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Gender differences in the clinical course of depression in bipolar disorder

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 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, 10th 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. 

About the Authors

N. A. Tyuvina
Department of Psychiatry and Narcology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

 11, Rossolimo Str., Build. 9, Moscow 119021, Russia 

A. E. Stolyarova
Department of Psychiatry and Narcology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

 11, Rossolimo Str., Build. 9, Moscow 119021, Russia 

D. V. Morozova
Department of Psychiatry and Narcology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

 11, Rossolimo Str., Build. 9, Moscow 119021, Russia 

M. S. Verbitskaya
Department of Psychiatry and Narcology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

 11, Rossolimo Str., Build. 9, Moscow 119021, Russia 


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For citations:

Tyuvina N.A., Stolyarova A.E., Morozova D.V., Verbitskaya M.S. Gender differences in the clinical course of depression in bipolar disorder. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(2):47-55.

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