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Am J Psychiatry 1996; 153:163-173
Copyright © 1996 by American Psychiatric Association
Women with bipolar illness: clinical and research issues
E Leibenluft
Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892-1390, USA.
OBJECTIVE: The purpose of this article is to review the literature
concerning gender differences in the course of bipolar illness and discuss
issues relevant to the treatment of women with the illness. METHOD: The
literature concerning the following topics is reviewed: gender differences
in the course of bipolar illness; effects of the female reproductive cycle
on the course of bipolar illness; special considerations in the treatment
of bipolar women (focusing on the hypothalamic-pituitary-gonadal and
hypothalamic-pituitary-thyroid axes); and hypotheses to explain the greater
prevalence of rapid cycling among bipolar women than among bipolar men.
RESULTS: Data clearly indicate that rapid cycling is more common among
bipolar women. Data also suggest that bipolar women may have more
depressive episodes (and fewer manic episodes) and may be more likely to
suffer from mixed (as opposed to pure) mania than bipolar men. While it is
clear that bipolar women are at high risk for postpartum episodes, the
effects of other reproductive system events (i.e., puberty, menstrual
cycle, pregnancy, menopause, use of oral contraceptives or hormone
replacement therapy) on the course or treatment of bipolar illness have
received little systematic study. It is unclear whether women are at higher
risk than men for developing lithium-induced hypothyroidism. Higher rates
of hypothyroidism, greater use of antidepressants, and gonadal steroid
effects are possible explanations for the greater prevalence of rapid
cycling among bipolar women. CONCLUSIONS: Gender differences in bipolar
illness and the effects of the female reproductive system on the course and
treatment of the illness deserve more study. The importance of a
longitudinal approach to these questions is emphasized.
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