"Don't you Know That It's Different for Girls?"

Anyone else out there remember the 30 year old pop song? Joe Jackson may not have been singing about bipolar disorder, but it seems that bipolar is, indeed, "different for girls". Although men and women experience the same rate of bipolar disorder, women are more likely to be misdiagnosed and to take longer to get a correct diagnosis. According to The Black Dog Institute, a leading bipolar research organization, this is because women:

1. Have more mixed episodes than men
2. Are more likely to be rapid-cyclers
3. Have higher rates of anxiety disorders, and
4. Have more episodes of depression than men.

Assuming you are a woman with a reliable diagnosis of bipolar disorder, what other differences should you be aware of? A major issue is differences in how medications may work for you:

1. Recent studies suggest women may need smaller doses than men.

2.Tegretol (carbamazepine) may cause oral contraceptives to be less effective. Alternative or back-up methods of contraception should be considered.

3. Typical antipsychotics such as Thorazine may raise prolactin levels. Prolactin is the hormone that causes lactation so that women can breast-feed after giving birth, and is also a mood regulator. Elevated prolactin levels can cause side effects such as visual problems or disrupted menstrual cycles.

4. The atypical antipsychotics such as Seroquel, Clozapine, and Geodon can also disrupt the menstrual cycle, but are less likely to do so than the older "typicals".

5. Most mood stabilizers (the classic being lithium) are thought to increase risk of birth defects. However, this DOES NOT mean women should stop taking mood stabilizers as soon as they discover they are pregnant. Talk to your doctor immediately instead.

We have talked previously about the special issues facing teenage girls who take Depakote (valproic acid). According to the National Institute of Mental Health (NIMH): "Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Young girls and women taking valproic acid should be monitored carefully by a doctor." Finally, women have to carefully consider their medication if pregnant or breastfeeding.

In closing, consider this research finding. We mentioned that women are more likely to be misdiagnosed, but there is also a gender bias in the form that misdiagnosis takes. Research from the Depression and Bipolar Support Alliance (DBSA) in 2000 showed this gender bias - women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia.