Women and Bipolar Disorder

The first time I was aware of bipolar disorder was years ago in New York.  It was there that I learned that my sister was manic depressive.  She had suffered from a nervous breakdown.  I never knew that she was manic depressive.   It was not evident to me.  She seemed fine to me.

While living in New York, she only had one episode where she had to stay in the hospital overnight but after that she was fine.  She had a good doctor who was diligent in her care.  I have other relatives who suffer from bipolar disorder.  And a co-worker of mine is no longer working because she had a relapse.  The last time I saw her I couldn’t believe it was the same person.  She called me on the phone and she was saying things that didn’t make sense and using language I never expected to hear coming out of her mouth.  I realize that when a person has bipolar disorder, he or she is different.  The illness changes the person.  Things from the past are dredged up, there are resentments and the belief that there is a conspiracy against him or her.

It’s hard to see someone you love suffering from a mental illness.  It’s harder when the person comes off of the medication and winds up back in hospital.  Each time he or she comes off the medication, it becomes harder to get back on track.  And the scary thing is they get into debt or in some cases trouble.  It’s hard for family members to know just how to cope, especially if during these episodes harsh and hurtful things are said.  It’s so disappointing when the person is doing well for a long time and then there is a relapse.  Each time he or she gets better, you are wary, wondering how long it would last.  Each time he or she promises not to come of the medication and vows to stay out of the hospital but something happens and there is an episode.

Even though I am aware of bipolar disorder, I still don’t know much about it.  I thought that I would search the web and gather all the information I could find just to get a better understanding of the illness.

What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

What are the symptoms of Bipolar Disorder?
Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

• Increased energy, activity, restlessness
• Euphoric mood
• Extreme irritability
• Poor concentration
• Racing thoughts, fast talking, jumping between ideas
• Sleeplessness
• Heightened sense of self-importance
• Spending sprees
• Increased sexual behavior
• Abuse of drugs, such as cocaine, alcohol and sleeping medications
• Provocative, intrusive or aggressive behavior
• Denial that anything is wrong

Depressive Episode Signs:

• Sad, anxious or empty-feeling mood
• Feelings of hopelessness and pessimism
• Feelings of guilt, worthlessness and helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, fatigue
• Difficulty concentrating, remembering or making decisions
• Restlessness and irritability
• Sleeplessness or sleeping too much
• Change in appetite, unintended weight loss or gain
• Bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide

Apparently there are several types of bipolar disorder but the two main ones are bipolar I and II.  Bipolar type I disorder is the “classic” form, and patients often experience at least one full or mixed episodes with major depressive episodes. Bipolar type II disorder is where patients have at least one milder form of mania and one major depressive episode.  However, they never get a full manic or mixed episode.  Bipolar II is harder to diagnose because some symptoms of hypomania may not be as apparent. Hypomania is described as a milder form of mania with less severe symptoms.  I believe that my sister displays more symptoms of mania.

All the people I know who have bipolar disorder are women.  Although it is prevalent among men as well, it seems that it is approximately three times more common in women than in men.  For women it is rapid cycling.  Rapid cycling describes incidences where a bipolar patient experiences four or more episodes of mania, hypomania, or depression within a time period of a year (Leibenluft, 1997).

The article explains why rapid cycling bipolar disorder more common in women than in men. Three potential hypotheses to explain the higher prevalence of rapid cycling in women are hypothyroidism incidence, specific gonadal steroid effects, and the use of anti-depressant medications. First, more women encounter hypothyroidism than men do; however, there is not a general consensus on it being a primary cause of increased rapid cycling. Second, gonadal steroids, such as estrogen and progesterone, fluctuate throughout the menstrual cycle. Sixty-six percent of bipolar type I women had regular mood changes during either their menstrual or premenstrual phase of their cycle. They were more irritable and had increased anger outbursts (Blehar et al., 1998). These may set up women to frequent mood changes (especially prior to the menstrual cycle, as noted in the term “premenstrual syndrome”). Increased estrogen may cause women to develop hypercortisolism, which may increase the risk of depression. Stress levels are associated with cortisol level, so this may possibly be the reason for increased risk for depression.

There are risks involved in pregnant women who suffer from bipolar disorder.  Manic episodes and cycling seemed to occur exclusively during pregnancy.  For reasons still unclear, apparent pregnancy poses a question of relapse, which has an important effect on women and the fetus that they are carrying. The fetus can be at risk due to lack of attention to prenatal care, if the woman is not treated for the psychiatric illness. Precipitated episodes in the absence of treatment may be very detrimental to both parties involved. Secondly, the woman would be at risk because with each successive episode, the length of time to following episodes gets smaller. That is, the woman could have manic and depressive episodes more often. This would neither be beneficial to the woman or her child. The effect on the fetus due to many mood episodes is unclear (Viguera et al., 1998). “During pregnancy, a woman’s glomerular filtration rate increases” (Llewellyn et al., 1998). This means that any medication that she takes, such as lithium (discussed below), will be excreted more rapidly. This is very dangerous because if she does not have enough medication in her system, she can fall into relapse.

A dilemma arises in that if she increases her medication amount, she may be exposing her fetus to grave side effects and even danger (discussed below). Moreover, during labor, it is important that women remain fully hydrated. Since the period of time for delivery varies with each individual, a pregnant woman can become very dehydrated. When a woman gets dehydrated, the serum medication concentrations will increase (Llewellyn et al., 1998). This is the opposite effect of the increase in glomerulus filtration. Nonetheless, both situations are dangerous and can be very toxic to the woman and indirectly to the fetus.  As varying as the symptoms of bipolar disorder, per individual, so are the treatments. It is very important that bipolar pregnant women get the appropriate care and treatment that they need, in order to properly care for themselves as well as for the child that they are carrying.

It is disturbing to know that women with bipolar disorder are more susceptible to misdiagnosis.   recent study estimated that the odds that a woman with bipolar disorder will fail to be correctly diagnosed are roughly three times the odds for a man. This disparity may be explained in part by the fact that bipolar disorder tends to look different in women than it does in men—in the same way that physicians sometimes fail to catch heart disease in women because they are effectively looking for the male version of the disease, mental health professionals may not always be aware of the distinctive signs of bipolar disorder in women.  According to Vivien Burt, MD, PhD, director of the Women’s Life Center at UCLA’s Resnick Neuropsychiatric Hospital, “Women are more demonstrative—they have more of what’s known as ‘affective loading’—so it’s not surprising that bipolar disorder might be underdiagnosed in women compared to men.”

Another article stated that 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).

My sister had the disorder since she was in her thirties.  She is unmarried and doesn’t have any children.  If she had children would they be at risk?  Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is estimated to be 15-30%.  Bipolar symptoms may appear in a variety of behaviors. According to the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.4 million children with depression in the United States may actually be experiencing the early onset of bipolar disorder.

If you notice mood swings in yourself or someone else, don’t write them off as hormonal changes.  Seek medical help.  And if you are diagnosed with bipolar disorder, consult a psychiatrist or a general practitioner with experience in treating this illness.

My sister is currently on disability.  A bipolar diagnosis can have a great effect on your job and career.  In a survey of people with depression and bipolar disorder conducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.  Don’t be discouraged, though.  Being diagnosed with bipolar disorder doesn’t necessarily mean that you can’t keep your job. Plenty of people with bipolar disorder work and live normal lives.  If you are currently unemployed and are seeking employment, find a job that is a good fit for you–one that is not stressful and has a flexible schedule.  If you are currently in a job that is not working for you–is affecting your health, not letting you get enough sleep, maybe it’s time to make some changes.  Here are some things you should consider:

• Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day to reduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
• Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job — both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health care provider.
• Look into financial assistance. If you do need to take time off because of your bipolar disorder, see if your employer has disability insurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
• Go slowly. Returning to work after you’ve taken time off can be stressful. Think about starting in a part-time position, at least until you’re confident that your bipolar disorder has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.

Unfortunately you may encounter stigma at work.  Some people might treat you unfairly because of your disorder.  If you feel that you are being passed over for promotion or are being treated unfairly, there are things you can do.  Find out what policies are in place at your company that will protect you from this kind of discrimination which is illegal.    The Americans with Disabilities Act can protect some people who are discriminated against because of a health condition.  Before you do anything, research the law and talk things over with family, friends and therapist.  Mitzi Waltz, author of “Adult Bipolar Disorders,” advises bipolar employees to call a counselor or local support group to help them with workplace problems.

Bipolar disorder is tough on families and spouses.  They have to cope with behavioral problems.  Family members often experience feelings of extreme guilt after the individual is diagnosed. They are concerned about having had angry or hateful thoughts, and many wonder whether they somehow caused the illness by being un-supportive or short-tempered, although this is not the case.  There are times when I feel guilty because I didn’t touch base with my sister as often as I should have.  There are times when I am frustrated with her for coming off her medication because she is aware of what happens when she does.  I feel that she should take more responsibility for keeping the disease under control by taking her medication.  I see how her relapses affect my mother who has Parkinson’s.

I realize that although it is difficult to cope, families of patients with bipolar disorder need to be more supportive.  It is in the best interest of the person to be hospitalized for his or her own protection and for much needed treatment if he or she is in the middle of a severe episode.  And it is important for the patient to  to understand that bipolar disorder will not go away, and that continued treatment is needed to keep the disease under control. It is important that they understand that proper therapy will enable them to have a good quality of life and enable them to have a productive life.

The following tips are for families who want to help their loved ones to cope with the illness:

1. Educate Yourself
2. Learn How–and When–to Talk
3. Make Some Rules
4. Plan Even More
5. Listen
6. Go Gentle
7. Laugh Together
8. Support Yourself

I encourage families of people with bipolar disorder to educate themselves and then see how they can help their loved ones to cope.

Sources:  http://bbrfoundation.org/frequently-asked-questions-about-bipolar-disorder; http://psychcentral.com/lib/2007/women-and-bipolar-disorder/all/1/; http://www.health.com/health/condition-article/0,,20274376,00.html; http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women; http://www.bphope.com/BipolarIndepth.aspx; http://www.ehow.com/about_5032842_signs-bipolar-disorder-women.html; http://www.webmd.com/bipolar-disorder/going-to-work-bipolar; http://www.livestrong.com/article/23014-good-career-those-bipolar-disorder/; http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=bipolar_family; http://www.beliefnet.com/Health/Emotional-Health/Bipolar/8-Ways-to-Help-Your-Bipolar-Loved-One-Cope.aspx