Long story, worse at menopause (see my italics below)

Q: I was diagnosed over 13 years ago as bipolar and put on lithium and Prozac. I thought they were exaggerating because while I had depression up the wazoo, I never got beyond hypomanic. I went off both drugs and, except for a few short (as in couple of weeks) trials of Zoloft and Effexor I haven't taken psychoactive medication. I see now that I probably have what's now called Bipolar II, but frankly, I can handle mild to moderate depressions with Zen and endurance, and I LIKE being hypomanic--after the depression, it's invariably fun and productive, not problematic. But what is liable to drive me to suicide one of these days is the daily cycling. Every single day for most of my life, I wake wishing I wasn't alive, completely gloomy about my life. Once I'm out of bed and moving around I get better, and as the day wears on I get to feeling really good, sometimes even euphoric by late at night. I start projects, I make plans, I'm social...then the next morning I crash completely, I can't follow through on plans--sometimes I don't feel human till after 5 pm so errands don't get run. I also chronically forget things I intended to do, unless I wrote them down on a list. This roller coaster is killing me. And when as now I have a real problem--the house I've rented for 9 years is being sold and I have such bad credit due to past problems with depression, CFIDS, and 2 bouts of breast cancer that I am not going to be able to find another rental, I will either have to be taken in by compassionate friends or I will be living in my truck with my cat--waking is accompanied by terror and desire to die, most of the day is taken up simply getting myself to function minimally (my house is a mess, I'm physically unkempt). FINALLY around late evening when everyone else is going to bed, I am at last able to, and need to talk, and no one is around except a friend I talk to on the internet who is across the country. By the time i feel like maybe this situation won't kill me after all it's time to go to sleep, only to wake up in hell again, and start from scratch. I really don't want to be dependent on drugs, but I have spent most of my energy all my life climbing every day out of despair only to fall back into it again. During rare periods of productivity I have been a straight A student, at the top of my law school class, and a valued employee. During prolonged slumps I have been fired, hospitalized for suicidal depression, and my finances are a disaster and have been for over a decade. I know I have many skills and talents and have great willpower and a fabulous sense of humor. But I'm 49 and I'm about to be on the street and I don't think if I have to fight my moodswings in order to rise above this that I'm going to make it. Right now the only things that are keeping me alive are my cat and the fact that before the bottom fell out I had bought a ticket to Greece for my vacation in the spring. If I have to give up the cat due to the homelessness, or can't make my trip, I am afraid I will decide there is nothing to stick around for. I'm sorry this is so long. Normally by this time of night I'd be chipper, but this is the week a month that I feel like blowing my brains out anyway, and since I became perimenopausal it's ten times worse than when I was younger. I'm not sure that there's anything anyone can do for me because I can't bring myself to take the drugs, but if you can think of any other methodology that might help me cope with this without them, I would be very grateful. 

Thank you, Chris

Dear Chris -- 
OK, we'll start with the non-medication approaches, but at first this ain't going to sound pretty to you either -- check out the graphs to believe it's possible, if you haven't done this yet: 


Then there's exercise.  For all the years you've been dealing with this, you must have discovered whether this has much impact (or is even possible, given your energy starting place).  

See the complete list of options under my section on treatment details, if you haven't been there yet.  I confess I believe there's a 50% chance or better that you could find a medication that would be so far better than the no-meds options you'd never even think of not taking it, after seeing what it could do.  If I hear you right, you've never had a mood stabilizer without an antidepressant, so at minimum you could try lithium at whatever lowest dose your body can tolerate without any side effects at all, even if it's only 300 mg, and compare that to no med's.  Then you should consider trying, in the same I-won't-tolerate-a-single-side-effect way, low-dose Depakote (say 250-500mg, which would bother perhaps only 1 person in 100)(as long as it's medically safe to try, e.g. no liver problems, etc.).  

You're helping me be even more certain that hormones play a role in the severity of all this.  See my hormones and mood site re: menopause, even though at present there's virtually nothing that tells us about how to proceed (since estrogen-replacement is a controversial subject even amongst the OB-GYN crowd).  Good luck.  Take a look at the hope section too, which I just put up, if you haven't seen that one yet...

Dr. Phelps

Published January, 2001