Are bipolar mood symptoms affected by the phase of the menstrual cycle?

Geetha Shivakumar, Ira H. Bernstein, Trisha Suppes, Paul E. Keck, Susan L. McElroy, Lori L. Altshuler, Mark A. Frye, Willem A. Nolen, Ralph W. Kupka, Heinze Grunze, Gabriele S. Leverich, Jim Mintz, Robert M. Post

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Evidence suggests gender differences may exist in bipolar disorder, and a review of the literature shows that more women than men may experience rapid-cycling bipolar disorder. The issues contributing to these gender differences are unknown; a number of case reports have indicated the possibility of mood changes secondary to hormonal influences during the menstrual cycle. We sought to examine the relationship between bipolar disorder and menstrual cycle-related mood changes. To our knowledge, this is one of the largest samples in the literature addressing this issue. Methods: Outpatient women with bipolar disorder I, bipolar disorder II, and not otherwise specified (NOS), between the ages of 18 and 45, were evaluated. The National Institute of Mental Health Life Chart Method-p (NIMH-LCM-p) was used for daily mood ratings of depression and mania. Repeated measures of ANOVA and t tests were conducted separately for depressive and for manic symptom scores. Results: One hundred nineteen women met the age criterion, and only 41 women met the rest of the inclusion criteria. In this sample of 41 women, there was no significant relationship between phases of the menstrual cycle (early and late follicular and early and late luteal phases) and changes in depression or mania. In an exploratory examination, 8 of 41 women showed a numerically higher mean depression score in the luteal phase than in the follicular phase; 5 of 41 women showed a numerically higher mean mania score in the luteal phase than in the follicular phase of the menstrual cycle. Conclusions: Different phases of the menstrual cycle were unrelated to depression and mania in a heterogeneous group of women with bipolar disorder. Prospective studies are needed to identify a vulnerable subpopulation in a homogeneous clinical sample.

Original languageEnglish (US)
Pages (from-to)473-478
Number of pages6
JournalJournal of Women's Health
Volume17
Issue number3
DOIs
StatePublished - Apr 1 2008

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Menstrual Cycle
Bipolar Disorder
Depression
Luteal Phase
Follicular Phase
National Institute of Mental Health (U.S.)
Analysis of Variance
Outpatients
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Shivakumar, G., Bernstein, I. H., Suppes, T., Keck, P. E., McElroy, S. L., Altshuler, L. L., ... Post, R. M. (2008). Are bipolar mood symptoms affected by the phase of the menstrual cycle? Journal of Women's Health, 17(3), 473-478. https://doi.org/10.1089/jwh.2007.0466

Are bipolar mood symptoms affected by the phase of the menstrual cycle? / Shivakumar, Geetha; Bernstein, Ira H.; Suppes, Trisha; Keck, Paul E.; McElroy, Susan L.; Altshuler, Lori L.; Frye, Mark A.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinze; Leverich, Gabriele S.; Mintz, Jim; Post, Robert M.

In: Journal of Women's Health, Vol. 17, No. 3, 01.04.2008, p. 473-478.

Research output: Contribution to journalArticle

Shivakumar, G, Bernstein, IH, Suppes, T, Keck, PE, McElroy, SL, Altshuler, LL, Frye, MA, Nolen, WA, Kupka, RW, Grunze, H, Leverich, GS, Mintz, J & Post, RM 2008, 'Are bipolar mood symptoms affected by the phase of the menstrual cycle?', Journal of Women's Health, vol. 17, no. 3, pp. 473-478. https://doi.org/10.1089/jwh.2007.0466
Shivakumar, Geetha ; Bernstein, Ira H. ; Suppes, Trisha ; Keck, Paul E. ; McElroy, Susan L. ; Altshuler, Lori L. ; Frye, Mark A. ; Nolen, Willem A. ; Kupka, Ralph W. ; Grunze, Heinze ; Leverich, Gabriele S. ; Mintz, Jim ; Post, Robert M. / Are bipolar mood symptoms affected by the phase of the menstrual cycle?. In: Journal of Women's Health. 2008 ; Vol. 17, No. 3. pp. 473-478.
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abstract = "Background: Evidence suggests gender differences may exist in bipolar disorder, and a review of the literature shows that more women than men may experience rapid-cycling bipolar disorder. The issues contributing to these gender differences are unknown; a number of case reports have indicated the possibility of mood changes secondary to hormonal influences during the menstrual cycle. We sought to examine the relationship between bipolar disorder and menstrual cycle-related mood changes. To our knowledge, this is one of the largest samples in the literature addressing this issue. Methods: Outpatient women with bipolar disorder I, bipolar disorder II, and not otherwise specified (NOS), between the ages of 18 and 45, were evaluated. The National Institute of Mental Health Life Chart Method-p (NIMH-LCM-p) was used for daily mood ratings of depression and mania. Repeated measures of ANOVA and t tests were conducted separately for depressive and for manic symptom scores. Results: One hundred nineteen women met the age criterion, and only 41 women met the rest of the inclusion criteria. In this sample of 41 women, there was no significant relationship between phases of the menstrual cycle (early and late follicular and early and late luteal phases) and changes in depression or mania. In an exploratory examination, 8 of 41 women showed a numerically higher mean depression score in the luteal phase than in the follicular phase; 5 of 41 women showed a numerically higher mean mania score in the luteal phase than in the follicular phase of the menstrual cycle. Conclusions: Different phases of the menstrual cycle were unrelated to depression and mania in a heterogeneous group of women with bipolar disorder. Prospective studies are needed to identify a vulnerable subpopulation in a homogeneous clinical sample.",
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AU - Bernstein, Ira H.

AU - Suppes, Trisha

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AU - McElroy, Susan L.

AU - Altshuler, Lori L.

AU - Frye, Mark A.

AU - Nolen, Willem A.

AU - Kupka, Ralph W.

AU - Grunze, Heinze

AU - Leverich, Gabriele S.

AU - Mintz, Jim

AU - Post, Robert M.

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N2 - Background: Evidence suggests gender differences may exist in bipolar disorder, and a review of the literature shows that more women than men may experience rapid-cycling bipolar disorder. The issues contributing to these gender differences are unknown; a number of case reports have indicated the possibility of mood changes secondary to hormonal influences during the menstrual cycle. We sought to examine the relationship between bipolar disorder and menstrual cycle-related mood changes. To our knowledge, this is one of the largest samples in the literature addressing this issue. Methods: Outpatient women with bipolar disorder I, bipolar disorder II, and not otherwise specified (NOS), between the ages of 18 and 45, were evaluated. The National Institute of Mental Health Life Chart Method-p (NIMH-LCM-p) was used for daily mood ratings of depression and mania. Repeated measures of ANOVA and t tests were conducted separately for depressive and for manic symptom scores. Results: One hundred nineteen women met the age criterion, and only 41 women met the rest of the inclusion criteria. In this sample of 41 women, there was no significant relationship between phases of the menstrual cycle (early and late follicular and early and late luteal phases) and changes in depression or mania. In an exploratory examination, 8 of 41 women showed a numerically higher mean depression score in the luteal phase than in the follicular phase; 5 of 41 women showed a numerically higher mean mania score in the luteal phase than in the follicular phase of the menstrual cycle. Conclusions: Different phases of the menstrual cycle were unrelated to depression and mania in a heterogeneous group of women with bipolar disorder. Prospective studies are needed to identify a vulnerable subpopulation in a homogeneous clinical sample.

AB - Background: Evidence suggests gender differences may exist in bipolar disorder, and a review of the literature shows that more women than men may experience rapid-cycling bipolar disorder. The issues contributing to these gender differences are unknown; a number of case reports have indicated the possibility of mood changes secondary to hormonal influences during the menstrual cycle. We sought to examine the relationship between bipolar disorder and menstrual cycle-related mood changes. To our knowledge, this is one of the largest samples in the literature addressing this issue. Methods: Outpatient women with bipolar disorder I, bipolar disorder II, and not otherwise specified (NOS), between the ages of 18 and 45, were evaluated. The National Institute of Mental Health Life Chart Method-p (NIMH-LCM-p) was used for daily mood ratings of depression and mania. Repeated measures of ANOVA and t tests were conducted separately for depressive and for manic symptom scores. Results: One hundred nineteen women met the age criterion, and only 41 women met the rest of the inclusion criteria. In this sample of 41 women, there was no significant relationship between phases of the menstrual cycle (early and late follicular and early and late luteal phases) and changes in depression or mania. In an exploratory examination, 8 of 41 women showed a numerically higher mean depression score in the luteal phase than in the follicular phase; 5 of 41 women showed a numerically higher mean mania score in the luteal phase than in the follicular phase of the menstrual cycle. Conclusions: Different phases of the menstrual cycle were unrelated to depression and mania in a heterogeneous group of women with bipolar disorder. Prospective studies are needed to identify a vulnerable subpopulation in a homogeneous clinical sample.

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