Interaction Problem w/Premarin...&My Meds?
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Q:  Interaction Problem w/Premarin... & My Meds?

my drug regime currently includes

1 x 250mg lithium carbonate am                           
1 x 25mg thyroid tablet am
1 x Brenda 35 (contraceptive pill) am
1 x Endep 10 pm
1 x 250mg lithium carbonate pm
3 x 25mg mogadon (sleeping pills) pm
1 x 25mg serequoil tablet pm
1mg of a 2mg valium tablet pm
1 x senekot tablet - helps relieve constapated bowel actions and
1 x coloxyl and senna tablet which helps with the abovementioned senekot.

However I have been on Brenda 35 for over nine weeks straight without a break for bleeding.  However I have been experiencing daily "spotting" for some weeks now.  My doctor has recommended that I take a break from Brenda 35 and use Premarin and other oestrogen based substances to keep me stable whilst off the contraceptive pill.  However from my web based research I can find nothing about the interactions of Premarin & other estrogen based products and lithium or any of the other drugs I am currently taking.

Can you assist please Doctor, will there be any bad intereactions (note I have had a "bad" time with medication, for instance lithium was the only drug that I didn't have an a bad adverse reaction I did have an adverse reaction to it but as I had worse reactions to all other medications trialled...i was left with lithium).

Any assistance you could offer would be appreciated.


Dear Sarah -- 
To my knowledge there is not an "interaction" problem with the kind of change in hormone use you're looking at.  There is some very underappreciated interaction between the entire female reproductive hormone system and bipolar disorder.  This is obvious at one level, like who hasn't heard of PMS, which has
remarkable resemblance to "bipolar mixed state" symptoms.  

At another level, we're just beginning to recognize how another hormonal syndrome may relate (or I am, anyway, and one other research psychiatrist I just read!  Here's a summary), called "metabolic syndrome" or "Syndrome X".  

So, while I wouldn't be looking for interaction problems, I would be thinking about how these issues relate.  Unfortunately, not much is known (at least by psychiatry) yet. 

Dr. Phelps 

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