Jil, a 29-year-old from Mississippi, first experienced symptoms of bipolar disorder (depressed mood, insomnia, excess energy) in high school. When she was 16, her doctor diagnosed her with major depression and prescribed the antidepressant sertraline (then known by its brand name, Zoloft). The medication made Jil "completely manic"which antidepressants are believed to do in some people with bipolar disorderand a year later, a different doctor finally diagnosed her as bipolar.
In other ways, Jils story is all too typical. One of the reasons that bipolar disorder may be underdiagnosed in women is that the milder form of mania that Jil experiences appears to be more common in women. Although each case of bipolar disorder falls on a spectrum, rather than into neat categories, two main types of the disorder have been identified. The first, known as bipolar I disorder, is characterized by pronounced manicand even psychoticepisodes that often lead to hospitalization, and therefore a correct diagnosis. Bipolar II disorder features a more moderate form of mania known as hypomania, which is easier to mistake for an ordinary mood swing. While the prevalence of bipolar I is roughly the same among men and women, it has been suggested that bipolar II appears more often in the latter.
The biological differences between men and women are seen most readily when it comes to the treatment of bipolar disorder. Although talk therapy has of late assumed a more prominent role, the disorder continues to be treated primarily through medicationoften lots of it. Some medications prescribed for bipolar disorder have been linked to birth defects, however, which presents a dilemma for women of childbearing age. (The Food and Drug Administration, for instance, has warned that babies born to mothers who take lamotrigine in the first three months of pregnancy may have a higher chance of being born with a cleft lip or palate. )