WOMEN WITH BIPOLAR ILLNESS - CLINICAL AND RESEARCH ISSUES

Objective: The purpose of this article is to review the literature con cerning gender differences in the course of bipolar illness and discus s issues relevant to the treatment of women with the illness. Method: The literature concerning the following topics is reviewed: gender dif ferences in the course of bipolar illness; effects of the female repro ductive cycle on the course of bipolar illness; special considerations in the treatment of bipolar women (focusing on the hypothalamic-pitui tary-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 cyc ling among bipolar women. Data also suggest that bipolar women may hav e more depressive episodes (and fewer manic episodes) and may be more likely to suffer from mixed (as opposed to pure) mania than bipolar me n. While it is clear that bipolar women are at high risk for postpartu m episodes, the effects of other reproductive system events (i.e., pub erty, menstrual cycle, pregnancy, menopause, use of oral contraceptive s or hormone replacement therapy) on the course of treatment of bipola r illness have received little systematic study. It is unclear whether women are at higher risk than men for developing lithium-induced hypo thyroidism. Higher rates of hypothyroidism, greater use of antidepress ant, and gonadal steroid effects are possible explanations for the gre ater prevalence of rapid cycling among bipolar women. Conclusions: Gen der differences in bipolar illness and the effects of the female repro ductive system on the course and treatment of the illness deserve more study. The importance of a longitudinal approach to these questions i s emphasized.