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.

Jump to:

• Prevalence Of Bipolar Disorder In Women
• Symptoms Of Bipolar Disorder In Women
• Bipolar Depression Symptoms In Females: Unique Challenges 
• Treatment For Bipolar Disorder At Madison Avenue TMS & Psychiatry
• Contact Us

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:

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).

1. 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).
2. 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).
3. 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).
4. 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.

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:

• Exploring Transcranial Magnetic Stimulation (TMS) For Postpartum Depression
• Women And Mental Health: Understanding The Gender Depression Gap
• Depression Treatments That Are Safe For Pregnant Women

Resources:

1. National Institute of Mental Health. Bipolar disorder. 2020. Link. Accessed June 13, 2024.
2. 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.
3. Arnold, L. M. Gender differences in bipolar disorder. Psychiatric Clinics of North America. 2003;26(3), 595-620. Link. Accessed June 13, 2024.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.