Bipolar disorder is among the earliest known ill health conditions and has a notable developmental history. There is a mention of the related symptoms in the early medical records. Bipolar disorder was first noticed in the second century when Aretaeus of Cappadocia in ancient Turkey, identified symptoms of mania and depression, and expressed an opinion that there could be a link between the two. German psychiatrist Karl Leonhard in the early 1950s with his associates developed a classification system, which used the term ‘bipolar’ emphasizing the difference between unipolar and bipolar depression. With regard to medications in the treatment of bipolar disorder, the Australian physician John Cade deserves a special mention. In 1949, he introduced lithium in psychiatry after he accidentally observed that lithium urate calmed down guinea pigs. Since then, lithium has been one of the most effective medications in treating mood disorders.
Bipolar disorder may be described as a type of depression where an individual exhibits extreme temperaments. Also known as maniac-depressive illness, the mood swings corresponds to a high peak and a lowest low. Although bipolar disorder affects both men and women, it is women who are greatly affected by it and require special care. Research has also shown that women are more likely to develop bipolar II, in which there is no severe mania, and where depression is alternated with mild hypomania. Women with bipolar disorder experience maniac or depressive episodes just before their periods or after childbirth. It has been observed that over sixty six percent of women suffering from bipolar I, which is severe and involves extreme maniac episodes, experience regular mood changes, during menstrual or premenstrual periods. However symptoms of bipolar disorders in women are difficult to be identified as most of these are perceived as hormonal change based mood swings.
Bipolar disorder may be described as a type of depression where an individual exhibits extreme temperaments. Also known as maniac-depressive illness, the mood swings corresponds to a high peak and a lowest low. Although bipolar disorder affects both men and women, it is women who are greatly affected by it and require special care. Research has also shown that women are more likely to develop bipolar II, in which there is no severe mania, and where depression is alternated with mild hypomania. Women with bipolar disorder experience maniac or depressive episodes just before their periods or after childbirth. It has been observed that over sixty six percent of women suffering from bipolar I, which is severe and involves extreme maniac episodes, experience regular mood changes, during menstrual or premenstrual periods. However symptoms of bipolar disorders in women are difficult to be identified as most of these are perceived as hormonal change based mood swings.
Women in their childbearing age are at a risk for bipolar disorder, as this disorder is evident in their early adulthood, and persist throughout their life. Pregnancy and childbirth considerably affect the symptoms of bipolar disorder. Among women affected by bipolar disorder, it has been observed that pregnant women and women who have just delivered are about seven times more likely to be hospitalized compared to women who are not pregnant or delivered recently. Also the risk of recurring is twice in this category of pregnant and new mothers. Another important aspect of bipolar disorder is the rapid cycling. The American Psychiatric Association (APA) manual states that rapid cycling is when a person experiences four or more episodes of mood swings in a year. Each episode or swing can include depression, mania or mixed condition. Researchers have not been able to conclusively point out as to why women, succumb to rapid cycling. It is however suspected to be associated with changes in hormone levels and thyroid activity. It must be noted here that women receiving anti-depressant therapy are susceptible to mania too. When antidepressants are used in the treatment of bipolar disorder, they need to be always accompanied by a mood stabilizer.
Lithium is vital in the treatment of bipolar disorder. Taking lithium during pregnancy can at times be life saving for the mother. Lithium also has fewer risks to the developing fetus than most other medications. Women should ensure sufficient hydration when taking lithium to prevent lithium toxicity in themselves and in the fetus. Lithium levels also need to be carefully monitored particularly during delivery and its aftermath. This would prevent occurrence of relapse in mother and also indicate high levels in infants. Women who breastfeed their infants should realize that lithium is also secreted in their milk. Therefore mothers taking lithium should have their breast fed infants monitored for lithium in their blood. However, bipolar medications including that of lithium are not recommended during pregnancy as it might lead to birth defects or other complications. Electroconvulsive therapy (ECT) is recommended in such cases as an alternative and safe procedure.
Although bipolar disorder is an equal opportunity condition striking both men and women similarly, there is an over representation of women seeking treatment. The development and course of bipolar disorder is different in men and women. The disorder tends to occur later in women compared to men, but has a pronounced seasonal pattern of mood disturbance. The episodes of depression, mania and rapid cycling are more experienced by women than men. Bipolar II, which is characteristic of depressive episodes, is also very common in women than in men. Comorbidity of disorders is also more evident in women and impairs recovery from bipolar disorder. Comorbidity associated with thyroid, obesity and anxiety disorders are frequent and common in women while substance-based disorders are evident in men. Most often bipolar disorder in men is wrongly perceived as depression or other mental illnesses and treated appropriately, only to further devastate the man’s work and social life. Men take to substance abuse to ride over their uncomfortable symptoms of depression or mania. Alcohol and drug abuse not only mask the symptoms in men but may also interfere with the treatment and medications prescribed. Although there is no evidence that gender is relevant to mood stabilizer treatment, the clinical features of bipolar disorders are different in men and women.
