We've long known that gender affects how people experience bipolar disorder, impacting everything from what symptoms they experience to the specific point in life when the disorder first appears. But new research from Penn State has revealed that bipolar disorder is different for men and women on a biological level — which has big implications for the future of treatment.
Bipolar I and bipolar II disorder are both mental health issues that cause sufferers to experience extreme shifts in mood, from elevated highs to profound lows (though bipolar II disorder sufferers tend to experience less of an elevated mood than bipolar I sufferers). The disorder is equally common among women and men; but while the basics of the disorder are similar among sufferers, a vast body of research has found that gender impacts how these illnesses exhibit themselves. For example, in 2005, scientists found that women with bipolar disorders were more likely to experience bipolar II, rapid cycling and "mixed episodes" (which is when mood extremes happen extremely rapidly or even at the same time) than men. Research has also shown that giving birth can trigger an episode for many women, that bipolar disorder tends to show up later in life among women, and one 2010 study found that male bipolar disorder sufferers were more likely to also have problems with marijuana, alcohol, and gambling, while female sufferers were more likely to encounter problems with insomnia and disordered eating.
But while women are taken into account in some bipolar disorder research (unlike many other illnesses, where research skips over women's experiences), this research doesn't always make its way down to doctor's offices and school health clinics. Men's experiences are still often treated as the default, which can shape how we talk about bipolar disorder — or treat it.
Doctors Have A Hard Time Properly Diagnosing Women
Despite the research on gender difference in bipolar disorders, female bipolar disorder sufferers aren't always able to get help that reflects their specific experience. Some women aren't even able to get diagnosed with a bipolar disorder, period — because female sufferers experience more depressive episodes than men, and often get misdiagnosed as purely depressive. Emma, 32, who was diagnosed with unipolar depression in high school, was completely unprepared when she did begin exhibiting manic symptoms in the last semester of college. "Therapists and doctors would always ask me if I'd had a manic episode and the answer was always no," she tells Bustle.
"I didn't know what it was at first," she continues. "I thought I was just full of energy and was enjoying it. Then it tipped over into scary territory. I'd get packages from eBay that I didn't remember buying (like a fur coat and white go-go boots). I'd raise my hand to answer a question in class and then would lose my train of thought while talking. I was in the computer lab after class one day and my hands wouldn't stop shaking." She went to hospital and was diagnosed with bipolar II "almost immediately."
And even when women are able to get correctly diagnosed, their providers don't always tell them that the disorder often manifests differently for women. Emma tells Bustle that her doctor "hasn't said anything to me about gender differences," despite being in treatment for years. Melanie, a Ph.D. student with a new baby, who was diagnosed with bipolar I in 2007, concurs.
"The only thing a psychiatrist has mentioned (aside from pregnancy-related advice)," she says, "is that part of the menstrual cycle can exacerbate mood symptoms. So like three days before my period starts, I get really angry."
The impacts of pregnancy on female bipolar disorder sufferers are particularly crucial to understand, because being postpartum can severely exacerbate the condition. Suzanne, who wasn't properly diagnosed until her 50s, tells Bustle that not having this information as a young woman wreaked havoc on her life. "In my 20s, as a new wife and mother, I had uncontrollable rages followed by bouts of severe depression, rinse and repeat," says Suzanne. "This is what ultimately destroyed my marriage to a good man, something I grieve for to this day."
Being diagnosed before pregnancy helps — but it doesn't solve every problem. When Melanie became pregnant, she was given some guidance about how to manage her disorder throughout pregnancy and childbirth, including how to properly medicate, plan for "breakthrough symptoms," and manage her baby's feeding schedule so that her husband and mother-in-law could help. Still, she says, despite having that knowledge, "I feel like being pregnant made me double bipolar. There was so much crying."
This Research May Change The Way We Treat Bipolar Disorder
The new Penn State research might be able to help women get more accurate diagnoses — and better treatment.
Though traditional thinking about mental health disorders painted them as purely issues of brain chemistry, science has realized that they can have complex effects throughout the body, and bipolar disorders are a prime example. The Penn State study emphasized this, as it found that men and women with bipolar disorder often have two particular and unique immune responses in the body.
It's a bit complicated, but here's the basic idea: Bipolar disorder seems to be related to some abnormality in the immune system, because a lot of people with bipolar disorder have autoimmune issues and their immune "markers" are different from those of healthy people. Two of those markers, zinc and neopterin blood levels, tend to show up as abnormally elevated in people with bipolar disorder — and there's a gender difference in how that plays out.
When bipolar women had high zinc levels in their blood, their depression was more severe, while men with high levels of neopterin had more severe mania (nothing was linked to men with higher zinc levels or women with higher neopterin ). This might provide a biological explanation for why men and women's bipolar disorders experiences can be so different: Their immune systems are going awry in different ways. And that has big implications for treatment.
This new information is, scientists hope, going to lead to much more personalized treatment. "What we are aiming for," lead researcher Erika Saunders commented in a statement, "is to have a blood marker that we can use in the clinic that will help us predict when someone is developing a bipolar episode, and conversely when a treatment is working." Diagnosis and treatment are becoming much more personalized — and that's good news for women. Though we don't yet know how this research will figure into future medications, knowing more about how the disorder specifically manifests itself inside women's bodies will make it easier for women to get accurate, effective treatment — and easier for mental health professionals to stop treating men's experiences as the default.