Bipolar disorder, once known as manic depression, is a mental health condition that is characterized by significant fluctuations in mood. People with bipolar disorder often find themselves experiencing extreme highs (‘mania’) and extreme lows (‘depression’).
While anyone can experience bipolar disorder, there are certain ways that the mood disorder affects females differently. In this article, we’ll explore bipolar disorder in females, including:
- What is bipolar disorder and different types
- Common signs and symptoms
- Ways that bipolar can affect females differently
- Treatment options for managing bipolar disorder.
Before we begin, we’d like to acknowledge that sex and gender exist on spectrums. For the sake of this article, we will be using the terms ‘male’ and ‘female’ to refer to sex assigned at birth.
What is bipolar disorder?
Bipolar disorder is a chronic mental health condition that involves significant mood changes, from extreme highs to extreme lows. It affects more than 5 million Americans each year.
During mood changes, or episodes, people with bipolar disorder might find themselves feeling or behaving differently than usual. These episodes can last anywhere from days to weeks or months. Mood changes in bipolar disorder include:
- Manic episodes: Feeling extremely euphoric, excited, or high.
- Hypomanic episodes: These involve the same symptoms as mania but at a lower severity.
- Depressive episodes: Feeling extremely low, hopeless, or sad.
Most people begin to experience bipolar disorder symptoms during teenage years or early adulthood, however it can also develop later on in life. Bipolar disorder is more common in females than males.
Symptoms of bipolar disorder
The main symptoms of bipolar disorder are mania, hypomania, and depression. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a person needs to experience at least one episode of mania or hypomania to be diagnosed with bipolar disorder.
Let’s look at the different bipolar symptoms in more detail.
Symptoms of mania and hypomania
Symptoms of mania or hypomania (a less intense form of mania) include:
- Feeling unusually elated or euphoric, even when you’re in a tough situation
- Increased energy
- Having lots of new and exciting ideas
- Jumping rapidly from one idea to the next
- Racing thoughts
- Talking at an unusually fast pace
- Hearing voices that others can’t hear
- Feeling more jumpy or irritated than usual
- Having an inflated sense of self-confidence
- Being easily distracted and struggling to concentrate
- Not wanting to sleep or being unable to sleep
- Believing you can do much more than is realistically possible
- Making spontaneous or risky decisions without thinking them through.
During a manic episode, many people feel like they can do anything. This often leads to impulsive actions and behaviors that could have harmful effects, including:
- Spending excessive amounts of money
- Quitting your job suddenly
- Having casual sex with lots of different people
- Driving well above the speed limit
- Misusing alcohol and drugs
- Making a big investment on an impulse
- Going on a trip without telling anyone.
Of course, participating in these behaviors doesn’t always mean you are experiencing mania. What’s notable about manic episodes is that people wouldn’t normally partake in these activities when their mood is stable.
Symptoms of depression
Many people with bipolar disorder will also experience depressive episodes, sometimes referred to as bipolar depression. In one review, 75% of females experienced a depressive episode as the first sign of bipolar disorder, compared with 67% of males.
Symptoms of depression in bipolar disorder include:
- Persistent low mood
- Lack of energy
- Feeling slower or more restless than usual
- Feelings of hopelessness, worthlessness, or emptiness
- Feelings of guilt
- Lack of interest in activities you normally enjoy
- Oversleeping or experiencing insomnia
- Difficulty concentrating, remembering, or making decisions
- Changes in appetite
- Gaining or losing weight without meaning to
- Thoughts of death, dying, or suicide.
Similar Reading: Morning Depression: Everything You Need to Know. Symptoms & Treatment
Symptoms of psychosis
Some people with bipolar disorder might experience psychosis during severe episodes of mania or depression. This is a difficulty distinguishing what’s real and what’s not. Symptoms of bipolar psychosis include:
- Hallucinations: Seeing, hearing or feeling things that aren’t there
- Delusions: Believing things that others may find unusual or untrue.
The way psychosis symptoms present can differ depending on whether they appear during a manic or depressive episode. During a manic episode, for example, people may feel they have special powers or are being watched by the government. During a depressive episode, a person may feel overwhelmed by guilt over something they think they have done.
Types of bipolar disorder
There are two main types of bipolar disorder:
- Bipolar I: This involves at least one full manic episode that lasts for at least a week. It can also include psychosis or depression, however this is not needed for diagnosis. This type of bipolar disorder affects both males and females equally.
- Bipolar II: This involves at least one episode of hypomania, a less intense form of mania, that lasts at least four days, as well as at least one depressive episode that lasts around two weeks. People with bipolar II disorder also experience periods of stable moods in between, but they do not experience full manic episodes. This type of bipolar disorder is experienced more often in females.
Cyclothymic disorder, or cyclothymia, is another type of bipolar disorder. This involves periods of hypomanic symptoms and periods of depressive symptoms that don’t meet the full criteria for hypomania or major depression. Cyclothymia is less severe than bipolar I or bipolar II, but can still affect daily function.
How bipolar disorder can be different for females
While bipolar disorder can affect anyone, there are some ways that it can be different for females compared to males. Below, we’ll look at some of the ways that bipolar disorder can affect females differently.
More depressive symptoms
Research shows that females are more likely to experience bipolar II disorder than males. This is the type of bipolar disorder that involves depression and hypomania. Some research also suggests that females are twice as likely to experience depression as males. They are also more likely to experience psychosis with depression.
Because depressive symptoms can be more dominant in females, women with bipolar disorder are often incorrectly diagnosed with depression.
See More: 10 Tips for Finding Motivation When You’re Depressed
Different symptom patterns
Bipolar disorder symptom patterns can be different for females compared to males. For example, some research suggests that females are more likely to experience mixed episodes in bipolar disorder. This is when both ‘high’ and ‘low’ symptoms are felt at the same time, in other words, experiencing both mania and depression together.
Females are also more likely to experience rapid cycling, which is when moods fluctuate quickly within a short period of time. One 2015 review found that 30% of females with bipolar disorder experience rapid cycling compared with around 16% of males.
Response to seasons
The same 2015 review found that females are more likely to require hospitalization for bipolar disorder during the spring and fall months. This is different to males, whose symptoms tend to worsen in the spring.
Higher suicide risk
Another finding in the 2015 review is that females with bipolar disorder were twice or three times as likely to attempt suicide compared to males with bipolar disorder.
In a different study, researchers examined the risk of suicide in males and females with bipolar disorder and identified the following predictors of suicide risk in females:
- Experiencing frequent mixed episodes (simultaneous symptoms of mania and depression) over a lifetime
- Developing psychiatric symptoms earlier in life
- Having a personality disorder as well as bipolar disorder
- Experiencing ‘social problems’ in close relationships.
The same study found that, for males, a key predictor of suicide risk was substance abuse.
Links with other conditions
One 2012 review suggests that females with bipolar disorder may have a greater genetic predisposition to alcohol use disorder (AUD). Another study in 2010 found that they’re also more likely to experience eating disorders than males.
Other health conditions and factors more commonly associated with bipolar disorder in females include:
- Borderline personality disorder (BPD)
- Obesity
- Impulse control disorder
- Migraines
- Thyroid disease
- A history of physical or sexual abuse.
Keep Reading: How Alcohol Makes Your Depression Symptoms Worse
Social impact
As well as clinical differences, research also shows that females with bipolar disorder experience different social effects.
In one 2014 review, females were more likely than males to experience:
- Relationship changes
- Stigma and isolation
- Loss of self-determination
- Feeling misunderstood by healthcare professionals and others
- Pressure to appear ‘normal’ or suffer potential consequences, such as losing custody of children.
How bipolar disorder can affect menstruation, menopause, and pregnancy
Research shows that menstruation, menopause, and pregnancy can have some effects on how females experience bipolar disorder. Let’s take a look at some of these potential changes.
Bipolar disorder and menstruation
Females might experience worsened bipolar symptoms before their menstrual cycle. In one 2015 review, it was found that premenstrual depression affected ¼ of females with bipolar disorder. One potential reason for this is that the hormones which appear around menstruation can slightly reduce the effectiveness of lithium, a common bipolar medication.
Bipolar disorder and menopause
The same 2015 review found that bipolar disorder symptoms, especially depression, worsen around menopause for 20% of females. Women over 40 may require higher doses of bipolar medication compared to younger females, however those using hormone-based treatments for menopause symptoms seem less likely to experience worsened symptoms. These findings suggest a potential link between declining estrogen levels and worsening bipolar symptoms.
Bipolar disorder and pregnancy
Some research into bipolar disorder for females found that:
- ⅓ of women experience symptoms around the time of childbirth
- 20-30% experience psychosis after delivering a baby
- More than a third of females with bipolar first experience symptoms in weeks after delivery
- 10-20% experience hypomania after delivery
- There’s a 24-40% chance of bipolar symptoms returning in the weeks after childbirth.
Another study concluded that becoming a new parent was a factor in females experiencing severe episodes. It was not the same case for males, suggesting that hormones play a role in bipolar episodes. Researchers also considered that females were more likely to experience sleep issues as a new parent compared to males, which may also play a part.
If you’re a female with bipolar disorder and are pregnant or planning to conceive, be sure to reach out to your mental health provider to discuss any potential effects or changes to your treatment. Seeking support early on can be essential in maintaining your mental wellbeing after childbirth.
Treatment options for bipolar disorder
While there is no cure for bipolar disorder, there are various treatment options that can provide relief and help improve mental wellbeing for women with bipolar disorder. For the best results, bipolar treatment requires careful and ongoing management.
Treatments may differ depending on a person’s specific symptoms. Generally, however, treating bipolar disorder involves:
- Medication
- Psychotherapy
- Alternative therapies.
Bipolar treatment for females may be different to males due to:
- The effects of menstruation, menopause, and pregnancy on bipolar disorder
- The effects of medication on birth control
- Considerations around pregnancy and breastfeeding
- Higher risk of other conditions, such as thyroid disorder
- Increased risk of depressive symptoms.
Medication
Medication is usually the first line of treatment for bipolar disorder and helps to stabilize mood immediately. During an initial consultation, your mental health provider will assess your symptoms and prescribe a medication that suits your specific needs. They’ll then work with you on an ongoing basis to adjust medications and dosage to ensure you’re getting the results you need.
Bipolar medications can include one or a combination of:
- Mood stabilizers: These help control mania and hypomania. Examples include lithium (Lithobid), valproic acid (Depakene), and carbamazepine (Tegretol).
- Antipsychotics: These are often prescribed when symptoms of mania or depression don’t go away. They include olanzapine (Zyprexa), quetiapine (Seroquel), or aripiprazole (Abilify) and can be given alone or with a mood stabilizer.
- Antidepressant: These can be used to help manage depression. Because they can sometimes trigger manic episodes, antidepressants are usually prescribed along with mood stabilizers or antipsychotics.
It’s important to know that everyone is different, and finding the right medication for you can take some trial and error. It can also take weeks or months for medications to take full effect, requiring a certain degree of patience. If a medication doesn’t work for you, or you experience side effects, be sure to let your medication management provider know and they can adjust dosages or prescribe different medications.
See More: Mood Stabilizers for Depression and Anxiety: What You Need to Know?
Psychotherapy
Psychotherapy, also known as talk therapy, can also be helpful in treating bipolar disorder alongside medications. Talk therapy can help you learn how to cope with stressors or think differently about your life. Types of psychotherapy include:
- Cognitive behavioral therapy (CBT): This focuses on recognizing negative beliefs and behaviors and replacing them with healthy, positive ones.
- Interpersonal and social rhythm therapy (IPSRT): This focuses on stabilizing a daily routine, which can be helpful for bipolar disorder.
- Psychoeducation: This involves learning about bipolar disorder to better understand the condition.
Alternative therapies
Another way to treat bipolar disorder is with alternative therapies. These include:
- Electroconvulsive therapy (ECT): This involves passing electrical currents through the brain to trigger a brief seizure. This can change the brain chemistry and help reverse symptoms of mental illness. ECT might be prescribed for you if you don’t find relief through medication, experience side effects, or at a high risk of suicide.
- Transcranial magnetic stimulation (TMS): This involves using MRI-strength magnetic pulses to stimulate areas of the brain that are underactive in people with depression. It is non systemic and doesn’t require any anesthesia or sedation. TMS therapy shows promising results for those who don’t respond to antidepressants or experience side effects.
Continue Reading: How to Find & Choose a Good Psychiatrist for You
Seek support for bipolar disorder
If you’re seeking relief from bipolar disorder, the compassionate team at BestMind Behavioral Health is here to support you every step of the way. We understand that mental health conditions affect everyone differently and are committed to providing personalized care that meets your individual needs.
Whether you prefer the convenience of telemedicine or the comfort of an in-person visit at our clinics in Colorado and Oregon, we’re here to help. Reach out to us today to schedule an initial appointment, support is just a call or click away.
