Women With Bipolar Disorder
Posted byEranga Isaac
In this article
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:
- Abilify (aripiprazole)
- Carbatrol, Equetro, Tegretol (carbamazepine)
- Depakene, Stavzor (valproic acid)
- Depakote (divalproex sodium)
- Geodon (ziprasidone)
- Lamictal (lamotrigine)
- Lithobid (lithium)
- Risperdal (risperidone)
- Saphris (asenapine)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
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 Haldol
(haloperidol), as well as many available antidepressants during
pregnancy. That's because these drugs have shown less risk than some
other drugs to the unborn baby.
Also, because they
have been used for longer than the newer drugs, their effects in
pregnancy are better established. 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 she is pregnant, her
doctor may change her 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 Abilify (aripiprazole), Haldol
(haloperidol), Risperdal (risperidone), Seroquel (quetiapine), and
Zyprexa (olanzapine).
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 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 include:
- drowsiness
- dizziness
- headache
- constipation
For
women who prefer to avoid medications, electroconvulsive therapy (ECT)
may provide a safer option 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.
WebMD Medical Reference
Reviewed by
Joseph Goldberg, MD on July 08, 2014
© 2014 WebMD, LLC. All rights reserved.
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