Understanding Bipolar Disorder In Women: Prevalence, Symptoms, And Treatment

What do you think of this article?

Average: 5 Votes 1

Your vote:

By Dr. David Woo - July 8, 2024

Bipolar disorder is a complex and often misunderstood mental health condition that affects millions of people worldwide. While all genders are susceptible to bipolar disorder, bipolar symptoms in women can be exacerbated by certain factors unique to women. At Madison Avenue TMS & Psychiatry, we are dedicated to providing comprehensive treatments for bipolar disorder, including services like medication management and transcranial magnetic stimulation (TMS), with special consideration for the challenges that women with this condition face.

Prevalence Of Bipolar Disorder In Women

Bipolar disorder is equally prevalent among men and women, affecting approximately 2.8% of the US adult population (1). However, research indicates that women are more likely to experience rapid cycling (having four mood episodes in one year), mixed episodes (having both mania and depression at the same time), suicidal ideation, and co-occurring conditions such as anxiety disorders and eating disorders (2). These differences can significantly impact the course of the illness and the approach to treatment.

Symptoms Of Bipolar Disorder In Women

Bipolar disorder is characterized by intense mood swings, including periods of depression and mania. Recognizing the signs of bipolar disorder in women (or any individual) is crucial for early detection and effective treatment. The following symptoms may be experienced by anyone, regardless of gender:

Symptom Area	Depressive Episodes	Manic Episodes
Mood	Persistent sadness or hopelessness	Euphoria or extreme irritability
Activities	Loss of interest in previously enjoyed activities	Increased activity, restlessness, risky behavior
Energy levels	Fatigue and decreased energy	Intensely elevated mood and increased energy levels
Sleep patterns	Sleeps too little or too much	Feels less need for sleep
Concentration	Difficulty concentrating	Racing thoughts
Self-perception	Feeling worthless	Excessive feelings of grandeur and self-importance

Depressive Episodes

During depressive episodes, individuals with bipolar disorder may experience:

Persistent sadness or hopelessness
Loss of interest in previously enjoyed activities
Fatigue and decreased energy
Changes in sleep patterns (too little or too much sleeping)
Changes in appetite
Weight loss or gain
Difficulty concentrating or making decisions
Thoughts of death or suicide

Manic Episodes

Manic episodes are characterized by a markedly elevated mood and increased energy levels, which can lead to:

Euphoria or extreme irritability
Racing thoughts and rapid speech
Increased activity levels and restlessness
Impulsive or risky behaviors (e.g., excessive spending, reckless driving)
Decreased need for sleep
Inflated self-esteem or delusions of grandeur

Mixed Episodes

People with bipolar disorder may also experience mixed episodes, where symptoms of both depression and mania occur simultaneously, contributing to significant emotional turmoil and difficulties in daily functioning.

Bipolar Depression Symptoms In Females: Unique Challenges

Symptoms of bipolar disorder in women can present differently from those in men. Hormonal fluctuations associated with menstrual cycles, pregnancy, and menopause can influence the severity and frequency of bipolar episodes. These hormonal changes can make it more difficult to manage the disorder and require a tailored approach to treatment (3).

Rapid cycling and mixed episodes: Women are more prone to rapid cycling, defined as experiencing four or more episodes of mania, hypomania, or depression within a year. They are also more likely to have mixed episodes, where symptoms of mania and depression occur simultaneously. These patterns can be particularly distressing and challenging to treat (4).
Depressive episodes: Women tend to experience more depressive episodes than men, which can be severe and long-lasting. This can lead to an increased risk of developing co-occurring conditions like anxiety disorders and eating disorders, further complicating the treatment process (5).
Impact of hormonal changes: Hormonal changes throughout a woman’s life can significantly impact bipolar disorder symptoms. For instance, the menstrual cycle, pregnancy, postpartum period, and menopause can all influence mood stability. Women may require adjustments in their treatment plans during these times to effectively manage their symptoms (6,7).
Co-occurring conditions: Women with bipolar disorder are more likely to experience co-occurring conditions such as anxiety disorders, eating disorders, and thyroid disease. These additional health concerns can complicate the diagnosis and treatment of bipolar disorder, necessitating a comprehensive and integrated approach to care (8).

Treatment For Bipolar Disorder At Madison Avenue TMS & Psychiatry

At Madison Avenue TMS & Psychiatry, we understand the unique challenges women face when dealing with bipolar disorder. Our experienced team offers a range of evidence-based treatments tailored to meet the specific needs of each patient. Two of our primary treatment methods include medication management and transcranial magnetic stimulation (TMS). Depending on the patient’s particular needs, either can be used, in conjunction with compassionate consultations, to alleviate the symptoms of bipolar disorder in women and enable them to live a healthy life.

Medication Management

Medication is a cornerstone in the treatment of bipolar disorder, but different people respond differently to different drugs and doses. To make sure that you get the best results from your medication and avoid side effects, our team works closely with patients to develop a personalized medication plan that addresses their specific symptoms and needs. Medications used to treat bipolar disorder include:

Mood stabilizers: These medications help to regulate mood swings and prevent manic and depressive episodes. Common mood stabilizers include lithium, valproate, and lamotrigine.
Antipsychotics: These medications are often used to treat severe manic or mixed episodes. Atypical antipsychotics like quetiapine, olanzapine, and aripiprazole can be effective in managing symptoms.
Antidepressants: While antidepressants can be useful in treating depressive episodes, they must be used cautiously to avoid triggering manic episodes. Our team carefully monitors patients on antidepressants to ensure their safety and efficacy.
Hormone therapy: For women whose bipolar symptoms are significantly impacted by hormonal changes, hormone therapy may be considered as part of their treatment plan.

Life in New York City can be fast-paced and stressful, but taking the time to consult with an expert about your medication experience can make all the difference and help you achieve the best results from your treatment. If you’re not sure about whether your medication is working the way it should, don’t hold back on consulting a professional! That’s why our medication management services are available via telehealth video appointments, conveniently accessible from your device at home or on the go.

Transcranial Magnetic Stimulation (TMS)

TMS is an FDA-approved treatment for major depressive disorder that has shown promising results in treating bipolar disorder as well. TMS uses a helmet-like device that emits subtle magnetic fields to stimulate nerve cells in the brain, helping to improve mood and reduce symptoms of bipolar disorder and other mood disorders. This innovative treatment offers several benefits:

Non-invasive: TMS is a non-invasive procedure that does not require anesthesia or surgery. Patients can remain awake and alert during the treatment sessions.
Drug-free: Of particular interest to women who may wish to avoid drug interactions related to the hormonal cycle, medications, or the pre- or post-partum period, TMS is completely drug-free and does not carry any risk of pharmacological interactions that medications can pose.
Few side effects: Unlike medications, TMS has minimal side effects, making it a suitable option for patients who cannot tolerate medication or have not responded well to traditional treatments
Effectiveness: TMS has been shown to be effective in reducing depressive symptoms in patients with bipolar disorder, particularly those who have not found relief with other treatments (9,10).
Convenience: Treatment sessions are relatively short, typically lasting about 20-40 minutes, and are conducted on an outpatient basis. After each session, patients can simply return to their normal routines.

Women and mental health is a critical topic that deserves attention, as research shows that women are more susceptible to certain mental health conditions, such as depression, compared to men. Women often face unique challenges related to hormonal changes, gender roles, and societal expectations that can impact their mental well-being. Additionally, women’s mental health issues can manifest differently, and they may encounter barriers or discrimination when seeking treatment. At Madison Avenue TMS & Psychiatry, we are committed to providing compassionate care and effective treatment options tailored to the specific needs of women, including talk therapy, medication management services, and transcranial magnetic stimulation (TMS). Let´s break down the state of women’s mental health issues today, and how innovative treatments can help patients overcome traditional barriers to wellness.

Are Women More Susceptible To Certain Mental Health Conditions?

Studies indicate that women are more likely than men to experience certain mental health disorders. This discrepancy between the sexes is influenced by a combination of biological, psychological, and social factors. Key statistics include:

Depression: Women are nearly twice as likely to be diagnosed with depression compared to men (1, 2). Hormonal fluctuations during puberty, menstruation, pregnancy, postpartum, and menopause can contribute to this increased risk.
Anxiety Disorders: Women are more likely to experience anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and phobias (4).
Post-Traumatic Stress Disorder (PTSD): Women are more than twice as likely as men to develop PTSD after experiencing traumatic events. Women are also more likely to experience certain types of trauma, such as sexual violence, which further increases the risk of PTSD (5).
Obsessive-Compulsive Disorder (OCD): OCD affects both men and women, but women tend to have a later onset and are more likely to develop OCD related to contamination fears and compulsive cleaning (6, 7).
Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is often underdiagnosed in women, who may present with inattentive symptoms rather than hyperactivity. As a result, many women remain undiagnosed until adulthood (8).
Bipolar Disorder: Women are more likely to experience rapid cycling (more frequent mood changes) and mixed states of bipolar disorder compared to men, making it essential to identify gender-specific symptoms and treatment plans (9).
Borderline Personality Disorder (BPD): Approximately 75% of those diagnosed with BPD are women, with symptoms often linked to trauma, emotional instability, and interpersonal difficulties (10).

Do Women Manifest Different Mental Health Symptoms?

Women’s mental health issues often manifest differently compared to men, which can impact diagnosis and treatment. Mental health is not one-size-fits-all, and symptoms can present across the entire gender spectrum. However, women as a demographic display some differences in symptoms in certain conditions, such as:

Depression: Women with depression may experience more physical symptoms such as fatigue, changes in appetite, and sleep disturbances, while men may report more irritability and anger.
Anxiety: Anxiety in women often manifests as internalizing symptoms like excessive worry, phobias, rumination, and physical complaints (e.g., headaches, fatigue), whereas men tend to present externally, with a higher prevalence of irritability and risky behaviors.
PTSD: Women are more likely to experience symptoms such as hypervigilance, avoidance, and emotional numbing, while men may exhibit higher levels of aggression.
ADHD: Women with ADHD often show inattentiveness, forgetfulness, and disorganization, which can be mistaken for anxiety or depression.
Bipolar Disorder: Women with bipolar disorder tend to have more depressive episodes and fewer manic episodes than men, which can affect how the disorder is perceived and treated.
OCD: Women are more likely to develop OCD symptoms related to caretaking, contamination, and morality.

Hormonal changes in women, including pregnancy and the menstrual cycle, may also account for variations in symptoms. Pregnant women, new mothers, and pre- and post-menopausal women all experience changes in their body chemistry that can affect their vulnerability to certain mental health disorders as well as the presentation and severity of symptoms. It´s important to note that hormonal factors should not be an excuse for anyone to dismiss or minimize mental health symptoms—our mental health is intimately linked to our biochemistry, and hormones are a natural part of that.

Gender Differences In Symptoms Of Mood Disorders

This table presents an overview of gender-based differences in symptom manifestation in common mental health conditions:

Mental Health Disorder	Men	Women
Depression	More likely to present irritability, anger, substance abuse, risk-taking behavior, and physical pain (e.g., back pain, headaches).	More likely to experience sadness, excessive crying, fatigue, sleep disturbances, and rumination.
Anxiety	Externalizing symptoms like irritability, anger, restlessness; may self-medicate with alcohol or drugs.	Internalizing symptoms such as excessive worry, fear, avoidance, and physical symptoms (e.g., headaches, muscle tension).
Bipolar Disorder	More prone to manic episodes characterized by irritability, aggression, and impulsive behavior; higher risk of substance abuse.	More prone to depressive episodes; rapid cycling is more common, along with mixed states of mania and depression.
Borderline Personality Disorder (BPD)	Often underdiagnosed; may show aggression, substance abuse, or reckless behavior; stigma around “masculine” emotional expression.	More likely to exhibit mood swings, intense emotional reactions, fear of abandonment, and self-harm behaviors.
Obsessive-Compulsive Disorder (OCD)	More likely to have obsessions related to symmetry, checking, and contamination; less likely to seek treatment.	More likely to have obsessions related to cleanliness, contamination, and compulsive cleaning; higher rates of comorbid anxiety.
Attention-Deficit/Hyperactivity Disorder (ADHD)	Often presents with externalizing behaviors like impulsivity, hyperactivity, and risk-taking; more diagnosed in childhood.	Often presents with inattentiveness, forgetfulness, and disorganization; underdiagnosed and often identified in adulthood.
Post-Traumatic Stress Disorder (PTSD)	More likely to experience irritability, anger, emotional numbing, and substance abuse; symptoms linked to combat or accidents.	More likely to experience hypervigilance, flashbacks, avoidance, and emotional distress; symptoms often linked to sexual trauma or abuse.

Barriers Women Face In Mental Health Treatment

Despite the higher prevalence of mental health disorders among women, many face significant barriers to accessing effective care due to the negative impacts of sexism and societal expectations of women (11).

Misdiagnosis: Women are often misdiagnosed or have their symptoms attributed to hormonal changes or emotional overreaction, leading to delayed or inadequate treatment.
Financial and time constraints: Caregiving responsibilities and lower income levels can prevent women from seeking timely mental health care.
Gender discrimination: Some women report experiencing discrimination in the healthcare system, where their concerns are not taken seriously or dismissed, impacting their willingness to seek treatment.

Treatment Options For Women’s Mental Health Issues

At Madison Avenue TMS & Psychiatry, we offer a range of treatment options designed to address women’s mental health issues. These include:

Medication management: Personalized treatment plans to manage conditions such as depression, anxiety, ADHD, and bipolar disorder
Telehealth consultations: Convenient access to mental health care from the comfort of home, making it easier for women to prioritize their mental well-being.
Transcranial magnetic stimulation (TMS): A non-invasive and effective treatment option for depression, OCD, and anxiety, particularly for those who have not responded to medication or therapy.

As a drug-free depression treatment, TMS is safe for women who want to avoid the potential pharmaceutical interactions and side effects that come with taking antidepressants. This means that TMS is an effective treatment to undergo for women who are pregnant, breastfeeding, or on hormonal medications for birth control, menopause, or other reasons.

Get Compassionate Mental Health Care At Madison Avenue TMS & Psychiatry

Women face unique challenges when it comes to mental health, but effective treatments are available.

At Madison Avenue TMS & Psychiatry, we provide compassionate care tailored to the specific needs of women in a supportive environment. Our clinic stands for gender equality and mental health equity, and we encourage women with mental health concerns to contact us for a consultation without fear of discrimination or judgment.

If you or a loved one is struggling with mental health issues and based in the New York area, contact us today via our website or by calling (212) 731-2033. Our team of professionals is here to help you regain control of your mental well-being and lead a healthier, more fulfilling life.

More Resources On Women And Mental Health:

Sources

Hyde, Janet S. PhD; Mezulis, Amy H. PhD. Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors. Harvard Review of Psychiatry 28(1):p 4-13, 1/2 2020. Link. Accessed September 16, 2024.
Albert, P. R. Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience.. 2015;40(4), 219-221. Link. Accessed September 16, 2024.
Farhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science Progress. 2022. Link. Accessed September 16, 2024.
Javaid, S.F., Hashim, I.J., Hashim, M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry 2023;30, 44. Link. Accessed September 16, 2024.
Hiscox, L.V., Sharp, T., Olff, M. et al. Sex-Based Contributors to and Consequences of Post-traumatic Stress Disorder. Curr Psychiatry Rep 25. 2023; 233–245. Link. Accessed September 16, 2024.
Tiyatiye, B., & Akosile, W. (2022). A systematic review of prevalence of comorbid obsessive-compulsive disorders and substance use disorders in clinical settings, 1990-2021. Journal of Substance Use. 2022;29(2), 180–185. Link. Accessed September 16, 2024.
Dr. Noreena Kausar, Amna Ishaq, & Dr. Muneeb Ahmed Toor. (2023). Prevalence of Obsessive-Compulsive Disorder in Psychiatric Patients. PAKISTAN JOURNAL OF LAW, ANALYSIS AND WISDOM, 2023;2(02), 1032–1041. Link. Accessed September 16, 2024.
Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. J Child Psychol Psychiatry. 2022;Apr;63(4):484-496. Link. Accessed September 16, 2024.
Miola, A., Fountoulakis, K. N., Baldessarini, R. J., Veldic, M., Solmi, M., Rasgon, N., Ozerdem, A., Perugi, G., Frye, M. A., & Preti, A. (2023). Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. Journal of Psychiatric Research. 2023;164, 404-415. Link. Accessed September 16, 2024.
Bozzatello, P., Blua, C., Brandellero, D., Baldassarri, L., Brasso, C., Rocca, P., & Bellino, S. Gender differences in borderline personality disorder: A narrative review. Frontiers in Psychiatry. 2024;15, 1320546. Link. Accessed September 16, 2024.

Garb, H. N. Race bias and gender bias in the diagnosis of psychological disorders. Clinical Psychology Review. 2021;90, 102087. Link. Accessed September 16, 2024.

Contact Us

If you or a loved one is struggling with bipolar disorder, it is crucial to seek professional help, regardless of gender. At Madison Avenue TMS & Psychiatry, we are committed to providing compassionate, personalized care to help patients in New York manage their bipolar disorder and improve their quality of life. Our team of experienced psychiatrists and mental health professionals is here to support you every step of the way.

For more information about our services or to schedule a consultation, please contact Madison Avenue TMS & Psychiatry today, either online or by calling (212) 731-2033. Together, we can work towards a brighter and more stable future.

Discover more about depression and women’s mental health:

Resources:

National Institute of Mental Health. Bipolar disorder. 2020. Link. Accessed June 13, 2024.
Dell’Osso, B., Cafaro, R. & Ketter, T.A. Has Bipolar Disorder become a predominantly female gender related condition? Analysis of recently published large sample studies. Int J Bipolar Disord. 2021;9, 3. Link. Accessed June 13, 2024.
Arnold, L. M. Gender differences in bipolar disorder. Psychiatric Clinics of North America. 2003;26(3), 595-620. Link. Accessed June 13, 2024.
Miola, A., Fountoulakis, K. N., Baldessarini, R. J., Veldic, M., Solmi, M., Rasgon, N., Ozerdem, A., Perugi, G., Frye, M. A., & Preti, A. Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. Journal of Psychiatric Research. 2023;164, 404-415. Link. Accessed June 13, 2024.
Menculini G, Steardo L Jr, Sciarma T, D’Angelo M, Lanza L, Cinesi G, Cirimbilli F, Moretti P, Verdolini N, De Fazio P and Tortorella A. Sex Differences in Bipolar Disorders: Impact on Psychopathological Features and Treatment Response. Front. Psychiatry. 2022;13:926594. Link. Accessed June 13, 2024.
Sepede, G., Brunetti, M., & Di Giannantonio, M. Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges. Neuropsychiatric Disease and Treatment, 2020;16, 415–426. Link. Accessed June 13, 2024.
Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert Review of Neurotherapeutics, 20(4), 373–383. Link. Accessed June 13, 2024.
Fornaro, M., Daray, F. M., Hunter, F., Anastasia, A., Stubbs, B., De Berardis, D., Shin, J. I., Husain, M. I., Dragioti, E., Fusar-Poli, P., Solmi, M., Berk, M., Vieta, E., & Carvalho, A. F. The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: Systematic review and meta-analysis. Journal of Affective Disorders. 2021;280, 409-431. Link. Accessed June 13, 2024.
Myczkowski ML, Fernandes A, Moreno M, Valiengo L, Lafer B, Moreno RA, Padberg F, Gattaz W, Brunoni AR. Cognitive outcomes of TMS treatment in bipolar depression: Safety data from a randomized controlled trial. J Affect Disord. 2018;235:20-26. Link. Accessed June 13, 2024.
Gold AK, Ornelas AC, Cirillo P, et al. Clinical applications of transcranial magnetic stimulation in bipolar disorder. Brain Behav. 2019;9(10):e01419. Link. Accessed June 13, 2024.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

Mental Health Women Mental Health

Madison Avenue TMS News