How does bipolar disorder affects girls? Frank talk about premenstrual symptoms, self-injury, hypersexuality, addiction, weight gain, more in bipolar girls.
Girls with Bipolar Disorder: Special Concerns
What remedy is there for the teenage girl with bipolar disorder who suffers suicidal depression for several days before each menstrual period? How do bipolar illness and its treatments affect a girl's sexual feelings, fertility, and unborn children? What can parents do to keep a risk-loving daughter safe as she passes through adolescence?
As parents, we dread our daughters' descent into the maelstrom of raging hormones, bipolar mood swings, adolescent rebellion, street drugs and alcohol, and medication side-effects. Families seeking professional guidance often feel trapped in a revolving door of disjointed referrals—to pediatricians, psychiatrists, psychotherapists, substance abuse counselors, gynecologists and endocrinologists—hearing from each some version of "sorry, that's not my area of expertise." Meanwhile, a girl's energy, judgment, demeanor and appearance can vary dramatically throughout the month depending on which biochemical, hormone, or neural circuit has seized the reins. Bonds forged or projects begun in periods of wellness or mania may be abandoned in despair or derailed by impulsive self-injury and suicide attempts, which themselves bring further trauma. Periods of extended grief and shame can occur when a girl comprehends the depth of her wounds.
Cognizant of the risks our growing daughters face in the world beyond our doors, and of that fast-approaching eighteenth birthday when our role as legal guardians abruptly (and absurdly) ends, we scramble to equip them—and ourselves—with the knowledge, tools and skills needed to survive the perils that lie ahead. Too often, lacking the means to protect our beloved daughters, we grieve—then rage—as did the Greek goddess Demeter upon learning that her young, risk-loving Persephone had been abducted to the underworld.
Note: Concerns discussed in this article may be painful to discuss or recall.
Risk factors and gender
In childhood, fewer girls are diagnosed with bipolar disorder than boys. CABF's 2003 Membership Survey revealed that 65% of its members' affected children are male and 35% female. Some neuropsychiatric illnesses—such as autism—affect girls at lower rates than boys, and others—such as schizophrenia—tend to emerge later, on average, in girls. Beginning in adolescence, bipolar disorder occurs with equal frequency in males and females. Girls, who often are less disruptive in school than boys, or whose symptoms are more internalized than externalized, may be less likely to be referred for treatment. There are as yet no epidemiological data from research studies to inform us how many prepubertal girls or boys, for that matter, actually have bipolar disorder.
In adults, women appear to manifest rapid-cycling and depression more often than men, but gender differences remain largely unexplored.
Parents of girls with bipolar disorder often report on the CABF message boards that their daughters have difficulty with their periods. Females with bipolar disorder may have higher than usual rates of anovulation (absence of periods) and longer than normal cycles. These abnormalities are associated with an increased risk for diabetes. Heavy bleeding and severe cramps interfere with school attendance and participation in sports. A consultation with a gynecologist and/or endocrinologist may be helpful if puberty seems abnormally early or delayed or if periods are highly irregular or painful. Careful charting of symptoms and monthly cycles is essential, and should be started at the earliest possible time. Several mood charts are available on the CABF Web site (see below).
Some CABF parents report that their daughters have a sharp increase in irritability, depression, impaired concentration, sleeplessness, panic attacks, self-injury or anxiety prior to their first menstrual period, and experience these symptoms before each subsequent period. Symptoms of other chronic illnesses—epilepsy, migraine, and multiple sclerosis, for example—also are known to worsen premenstrually. A sudden increase in symptoms may signal that a period is imminent, but until the bleeding actually starts, it is impossible to tell whether the symptoms are worsening due to the hormonal change.
Psychiatrists in the emerging specialty of reproductive psychiatry study the interaction between mood and hormonal changes at all stages of a woman's life. They find that premenstrual dysphoric disorder (PMDD) (a severe form of premenstrual syndrome, or PMS) may be associated with a serotonin deficiency during the luteal phase (second half) of the monthly cycle. Low serotonin is associated with depression. The current treatment for simple PMDD includes low-dose antidepressants, such as a selective serotonin reuptake inhibitor (SSRI), administered for a few days during the luteal phase. However, girls with both bipolar disorder and PMDD who take SSRIs risk increased cycling, irritability, or induction of mania. Some CABF parents report that their daughters become disinhibited on SSRIs, with increased self-injurious and suicidal behaviors.
Other treatment strategies have been reported in medical journals and by parents on the CABF Web site, but data supporting these strategies in teens and young women with bipolar disorder are limited. For patients taking lithium, doctors may order pre-and-post period lithium levels to determine whether the level is dropping premenstrually. If so, and the girl's periods are regular and predictable, dose adjustments can be made as needed. Some doctors prescribe birth control pills or the contraceptive patch. One recent study of women with bipolar disorder found that women taking oral contraceptives had much less cycling during the entire month than women not receiving oral contraceptives. Some gynecologists will prescribe "the Pill" to be taken continuously for several months at a time. The Pill reduces the risk of unplanned pregnancy but some medications—such as Trileptal® and Carbamazapine—interfere with the effectiveness of oral contraceptives. Trials of several different brands (with differing types and levels of hormones) may be necessary, and some girls report increased depression on some brands. In some studies, complementary and alternative measures, including light therapy, exercise, L-tryptophan, calcium carbonate, and cognitive behavior therapy have been shown helpful in treating PMDD. Benzodiazapines are sometimes prescribed for premenstrual anxiety and agitation, but they can be abused and create dependence.