ABSTRACT
Gender plays a significant role in the development of major depression, a fact evidenced by lifetime prevalence rates as high as 21% in women compared with 12.7% in men (Kessler et al., 1994; Alonso et al., 2004). Although the diagnostic criteria for depression are the same for both sexes, women with depression more frequently experience guilt, anxiety, increased sleep, weight gain and comorbid eating disorders. In addition, women with bipolar disorder spend more symptomatic time in the depressive state compared to men with the same diagnosis (Perugi et al., 1990). The role of gender in bipolar disorder has not been studied to the same extent as has gender in other chronic mental illnesses (Leibenluft, 1996; Hendrick et al., 2000, 2003; Blehar et al., 1998; Weissman et al., 1988) but there are some specific features of bipolar disorder in women that set them apart from other patient populations. Women have a higher incidence of bipolar II disorder with lifetime prevalence rates ranging from 5% to 10% (Angst & Gamma, 2002; Tondo & Baldessarini, 1998); women also present with a higher incidence of rapid cycling episodes, mixed states and antidepressant-induced mania (Coryell, Endicott, & Keller, 1992; Swann, 2005; Burt & Rasgon, 2004; Taylor & Abrams, 1981; McElroy et al., 1995). Gender differences in patterns of substance abuse have also been described with both higher prevalence rates of alcoholism in women with bipolar disorder as compared to women without bipolar (Frye et al., 2003), and an increased amount of time spent in a depressed state among female alcoholics with bipolar disorder (Salloum et al., 2001). The presence of medical co-morbidities such as obesity, migraine and thyroid dysfunctions are also common in this population (Kuijpens et al., 2001) and clinicians should be aware of such vulnerabilities when contemplating treatment strategies. There is also evidence that in at least some women, hormonal changes associated with reproductive cyclicity may trigger mood episodes that further introduces multifactorial complexities in diagnosis and management.
