Gender differences in the clinical course of depression in bipolar disorder

Abstract

Objective: to investigate gender differences in patients with depression and bipolar disorder (BD) and their impact on the clinical course of the disease. Patients and methods . 50 women and 50 men with bipolar disorder (BD) (F31 according to the International Classification of Diseases, 10 th revision – ICD-10) were examined using a specially developed survey. Patients symptoms was assessed in accordance with the diagnostic criteria of affective disorders according to ICD-10 and DSM-V, MADRS (Montgomery-Asberg Depression Rating Scale) and Q-LES-Q-SF (Scoring the Quality of Life Enjoyment and Satisfaction Questionnaire). Results and discussion . Gender differences in the clinical course of BP were revealed. In men the disease usually starts with a mania phase followed by a marked mood increase in BD- I, a shorter period before the first mania (hypomania) if the onset is with the depression phase, mood swings and substance use disorders in puberty, which makes the diagnosis easier. In women BD diagnosis may be harder due to higher frequency of BD-II, clinical presentation with depression, longer period before the first mania (hypomania). Therefore the most important clinical markers of BD in women include the early onset of the disease, its association with neurohormonal factors, history of affective variability, substance use disorders, schizophrenia, hereditary or comorbid eating disorder in puberty or later in life. The most common clinical features during the depression phase in men include: seasonal fluctuation (worsening of symptoms in autumn and winter) and diurnal variations (improvement of symptoms in the evening), numbed emotions, depersonalization-derealization syndrome, decreased libido, difficulty in falling asleep and increased appetite and/or body mass, comorbid depression, panic attacks and alcohol and substance abuse. The depression in women with BD is characterized by a higher prevalence of apathy, tearfulness, self-harm, body dysmorphic disorder, decreased appetite. Both male and female patients with depression and BD have a high level of anxiety, presence of psychomotor retardation, self-accusation and irritancy, 10% had atypical features according to the DSM-V criteria. Women have a higher proportion of depressive episodes (including rapid cycling BD) and a higher risk of suicidal behavior, and men, due to a higher frequency of manic phases, change partners and have a history of divorce significantly more often. Conclusion. The revealed features of psychopathological symptoms, comorbid disorders, the course of the disease and correlations between individual characteristics and factors due to gender differences, can be used as markers of bipolarity, which will allow to diagnose BD earlier and more accurately and prescribe adequate therapy.