First published on International Bipolar Foundation's, "Men's Corner", in April 2021
Did you know that 46 million people worldwide are living with bipolar disorder?
This breaks down to a slightly uneven split of 48% male 52% female, and this pattern is seen in almost all countries .
But are there other ways in which bipolar disorder differs between males and females, and do they really change how males should be treated?
Before we continue, here’s a quick reminder on the main subtypes of bipolar disorder.
Bipolar I is characterized by at least one episode of mania that affects functioning.
Bipolar II is characterized by at least one episode of hypomania (a briefer and less severe form of mania) plus at least one episode of major depression.
Rapid cycling is characterized by at least four episodes of mania, hypomania, depressive or mixed episodes in any 12-month period.
Which subtypes of bipolar disorder are men more likely to have?
Many papers have been written on this controversial topic, but this article (based on various studies) should help to clarify some of the data.
Do men present with different symptoms compared to women?
What’s the relevance of conduct disorder and substance abuse in men?
Conduct disorder is a clinical definition, which can be characterized as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.” The person diagnosed with conduct disorder has to have met at least three criteria in the past 12 months, which may include bullying or threatening behaviour, use of a weapon, stealing from someone’s person and so on .
There can be a misperception in the general public and media that people with bipolar disorder, especially men, are physically aggressive and dangerous. The real story is that although there is an increased risk of aggression in men with bipolar disorder this generally only applies to those who have substance abuse problems, that is, those who have addiction problems with tobacco, alcohol or other drugs .
As well as affecting behavior towards others, we can also see from research that substance abuse, as well as male gender, and younger age of onset are also associated with not sticking with a treatment plan .
Worryingly, researchers in 2011 suggested that 8% of men and 5% of women with bipolar disorder died from suicide .
The next logical question is why is there a difference between the figures for men and women? If we could understand the story behind these figures, then surely we can save lives. Here are some points we could consider as relevant:
Let’s work with what we can have some control over.
1. Substance abuse is seen more frequently in men than women. It reduces speed of recovery, reduces ability to stick to a medication regime, and increases suicide risk. Not only that, but stimulants (like amphetamines and cocaine) may induce mania and consequent risky, dangerous behaviours; and depressants like alcohol and benzodiazepines can trigger or exacerbate depression . If substances might be affecting your mental health, get help.
2. Thinking about stopping medication is not unusual in anyone taking long-term treatment, but if you feel that you no longer need to take a drug, see your doctor first to discuss things further.
3. Learn more about what the warning signs are when you are starting to head towards a relapse.
4. Seek help and support from trusted people when you need it. Stigma is a complex and strange beast, whether it comes from society or our culture, or even ourselves. Not having compassion for ourselves can get in the way of seeking help, worsening mental health, and then we could get caught in a vicious cycle. Don’t let stigma be a barrier to living life well [15,16]
5. Follow a healthy lifestyle, including a good routine and sleep pattern; reduce stressors where you can. Do things that make you happy.
1. Ritchie, H. and Roser, M. (2018). Mental Health. [online] Our World in Data. Available at: https://ourworldindata.org/mental-health [Accessed 11 Apr. 2021].
2. Gogos, A. and et al. (2019). Sex differences in schizophrenia, bipolar disorder, and post‐traumatic stress disorder: Are gonadal hormones the link? British Journal of Pharmacology, [online] 176(21), pp.4119–4135. Available at: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bph.14584 [Accessed 11 Apr. 2021].
3. Kennedy, N. and et al. (2005). Gender Differences in Incidence and Age at Onset of Mania and Bipolar Disorder Over a 35-Year Period in Camberwell, England. American Journal of Psychiatry, [online] 162(2), pp.257–262. Available at: https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.2.257 [Accessed 11 Apr. 2021].
4. Vega, P. and et al. (2011). Bipolar Disorder Differences between Genders: Special Considerations for Women. Women’s Health, [online] 7(6), pp.663–676. Available at: https://journals.sagepub.com/doi/10.2217/WHE.11.71#articleCitationDownloadContainer [Accessed 9 Apr. 2021].
5. Deflorio, A. and Jones, I. (2010). Is sex important? Gender differences in bipolar disorder. [online] International Review of Psychiatry. Available at: https://www.tandfonline.com/doi/full/10.3109/09540261.2010.514601?scroll=top&needAccess=true [Accessed 11 Apr. 2021].
6. INSERM Collective Expertise Centre (2015). Conduct: Disorder in children and adolescents. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK7133/ [Accessed 11 Apr. 2021].
7. Fazel, S. and et al. (2010). Bipolar Disorder and Violent Crime. Archives of General Psychiatry, [online] 67(9), pp.931–938. Available at: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210872 [Accessed 11 Apr. 2021].
8. P, R., Robert and et al. (2017). Bipolar Disorder. 2nd ed. [online] Google Books. Hogrefe Publishing. Available at: https://play.google.com/books/reader?id=3wFQDwAAQBAJ&pg=GBS.PP1 [Accessed 11 Apr. 2021].
9. Messer, T. and et al. (2017). https://www.researchgate.net/publication/315886339_Substance_abuse_in_patients_with_bipolar_disorder_a_systematic_review_and_Meta-analysis. [online] ResearchGate. Available at: https://www.researchgate.net/publication/315886339_Substance_abuse_in_patients_with_bipolar_disorder_a_systematic_review_and_Meta-analysis [Accessed 11 Apr. 2021].
10. Miller, J.N. and Black, D.W. (2020). Bipolar Disorder and Suicide: a Review. Current Psychiatry Reports, [online] 22(2). Available at: https://link.springer.com/article/10.1007/s11920-020-1130-0 [Accessed 11 Apr. 2021].
11. Cunningham, R. and et al. (2020). Gender and mental health service use in bipolar disorder: national cohort study. BJPsych Open, [online] 6(6), p.E138. Available at: https://www.cambridge.org/core/journals/bjpsych-open/article/gender-and-mental-health-service-use-in-bipolar-disorder-national-cohort-study/06F6A2CABEAF9C45E1FCBBC6D7A017FD [Accessed 11 Apr. 2021].
12. Öhlund, L. and et al. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, [online] 18(1), p.37. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29415689 [Accessed 11 Apr. 2021].
13. Fink, C. and Kraynak, J., 2016. Bipolar Disorder for Dummies. 3rd ed. New Jersey, USA: John Wiley & Sons, Inc.
14. Jensen, Tom. “Of Mind and Men: Mental Health, Addiction and Hope - International Bipolar Foundation.” International Bipolar Foundation, 2014, ibpf.org/articles/of-mind-and-men-mental-health-addiction-and-hope/. Accessed 11 Apr. 2021.
15. Lam, Alice. “Stigma and Bipolar Disorder.” Dr Alice Lam, GP & Health Writer, 2019, www.dralicelam.com/the-write-action/stigma-and-bipolar-disorder. Accessed 11 Apr. 2021.
16. Chatmon, Benita N. “Males and Mental Health Stigma.” American Journal of Men’s Health, vol. 14, no. 4, 2020, p. 155798832094932, www.ncbi.nlm.nih.gov/pmc/articles/PMC7444121/, 10.1177/1557988320949322. Accessed 11 Apr. 2021.
First published in Bipolar Life on 21 March 2021, and republished on the International Bipolar Foundation's (IBPF) and www.nami.org/Blogs/NAMI-Blog/May-2021/How-to-Predict-Your-Next-Bipolar-EpisodeNational Alliance on Mental Illness' (NAMI) websites.
Wouldn’t it be great if you could stop a depressive or manic episode in its tracks?
Is there any proof that anything can be done to keep yourself from having a relapse of illness?
Fortunately, for many people with bipolar disorder, they are able to sense a relapse.
What we are talking about here is the prodrome, a set of early signs of relapse or recurrence of illness. (Although the term “prodrome” can be used for symptoms evolving before a person’s first episode, this article is for people who already have been diagnosed with bipolar disorder.).
For those with bipolar disorder, and people in their support network, not knowing how to recognise the prodrome could be a significant contributing factor to the stress of the condition. Self-monitoring is therefore an important part of bipolar management.
What do the studies show?
A 2003 review of 17 studies, looking at over 1,000 people with bipolar disorder was undertaken by researchers. They looked at the prodromal symptoms and duration before a depressive or manic relapse. These were their main findings:
In 2016, another review of 11 studies was undertaken, again covering over 1,000 people. The researchers concluded that prodromes before recurrent episodes were much shorter than before first episodes, lasting about one to two months. The symptoms in the prodrome period were similar to those in the impending recurrent episode .
What does this mean for me?
It is helpful to know that if you are able to pick up on any early warning signs, it could mean you prevent a relapse altogether; or at least that the episode will be milder and more manageable.
If you are well enough to think back on your previous episode(s), why not make some notes on what your early signs were.
Although there isn’t a definitive test or list of symptoms that applies to everyone, the good news is, there is some evidence that your warning signs are a useful marker for you. About half of people with bipolar disorder are able to identify at least three features that indicate impending mania or depression .
Below you will find some general examples. Try to be as specific as you can.
Okay, I think I might be heading towards a relapse; now what?
Get help from your doctor, whether that is your GP or psychiatrist. They might need to review your medications. It could be that your sleep cycle is out of balance, or perhaps there are stressors that need to be managed. If you are getting worse, such as feeling you feel you can’t cope on your own, or you might harm yourself or someone else, go to your nearest Emergency Department or call the ambulance service.
And finally, get support from your partner, family and/or friends.
1. Geddes, J. “Prodromal Symptoms May Be Identified by People with Bipolar or Unipolar Depression.” Evidence-Based Mental Health, vol. 6, no. 4, 2003, pp. 105–105, https://ebmh.bmj.com/content/6/4/105. Accessed 21 Mar. 2021.
2. Meter, Anna R. Van, and et al. “The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence prior to Initial or Recurrent Mood Episodes.” Journal of the American Academy of Child & Adolescent Psychiatry, vol. 55, no. 7, 2016, pp. 543–555, jaacap.org/article/S0890-8567(16)30171-X/fulltext, 10.1016/j.jaac.2016.04.017. Accessed 21 Mar. 2021.
3. Geoffroy, Pierre Alexis, and Jan Scott. “Prodrome or Risk Syndrome: What’s in a Name?” International Journal of Bipolar Disorders, vol. 5, no. 7, 2017, journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0077-5#Abs1, 10.1186/s40345-017-0077-5. Accessed 21 Mar. 2021.
Dr Alice Lam
I'm a doctor who is passionate about writing quality health content.