BC Pills Dc'd & Hypomanic Symptoms
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Q:  BC Pills Dc'd & Hypomanic Symptoms

My wife age 33 stopped taking birth control pills in June after taking them for seven years. Starting in July she started showing symtoms of Hypomania including needing less sleep, increased energy, lost ten pounds, wanting to engage in more risky behavior like wanting to drive real fast, felt like the "life of the party", increased libido, desire for sex outside of marriage, wanted to have fun and stay up late seven nights a week. The after three months the mania has gone away but some of the libido symtoms remain. Now we and the doctors are wondering if this is Bipor II at all. No depression has come following the mania. Thyroid has been checked out OK. Just wild hormones needing to settle done a bit? Have you seen cases like this?


Dear Mr. H' -- 
Very interesting.  "Life of the party", well, that could still be thought of as a sort of "sexual" activity; but driving real fast, that's much more the kind of thing we see in bipolar disorder all right.  

Now there's a phenomenon, not very common, but recognized enough to get a name, called "antidepressant-withdrawal induced mania".  If you consider estrogen as an "antidepressant", which in some respects is true, at least in some women (although a serious oversimplification), then perhaps you could invoke this "withdrawal induced mania" concept to explain what you're seeing.  I've not seen this phenomenon myself.  

Searching "estrogen mania" using Pub Med led to this interesting report you might want to get a local librarian to help you dig up: 

Post-abortion mania
V Mahe, F Montagnon, J Nartowski, and A Dumane
Br J Psychiatry 175: 389-390.

After abortion there would be a precipitous drop in estrogen.  Maybe your wife's case could be somewhat similar; at least here's one report of something similar.  However, just as has been my experience in practice with estrogen, the opposite is also shown, namely mania going onto hormone replacement (here's that abstract).  Estrogen is just really variable in terms of its effects on mood.  Your wife's experience is going into my collection of stories on that subject -- which collection at this point does not really lead to some sort of unifying theory here, except that idea about estrogen acting like an antidepressant of sorts.  

As for "prognosis", i.e. what does this mean for her future...  Sorry, because we know too little to explain it, we also know to little to predict.  Again, I've seen cases sort of like this (some dramatic response to estrogen, of one type or another) go on to recurrence; and also some which didn't (obviously the latter are less likely to show up in my practice, so I don't have a good sense of how many of those there are.  It could be the vast majority of women -- e.g postpartum depression is common and does not suggest that a woman is going to have recurrent depression thereafter (although it does suggest that she is highly vulnerable to repeat after subsequent pregnancies).  

I hope something in there is helpful to you. 

Dr. Phelps

Published October, 2002


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