have the disorder, almost one in five reported severe emotional disturbances during the transition into menopause.

Studies have looked at the association between bipolar disorder and premenstrual symptoms. These studies suggest that women with mood disorders, including bipolar disorder, experience more severe symptoms of premenstrual syndrome (PMS).

Other research has shown that women whose disorders are treated appropriately actually have less fluctuation in mood over the course of the menstrual cycle.

The greatest evidence of a hormonal association with bipolar disorder is found during pregnancy and the postpartum period. Women with bipolar disorder who are pregnant or have recently given birth are seven times more likely than other women to be admitted to the hospital for their bipolar disorder. And they are twice as likely to have a recurrence of symptoms.

Bipolar Disorder Treatment

Treatment for bipolar disorder is targeted at stabilizing mood to avoid the consequences of both the manic and depressive states. In most cases, long-term treatment is required to relieve and prevent bipolar disorder symptoms.

Treatment often involves medication and talk therapy. Drug treatments include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Carbamazepine (Carbatrol, Equetro, Tegretol)
• Cariprazine (Vraylar)
• Divalproex sodium) (Depakote)
• Lamotrigine (Lamictal)
• Lithium (Lithobid)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Symbyax (olanzapine-fluoxetine combination)
• Valproic acid (Depakene, Stavzor)
• Ziprasidone (Geodon)

Some of these drugs carry a warning that their use may rarely increase the risk of suicidal behavior and thoughts in children and young adults. New or worsening symptoms, unusual changes in mood or behavior, or suicidal thoughts or behavior need to be monitored.

Treatment During Pregnancy

Treatment for bipolar disorder is generally the same for men and women. But special treatment considerations are necessary for some women, particularly during pregnancy.

While it is crucial that women continue treatment during pregnancy, risks to the baby are also considered. So treatment regimens may change to minimize risk.

In general, doctors prefer lithium and older drugs such as haloperidol (Haldol), as well as many available antidepressants, during pregnancy. That's because these drugs have a proven track record and more safety data than the newer drugs,

If women choose to try stopping treatment during pregnancy, doctors often use these drugs if treatment must be resumed. A number of newer atypical antipsychotic medications have been studied during pregnancy and, to date, have demonstrated no known risks for birth defects or developmental abnormalities.

Some drugs, such as valproic acid and carbamazepine, have been shown to be harmful to babies and contribute to birth defects. If a woman taking valproic acid discovers they are pregnant, their doctor may change their medication or adjust the dosage and prescribe folic acid to help prevent birth defects affecting the development of baby's brain and spinal cord.

Most experts avoid carbamazepine during pregnancy unless there are no other options. Carbamazepine not only poses risks to the unborn baby, but can also cause complications such as a rare blood disorder and liver failure in the mother, particularly if begun after conception.

Some drugs taken in late pregnancy may cause the baby to experience abnormal muscle movements, called extrapyramidal signs (EPS), or withdrawal symptoms at birth. The drugs include antipsychotics such as aripiprazole (Abilify), haloperidol (Haldol), risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa).

The symptoms for the baby may include:

• agitation
• abnormally increased or decreased muscle tone
• sleepiness
• difficulty breathing and feeding
• involuntary muscle contractions or twitching

In some babies, these symptoms go away within hours or days on their own. Other babies may need to stay in the hospital for monitoring or treatment.

In general, doctors try to limit the amount of medications a developing baby is exposed to during pregnancy. That is because even among drugs that have no known risk to the fetus, there are always unknown risks, which can be minimized by keeping an existing medicine whenever possible rather than adding new ones.

Other Treatment Considerations for Women

Girls and young women who are taking valproic acid should see their doctors regularly for monitoring. That's because the drug may rarely increase levels of the male hormone testosterone and lead to polycystic ovary syndrome (PCOS). PCOS is a condition that affects the ovaries and leads to obesity, excess body hair, and irregular menstrual cycles.

The use of lithium may lead to low levels of thyroid hormone in some people, which can affect symptoms of bipolar disorder. If thyroid hormone is low, thyroid hormone medication is needed. Other side effects of lithium include:

• drowsiness
• dizziness
• frequent urination
• headache
• constipation

When symptoms are especially severe or require urgent treatment, electroconvulsive therapy (ECT) may provide a safer option than medications for their unborn babies. During ECT, doctors monitor the baby's heart rate and oxygen levels for potential problems, which can be treated if necessary.

Pregnant women and women in the postpartum period who have bipolar disorder may also benefit from:

• psychotherapy
• stress management
• regular exercise

For women who are considering having a baby, it is important to work with their doctors well before conceiving to develop the best treatment during conception, pregnancy, and new motherhood. Because unplanned pregnancies can occur, all women of childbearing potential should speak to their doctors about managing bipolar disorder during pregnancy, regardless of their plans for motherhood.

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