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Bipolar Disorder and Gender

This is a synopsis of an article on bipolar disorder and gender. To see the original article, please click here.
According to certain scientific studies, bipolar disorder develops in men and women in about equal numbers, but there are gender differences in the ways that the illness manifests itself. Women with the disorder tend to have more depressive episodes and men tend to have more manic episodes.
"The typical bipolar woman will start with a depressive episode, whereas a man will usually get a manic episode first," says Michael First, M.D., professor of clinical psychiatry at Columbia University and editor of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association's diagnostic guidelines.
Women are also more likely to present with type II bipolar, which is a milder form of the disorder. Women are more prone than men to rapid-cycling bipolar, which is characterized by four or more episodes of depression and mania in one year.
Research suggests that abnormal thyroid levels may contribute to the way bipolar disorder manifests in women. Women are more likely than men to have thyroid imbalances.
"There seems to be an elevated level of thyroid disturbances associated with rapid-cycling bipolar disorder," says Carrie Bearden, Ph.D., a clinical neuropsychologist and associate professor of behavioral sciences and psychology at UCLA. 
Other medical conditions that are seen more often in bipolar women than in men include migraines, obesity, and anxiety and panic disorders.

Reproductive hormones may also play a role in the way bipolar disorder manifests in women. Women with bipolar disorder tend to be troubled by PMS/PMDD, and bipolar symptoms often worsen during perimenopause and menopause.
"During perimenopause, women may be especially at risk for depressive episodes because of declining estrogen levels," says Bearden.

Women also face the complications of managing bipolar disorder during and after pregnancy, when they appear to be more vulnerable to the condition's symptoms. Severe postpartum depression is thought to be a sign of possible bipolar disorder.
 According to the National Alliance on Mental Illness, pregnant women and new moms with bipolar disorder have seven times the risk of hospitalization and two times the risk of a recurrent episode compared with women who aren't pregnant or who haven't recently delivered.
Managing bipolar disorder during pregnancy and lactation can be a challenge because some of the medications used to treat the illness carry potential risks for developing fetuses and nursing infants. Research suggests that some anticonvulsants used to treat bipolar disorder — such as Depakote and Tegretol — can be harmful to fetuses, possibly contributing to birth defects. Lithium and first-generation antipsychotics such as Haldol and Thorazine are considered safer. Studies have found that they carry minimal risks to developing fetuses and nursing babies.

In men, manic episodes tend to be more pronounced. In addition, men are more apt to act out aggressively during mania.
"Guys are more likely to be out drinking, fighting, and yelling at people on the street, which often lands them in jail or causes them to be hospitalized for mania," says Bearden.
Men with bipolar disorder are more likely than women to have problems with drug or alcohol abuse. Men are less likely than women to seek treatment for psychological issues.

The most serious consequence of untreated bipolar disorder is suicide Studies show that between 10 and 15 percent of people with the bipolar disorder will take their own lives.
"Bipolar men are more at risk for suicide than women because suicide is more common in males," says First.

Bipolar disorder is a challenging condition, but it is manageable with proper treatment. Many people with bipolar disorder lead fulfilling, productive lives. Some well-known people with bipolar disorder include journalist Jane Pauley, actor Stephen Fry, actor Owen Wilson, actress Linda Hamilton, and psychologist/author Kay Redfield Jameson.

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Nutritional Supplements for Bipolar Disorder
I AM NOT A DOCTOR AND THIS IS NOT MEDICAL ADVICE! DO NOT DISCONTINUE YOUR MEDICAL TREATMENT WITHOUT CONSULTING YOUR PHYSICIAN.
My own physician is a holistic health practitioner. He is a real medical doctor who can and does prescribe pharmaceutical medication when he deems it necessary. But he is also willing to work using natural therapies. If you can locate a holistic physician that participates in your insurance plan, it can be very beneficial in working on your treatment.
The following are some supplements that I have found useful in managing my own condition. As I am hypersensitive to medications, I try to use as many natural supplements as possible in my own treatment.
Lithium is legally available in low doses without prescription. It is a naturally-occurring mineral salt. If you are already on prescription strength Lithium, do not switch to a non-prescription version without consulting your physician. This is, in fact, what I take, and it made a tremendous difference in my life within a week of incorporating it.  For the first time since childhood I knew what it was like to feel somewhat in balance, not paranoid or irritable, and I was able to control my emotional outbursts. It was truly a miracle.
Lithium Orotate is a highly bioavailable form of Lithium. It can be ordered from http://www.findserenitynow.com
I take two tablets a day and will never be without it again.
Taking an excellent vitamin supplement is important for everybody. I use and recommend Garden of Life, which has seperate formulas for men and women. It is more expensive than grocery store brands, but is well worth it.
Vitamin D is a very common and inexpensive supplement that is helpful in managing depressive symptoms. This is a good vitamin for everybody. It is very difficult to build up toxic levels of this supplement, making it safe for people of all ages. I take 4000 units a day. It is especially important for people who do shift work to take vitamin D.
B vitamins are also important for mood stabilization. People with mood disorders should consider taking a B-100 supplement. For those who have never taken B vitamins, do not be alarmed if your urine turns a somewhat darker color and has a noticeable odor, something like dry leaves. This is a property of B vitamin supplements and is harmless.
Omega fatty acids are also beneficial for mood stabilization and have many other general benefits as well. If you happen to have thyroid issues, they provide added benefits in stabilizing thyroid function. I use Ultra Omega from Country Life.
Mineral balance is also important for everyone, but is necessary for mood stabilization. I take the Caltrate mineral complete supplement. As well, I use Aqualyte coral calcium. This has the added benefit of alkalizing the blood pH so it remains at optimal levels. Most of us consume far too many acidic foods, and stress causes the blood to become more acidic as well. Aqualyte is provided in tea bag style sachets that can be used to treat up to 2 liters of water at a time and costs as little as $25 a month. Fear not--your water will not develop any sort of unpleasant taste. Aqualyte is currently only sold via the Internet. Click here to find out more.
I also take "Nerve" formula from Solaray. This should be available at most natural food stores, or can be found online. This helps balance the irritability and anxiety.
The supplement Sam-E can be helpful in the treatment of unipolar depression. However, persons with bipolar disorder should never take this supplement. Like prescription antidepressants, it can trigger mania.
Again, any treatment is not "one size fits all" and you may find other supplements or treatments that are particularly helpful for you. I welcome you to share your experiences.





My Story
Looking back on it, my first signs of bipolar disorder manifested on my tenth birthday. I was beginning to experience the changes of puberty, and this is often the time of onset for people. I was a devout Catholic in my youth and began to think of myself as possibly being similar to Nostradamus, someone who would be able to see the warning signs of Apocalypse and help guide people to salvation. The way this manifested was fairly subtle. I didn't go around preaching to people about Armageddon or anything of that nature, but I did spend hours at a time reading the Bible, looking for passages that would indicate the calamity to come, so I could help save the world.
On a more everyday level, the first time I attempted suicide was at age 14 when I swallowed a bottle of aspirin. I ended up vomiting before any real damage was done, and my parents never knew. A more overt occasion came when at age 16 I took an overdose of tranquilizers and then later cut my wrists. There was incredible stress in my life at this time. My aunt and cousin had come to live with us, I was having a great deal of trouble with people at school, and my then-boyfriend was proving himself to be quite the cold bastard--the last thing a highly sensitive person needs in their life. This dynamic would play itself out often over the years--highly needy person pursuing an individual who was incapable of giving affection. Conversely, I would end up withdrawing from affection that was offered because it scared me if it was unsolicited. This is probably more a symptom of borderline personality disorder than bipolar disorder, but the two conditions exacerbated each other.
I remember reading about "manic depression" when I was taking a psychology class at age 16, and telling the instructor that "this sounds like me." This was the early 1980's, and "manic depression" was still considered a psychosis because its an organic brain disorder. My instructor said in an almost panicked way "Oh, you don't have manic depression. You're just depressed, and maybe a little high strung. But there's no way you have manic depression." Unfortunately, misdiagnosis would continue to be the pattern for me until I was nearly in my middle years. I think my favorite misdiagnosis came from the Freudian butthead that was my shrink during my one weekend stay on the mental ward after I gouged the hell out of my wrists because my wonderful boyfriend dumped me after I gave in to his wish to have sex. "The diagnosis was "Hysterical neurotic." If there is a more useless diagnosis on this planet, I'd be interested in seeing it.
Unfortunately, during the years that passed where I did not realize what was wrong with me, I did a lot of damage in my relationships with people. I was never physically abusive, but I would become extremely irritable and fly into rages at people about anything they might say that aggravated me. The walls in my house have plaster on several areas due to my rages. I'm only glad that I never hit other people or my pets. However, I did say some things that I deeply regret, and while the people I said them to have forgiven me, I can never take these awful things back. I dearly wish that I could. It was as if I knew at the time that what I was saying was wrong and awful but I was unable to shut my mouth before the damage was done. Impulse control becomes limited during mania and hypomania.
The lack of impulse control in the hypomanic phase also lead to my becoming involved in seriously negative romantic relationships, always with emotionally unavailable, usually emotionally abusive, and sometimes physically abusive men. I would always hang on to the bitter end no matter how badly I was being misused by these guys because I thought that if I just cared enough I could make them love me back. Again, the bipolar disorder exacerbated the borderline personality disorder. This is especially true for me when it comes to romantic relationships. Controlling the bipolar disorder has helped me to be able to concentrate on making sense of my borderline personality disorder to a degree that I was unable to previously due to the extreme emotional volatility that is the hallmark of both of these conditions.
I was not diagnosed with bipolar disorder until I was 38 years old, because type II bipolar does not present with full manias, which can make diagnosis difficult. The discovery was made by a counselor I was going to whose son had type II bipolar, and so she was able to recognize the symptoms. The doctor I was going to at the time had been trying various antidepressants on me, which had the effect of pushing me into actual mania. I realized that something was really wrong when, while on Effexor, I got up on a counter and began spouting about how the world was getting ready for the next phase and there would be terrible calamities before the energy shift, or something of that nature. My then thirteen-year-old son very quietly said "Mom, I think you need to get help. There's something really, really wrong with you right now."
I said "I know, and I don't think these damn pills are helping. I'm getting rid of them now."
I wish that I could say that I never said anything hurtful to my son, but there were a few occasions when I did. He was very angry with me for a while and I don't blame him. I think that if the truth about my disease had not been discovered, my relationship with him would not be as good as it is now. Oh, he bristles when the old lady gives him a hug at the airport before he flies back to school, but I reckon he'll get over that in about 10 years. The main thing is that I was finally able to become a mom that he deserves, even if it was a little late and even if I'm not June Cleaver.
I have been taking a low dose of Lithium for five years now. This is the only medication that I am able to tolerate. I like the fact that it short circuits the irritability that was the most damaging part of my disease. I don't much like the fact that it short circuits my intensity, which was something I enjoyed when I was writing. But I would never go back to fearing that I might spout out something hurtful to someone I love, especially my son. I can still write and I still enjoy creating characters and bringing them to life. It's an acceptable trade-off.
Bipolar disorder is a chronic condition and living with it can be frustrating. However, it is better to know the truth than to live with the untreated symptoms. Do not stand for being treated with disdain by medical personnel when seeking treatment. Stand up for your rights and get what you deserve, which is nothing less than the best. No treatment is perfect and medication is not "one size fits all." Find a doctor who will work with you to discover what works for you. Bipolar is not a death sentence. You can lead a productive and positive life. Let's stand together to ensure that future generations do not have to endure the indignities that some of us have had to.
If you've found 'em, keep proving it
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