Hormone replacement and mood
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Hormone replacement and mood (Susan)

I have been diagnosed with bipolar II, mostly having episodes of depression and a secondary hypomanic state one time brought on by a TCA. I recently was put on Prempro for menopause and became severely depressed. Do you know of any HRT that would be the least likely to cause depression? thank you. Susan

Hello Susan --
Read the Q/A here about hysterectomy for another example of someone seeing mood effects from something related to hormone control.  Unfortunately, although evidence is rapidly accumulating to show that hormones (like hormone replacement therapy - HRT) can dramatically affect mood in some people, we still don't know how to adjust our mood treatment efforts accordingly.

 I hear about mood-hormone relationships a great deal from my bipolar patients.  In any given person, it seems that estrogen can have: a) no effect at all; b) a mood improving effect -- that's quite common; or c) the effect you've experienced, becoming depressed.  Perhaps this shouldn't be such a surprise: when people are given steroids like "Prednisone" for immune system problems, they can have manic episodes -- but they can also have depressive experiences.  And as you know, estrogen is a steroid hormone.

As you may also know, there is still a fair bit of controversy about HRT approaches even for women who don't have known mood problems: how much, and what progesterone form if any, are two major issues.  Which form and approach to use in your case depends of course, and first of all, on why you're taking HRT in the first place.  But, unfortunately, how to vary that approach given your mood history, and now your mood symptoms on estrogen -- is not known.  So regardless of why you're taking it, we have to approach your problem from the symptoms, not from the cause.  OK, if you have to take HRT (an open question?), then take it and we treat the depression -- tricky, in your case, given that history of hypomania.  I'd think strongly of lithium for it's antidepressant effect, and lamotrigine for the same reasons.  Beyond those options, it gets really tricky.

 See if you can find a mood specialist in your state who works from a women's clinic.  Call one of the bigger hospitals in your area and see if you can find someone who knows of one.  Or try the "find a therapist tools" and then select only those who have experience with "hormones and mood": you could ask for  a "one-time consultation" if they say they're not taking new patients (that may or may not work!).

Dr. Phelps

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