Bipolar Disorder in Women

Bipolar Disorder (BD) also referred to a manic-depressive illness is a disorder that affects the brain and results in abnormal mood swings, high activity levels, and a lot of energy. The formal conceptualization of bipolar disorder was done by Emil Kraeplin more than a century ago and was initially called manic-depressive insanity. Symptoms such as change in moods and depression were however, identified long before the conceptualization (National Institute of Mental Health, 2016). Although there are four different types of this disorder, they all portray similar traits. The mood shifts change from extremely elated to periods of hopelessness called manic and depressive episodes respectively. This disorder has been ranked fifth in the causes of disability in the world and the ninth cause of wasted periods to death. It has also been found that bipolar disorder is common in blacks than whites and those suffering from it have a higher chance of committing suicide compared to the general population. 

The four types of bipolar disorders are bipolar I, bipolar II, cyclothymia, and other forms of disorders that show unique symptoms. The bipolar I disorder is characterized by manic episodes (high moods) that can be experienced for at least one week. Some severe manic symptoms may eventually require hospitalization of the victim. Similarly, the depressive episodes occur and may last for at least fourteen days (Psych Central Staff, n.d). On rare occasions, mixed depressive and manic episodes are observed on BD victims. The bipolar II disorder manifests depressive episodes and slight manic episodes. On the other hand, the cyclothymia shows a number of slight manic and many depressive episodes that can continue for more than one year. Lastly, the form forms of disorders show unique bipolar disorder symptoms that are different from those shown by the other three types of BD.

Bipolar disorder in women differs from that in men in various ways hence, the need for special consideration when handling it (Barnes & Mitchell, 2005). In women, the BD comes at an age when they are highly productive and many of them at this period have life stressors. Although there exist little difference in the time that the bipolar prevail between men and women, a number of clinical attributes give the difference in the genders. Women with BD undergo more episodes of depression when compared to other disorders that cause depression. A study by the America epidemiology showed a low prevalence rate of 0.42 % in men compared to a 0.47% in women. Another study has shown that a third of women who had BD temporarily suffered manic episodes as a result of childbirth. A review showed that more women who have children and suffer from BD experience postpartum mood fluctuations and they have a higher chance of undergoing the same episodes in the next pregnancy (Miller et al., 2015). Compared to other psychotic sicknesses, postpartum psychosis is highly linked with BD. Women who have BD have almost 30% rate of experiencing postpartum psychosis. Furthermore, women who are almost reaching or have already passed the menopause stage are likely to experience enhanced mood characteristics.

The psychotic symptoms such as delusions and hallucinations are sometimes experienced by individuals with severe manic episode (Black Dog Institute, 2012). The delusion symptoms are normally referred to as psychotic symptoms and they are an indication of bipolar I disorder when they occur with symptoms of manic episode. People who show psychotic symptoms should be monitored since it is an indication of severe episode and hospitalization of the patient might be the only option. Home environment do not provide favorable conditions for bipolar disorder patients who experience delusions since what they belief may put them or people around them in danger. When a person has manic episode, delusions can be grandiose or persecutory. Grandiose delusions makes a person have a false believe of possessing unique powers that no other person has or that they know some things that others do not know. The persecutory delusion on the other hand makes a person feel that someone wants to hurt them or someone close to them. Hallucinations in mania can be experienced through any organ such as eyes, ears, or by touch. The most common one in bipolar people is auditory where an individual hears voices that instructs them or call their names (Black Dog Institute, 2012). Other forms of hallucinations also occur for people suffering from bipolar disorder and these makes them restless.

A number of women who have BD first show symptoms of depression and most of them are often wrongly diagnosed with unipolar depression (Miller et al., 2015). Most women suffering from BD as compared to men have a high chance of getting a depression diagnosis hence, wrong medication. The reproductive cycle in women have a significant influence on how BD in women manifests itself. The mood disorder associated with bipolar usually worsens at some point of the reproductive cycle especially during the menopausal stage. No clear analysis has shown how the menstrual cycle affects the manifestation of the BD. Research has, however shown that hormones in women play a critical role in developing and the extent of the disorder. Menopause is known to have a significant influence in the late onset of the disorder and one in every five women with the disorder have reported case of high emotional disturbances when they were transiting to the menopause stage. Proper treatment results in less mood fluctuation during the menstrual period.

The treatment plan undertaken aims at ensuring that the moods are stabilized to prevent consequences associated with both depressive and manic episodes. The treatment should provide long-term solutions in relieving and preventing the symptoms of the disorder. Treating the depression symptoms by using antidepressants are known to increase the chances of mood recurrence. Use of mood stabilizers helps women to live healthy lives since they take advantage of the puerperal prophylaxis. Most women begin to experience BD in their 20s while men may experience much earlier. Due to the difference in the effects of BD on man and women, women tend to have a more disrupted social life as a result of enhanced confidence, distractibility, irritability and being too talkative factors (Demmo et al., 2016). Due to these conditions, women are frequently admitted for medication compared to men. The mood patterns in women are more seasonal and the depressive episodes are mostly experienced during winter.

Women with BD are more likely to have medical co-morbidity that may result to substance abuse such as alcoholism. Studies have shown that more women with BD tend to use drugs and this implies that substance abuse can be used as an indicator of BD in most women. Compared to women who do not have BD, women with BD have up to four times risk of alcoholism. Use of such drugs may lead to increased cycling and elongated recovery period among other diseases. It is common to have women who suffer from BD to be obese, have migraine, and thyroid ailments. Obesity in women is highly associated with greater episodes of depression especially when lithium is used for treatment. In most cases, women with BD have had incidences of sexual abuse and this result in worse occurrence of the disorder such as being experienced at an early age and suicidal thoughts. 

Assessing women with disorder involves an extensive exercise that includes analyzing their medical history and family history to determine if there exists a family case of BD. The assessment also includes checking individual’s mental status to ascertain the existence of psychotic features, mood, eating disorders, and drug abuse among other factors (Demmo et al., 2016). Women who have bipolar II disorder often show signs of depression and this necessitates keen analysis of medical history to identify cases of manic symptoms. The onset of BD in women is mainly during the teen stage and early 20s and this exposes them to high chances of developing episodes in their entire reproductive period. During pregnancy treatment is done through balancing the treatment and the risks of the ailments. Strict consideration is made on the woman’s reproductive stage when pharmacological treatment is used. Women in their adolescent stage should avoid taking medication that can cause PCOS. Managing BD during pregnancy has been a complex issue that many researchers have not been able to come up with a conclusive strategy.

Recommended treatment for women with BD should begin during the preconception period where family planning aspects are taken into account. Providing the necessary information to women who suffer from BD will help them make proper decisions regarding pregnancy. Details on the safe contraception mode should be relayed to the patient and the appropriate medicine to administer to already expectant BD women should be considered so as to keep both the mother and the fetus safe. A patient who needs to conceive should consider stopping the use of mood stabilizers if the general health condition is stable (Mei-Dan, Ray & Vigod, 2015). This, however, requires that a patient progressively stops the use of the stabilizers so as to allow assessment of how the body responds. Women who stop the medication during pregnancy only reintroduce it once they experience signs of relapse. It is advisable to use medicines that have the least effects. Close monitoring of pregnant BD women should be done since the changes that occur in their bodies result in modified, malformations, drug metabolism. If proper medication is not administered cases of low birth weight, malformations, and early deliveries are likely to occur. 

Many scientists have tried to analyze the possible causes of bipolar disorder and have agreed that no single factor can be attributed to it. They pointed out that several factors are known to cause the illness or enhance the risk of getting BD. Brain functioning and structure is one of the factors that contribute to people developing BD (National Institute of Mental Health, 2016). People with BD have different brains from those who have other disorders or do not have any mental disorder. Genetics have also been suggested to contribute to BD. Certain genes are more susceptible compared to others. This however, has been known to have other underlying factors since cases of one of identical twins developing BD have been reported despite both twins sharing same genes. It has also been found that BD runs down family trees and a child who has a parent with BD have high chances of developing the disorder. This does not imply that everyone in a family where a parent has BD develops the illness. 

Generally, treating pregnant women with BD require medication that contains lithium and Haldol. These are the few drugs that have been found to pose fewer risks to the fetus. Furthermore, these drugs have been used for quite a long time hence; effects on pregnancy have been clearly understood compared to new drugs. Other drugs like carbamazepine should be avoided because research has shown that it causes birth defects and other abnormalities. In cases where pregnancy occurs when under such medication, folic acid should be used to help the development of the child’s brain and spinal cord. Other than affecting the unborn child, the carbamazapine may cause liver failure and rare blood disorder to the victim especially if taken after conception. 

Other drugs may make the child get abnormal movement of the muscles or withdrawal symptoms if they are taken during the last few months of the pregnancy. Other signs that the baby may show include sleepiness, feeding and breathing problems, agitation, and abnormal change in muscle tone among others. These signs are known to disappear within few days or hours after birth. Few reported cases have required medical attention to get rid of them. Doctors have, therefore, always minimized the exposure of the baby to medications by ensuring that no medication is added on the existing ones during pregnancy. In cases where young women are using valproic acid, frequent monitoring is required to ensure that the chances of developing testosterone are minimized (McIntyre, 2015). When this male hormone happens to increase from the required level, the victim develops PCOS, which will affect the ovaries and eventually cause obesity and irregular menstruation cycle. Another treatment option for BD is electroconvulsive therapy. This treatment option is more effective compared to inhibitors although the disadvantage is that it can enhance depression symptoms associated with bipolar.

Women who have already given birth have a high risk of developing BD. More studies have focused on the postpartum stage compared to the pregnancy period because it is an essential period in the life of a pregnant woman. The chance of getting a bipolar relapse after giving birth has been found to be approximately 33%. The fact that some women get depressed after giving birth should not be taken lightly since some cases might be elevated depression. When the depressive episode becomes dominant, women in the postpartum stage get suicidal and this poses danger to themselves and people around them. Such instances can be reduced by administering lithium before delivery and taken for several months after delivery.

Rapid cycling in women with bipolar has a three times chance of occurrence in women than men. Rapid recycling shows cases where a person suffering from bipolar experiences episode of depression or mania within a year (Psych Central Staff, n.d). The rapid cycling in women has been explained by incidences of hypothyroidism, certain effects of gonadal steroids, and anti-depressant use. Although many women experience hypothyroidism than men, it is not necessarily the main cause of the rapid cycling. A research carried out on women with bipolar showed that 60% of those who had bipolar type I experienced regular changes in their moods during or before their menstrual cycle. Other than this, they were often angry and irritable. Use of anti-depressant as the only treatment for people with bipolar is not sufficient. Chances of developing manic episodes are enhanced if this medication is taken in isolation. The manic episodes caused by the anti-depressants are however, very moderate. Treating rapid cycling is, therefore, difficult since it may result in manic episodes when anti-depressants are used. Before getting a lasting solution, victims are advised to reduce the use of anti-depressants and increase mood-stabilizers.

Psychotherapy also referred to as talk therapy is another bipolar medication option than can be used. It gives support and guidance to individuals who have BD as well as their families on how to handle such people. Some of the treatments that are adopted in psychotherapy include family-oriented therapy, cognitive behavioral therapy (CBT), psychoeducation, and interpersonal rhythm therapy (National Institute of Mental Health, 2016). CBT helps an individual to overcome problems by changing their way of behaving and thinking. In most cases, it is used to treat depression. The underlying concept of this therapy is that thoughts and feelings of an individual have connections and this connection that can result in negative thoughts is broken by breaking down serious problems into portions that can be easily solved. CBT is primarily aimed at tackling current problems rather than past experiences and it tries to incorporate practical means that will enhance the status of an individual’s mind day by day. The advantage of using this therapy is that it is effective and the therapy sessions can be completed within a very short time upon strict adherence to the schedule. On the other hand, this therapy may not be suitable if the depressive episodes are too severe. The CBT can be in form of individual, group, self-help book, and computer program therapy.

The family-focused therapy combines two forms of psychotherapy. It focuses on teaching the family members about the illness and the support that the patient requires from other family members. It appreciates the efforts of the other members to understand the independent nature of the patient. It also identifies the differences that exit in a family and are likely to result in stressful conditions to the patient (McIntyre, 2015). Conflicts that are likely to stress a bipolar person are identified and efforts are made to ensure that their occurrence in the family set up is minimized. This provides a good chance for the bipolar person to concentrate on issues that makes him relaxed.

The interpersonal and social rhythm therapy adopts the fact that the body of a bipolar patient gets altered rhythms which result into mood swings. This therapy teaches the patient to keep a moods chart to track how their moods change on a daily basis. The chart is then analyst with a therapist and proper advice and medication given to help avoid reoccurrence of mood episodes. Bipolar disorder is known to affect more than 2% adults in the world but many people fail to treat it especially if they come from low and middle income countries. A study showed that only 33.9% of people from middle income countries who have had mental illness were able to get treatment compared to 50.2% in high income countries (Warner, 2011). Only 25.2 % in low-income countries were treated. The low rate of people receiving treatment in developing countries can be associated with expensive medical cost and lack of enough information about bipolar disorder. These statistics are alarming as many of them end up with permanent disabilities hence, cutting down their productive years.

Problems associated with Bipolar I disorder for manic episode include less sleeping hours and hyperactivity. A person tends to have too many movements and cannot remain still in a particular location for some time. Their emotional problems also show a sense of anger as most of their responses contain slight insults. Some also appear extremely excited and this may cause problems. Their emotional instability is displayed as they over-react to events and their emotions tend to change rapidly. They also become over talkative and changes from one topic to another. In their activities, they appear reckless and do not consider the consequences of their actions. They will participate in activities such as gambling. Furthermore, they show cognitive problems such as exaggerated appraisal of their worth, importance, power, and knowledge (Black Dog Institute, 2012). Concentration ability becomes low and can rarely focus on tasks since their attention is easily taken away. Even with knowledge of their problems, such people lack the motivation to make a change in their problems. The social problems include irresponsibility where they are unreliable, being careless, shifting blame, and disregarding corrections. They have impaired normal activities such as being unable to work, study or carry out household chores. 

For the depressive episode, the physical problems include fatigue where they always feel tired. They also sleep less or more and have abnormally low or high appetite. The overall health appears poor and most of their activities are interfered with. The emotional problems include depression with frequent and intense sense of hopelessness. Even without doing anything wrong, people suffering from bipolar disorder feel shameful and tend to have suicidal thoughts (Psych Central Staff, n.d). They lack interest in various things and have no motivation to undertake tasks that are expected of them. The cognitive problems associated with this depressive episode include inattentiveness and lack of curiosity. Socially, the bipolar victims have low self-esteem and they believe that they are useless. They are mainly pessimistic and lonely. When faced with conflicts, such people find it difficult to solve them and they become submissive. They will always prefer to be alone and are not likely to be involved in any sexual relationships.

In conclusion, bipolar disorder is one of the common mental illnesses that affect both men and women. BD causes mood swings and high amounts of energy that makes individuals fast-paced in talking and walking around. Research has shown that women get an early onset of BD compared to men and the characteristics it portrays in women are quite unique. The reproductive cycle of women has a significant influence on how the disorder manifests in women hence, the need for proper consideration when taking treatments (Barnes & Mitchell, 2005). BD can result in depressive or manic episodes with each portraying different symptoms. Women in the menopausal transition stage experience cases of frequent mood changes compares to those in the early stage of their reproductive lives. There are a variety of factors that have been found to cause BD or pose as risk factors for developing the disorder. 

Treating bipolar disorder in women is a complex task especially when pregnancy is involved. All the medications administered must be ensured that they are safe for both the mother and the unborn child. Women with bipolar disorder and already use anti-depressants to stabilize their moods may opt to continue the medication or stop it once they become pregnant. Those who manage to progressively stop the use of the anti-depressants only reintroduce them once they get bipolar relapse. Lithium has been found to be the best medication for pregnant women with bipolar because unlike other drugs, they do not cause birth defects such as low birth weight or malformation which are known to occur when other medications are used.

Cases where BD is discovered when a woman is already pregnant are more difficult to handle. This is because getting the right medication that will not affect the mother and the child amid the various changes in the body is difficult. Once a woman becomes pregnant, the body experiences a number of changes that eventually changes the drugs metabolism hence, complicating treatment of bipolar disorder. Such women should be regularly monitored to ensure that the administered drug is suitable and no effects are experienced. Women who have given birth should also be taken care of to ensure that they do not develop severe depression as most women are known to develop depression as a result of childbirth. Just like during pregnancy, the postpartum period is crucial in women especially those already diagnosed with bipolar disorder. Other medical options include psychotherapy and electroconvulsive theory.

References

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Black Dog Institute (2012). Fact sheet: Bipolar disorder symptoms. Retrieved from <http://www.blackdoginstitute.org.au/docs/Symptomsofbipolardisorder.pdf/>

Demmo, C., Lagerberg, T. V., Aminoff, S. R., Hellvin, T., Kvitland, L. R., Simonsen, C., & ... Ueland, T. (2016). History of psychosis and previous episodes as potential explanatory factors for neurocognitive impairment in first-treatment bipolar I disorder. Bipolar Disorders , 18 (2), 136-147

McIntyre, R. S. (2015). Evidence-Based Treatment of Bipolar Disorder, Bipolar Depression, and Mixed Features. Journal Of Family Practice , S16-S23.

Mei-Dan, E., Ray, J. G., & Vigod, S. N. (2015). Perinatal outcomes among women with bipolar disorder: a population-based cohort study. American Journal Of Obstetrics & Gynecology , 212 (3), 367

Miller, L. J., Ghadiali, N. Y., Larusso, E. M., Wahlen, K. J., Avni-Barron, O., Mittal, L., & Greene, J. A. (2015). Bipolar Disorder in Women. Health Care For Women International , 36 (4), 475-498

National Institute of Mental Health (2016). Bipolar disorder. Retrieved from <https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml/>

Psych Central Staff (n.d). Women and Bipolar Disorder. Retrieved from <http://psychcentral.com/lib/women-and-bipolar-disorder/?all=1/>

Warner, J. (2011). Bipolar Disorder Often Untreated. Retrieved from <http://www.webmd.com/bipolar-disorder/news/20110306/bipolar-disorder-often-untreated/>