Special considerations in treating bipolar disorder in women


  • Dr. Burt has been on speaker/advisory boards for Eli Lilly, GlaxoSmithKline, Wyeth Ayerst, Forest Pharmaceuticals, Pfizer Pharmaceuticals, Bristol-Meyers Squibb, and AstraZeneka, and has been a consultant for Eli Lilly and has received grant/research support from Solvay Pharmaceuticals and Bristol-Meyers Squibb. Dr. Rasgon has been on speaker boards for Abbott Pharmaceuticals, Forest Pharmaceuticals, Pfizer Pharmaceuticals, GlaxoSmithKline, and Wyeth-Ayerst, and has received grant support from Forest Pharmaceuticals.

Vivien K. Burt MD, PhD, David Geffen School of Medicine at UCLA, Director, Women's Life Center, UCLA Neuropsychiatric Institute and Hospital, 300 UCLA Medical Plaza, Suite 2337, Los Angeles, CA 90095, USA.
Fax: 310 824 5750;
e-mail: vburt@mednet.ucla.edu


There are obvious gaps in research surrounding issues specific to women who suffer from bipolar disorder, including gender differences and their implications for management, the impact of the reproductive cycle, and evidence based treatment guidelines for pregnancy and the postpartum period. Gender differences have not been reported for the prevalence of bipolar disorder; however, women are more likely to experience rapid cycling, mixed mania, and antidepressant-induced manias. This may affect response to treatment, which has been found, in some cases, to differ in men and women. In addition, side effects in response to treatments may well differ in men and women, especially with regard to lithium and valproate prescription. The course of bipolar disorder in women may be influenced by the menstrual cycle, pregnancy, the postpartum period, and menopause, although many issues require further clarification. Treatment of bipolar disorder during pregnancy and the postmenopausal period requires careful consideration, as does treatment during the childbearing years, as some mood stabilizers influence the metabolism of oral contraceptives. This review article has attempted to evaluate existing literature regarding women with bipolar disorder in a comprehensive and critical way, and to consolidate into a single source the gender-specific aspects of the disorder that may have treatment implications for women.