Treating PMDD & Bipolar
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Q:  Treating PMDD & Bipolar


My question relates to treating severe PMS or PMDD symptoms if a person also has bipolar disorder.

I am a 39 year old female with rapid-cycling bipolar disorder and mixed moods (bipolar NOS) and I have a lot of trouble with out of control behavior during the 2-5 days preceding menstruation.  This happens almost every month, and before I hooked up with my current husband, I did not realize that it was even PMS - I thought it was only bipolar.  My psychiatrist says that it is just the bipolar disorder getting worse premenstrually, but I am not so sure, because much of the time I have no symptoms of bipolar before or after the 2-5 days before my period.  Within a day or two of my period starting, I'm miraculously better and don't even remember my aggressive behavior and negative moods.  I have pretty severe breast tenderness during this time too, maybe a 5 on the pain scale at times.  If I did not count the PMS symptom days as bipolar symptom days, I question if I am rapid cycling anymore.  I was at one time, definitely, but now other than PMS, I think I have about one depressive episode lasting about 2-3 months a year, and one hypo-manic episode lasting 1 to 1 1/2 months.  There can be long-lasting mixed mood episodes at times, too.

I am not taking any meds for bipolar at this time.  I tried lithium which helped with mania, but I could not tolerate the side-effects.  I also tried depakote and tegretol and they also gave me bad side-effects and didn't seem to help anyway even though I tried depakote about 2 months and tegretol about 2 weeks.  I have taken a number of anti-psychotics to no avail, and none of these trials were undertaken concurrently with anti-depressants. I tried lamictal too, and it didn't seem to help and made me dangerously clumsy. There are probably 30 meds I have tried over the past 10 years. Incidentally, I firmly believe the course of my illness got much worse since I took anti-depressants due to misdiagnosis early on. Maybe the reason the bipolar meds haven't been helping me is because I have two problems. The mood stabilizers didn't do anything for the PMDD, which I thought was just more bipolar symptoms, so I assumed that the drugs were worthless.  I should say my brother is also   bipolar, went through a lot of med trials also, and has not found anything helpful either.

Anyway, it seems that about 3/4 of my mood troubles occur just a few days a month, virtually every month.  Is there anything you can recommend?  The standard for PMDD is SSRI's, but Prozac and Zoloft made me severly manic for months, and probably are what induced the rapid-cycling to begin with.  Would it be safe and effective to take Prozac just on the few days my symptoms are acting up?  What about Wellbutrin or BuSpar?  Cost is an issue now, since I no longer have any prescription drug coverage and am fairly low income due to disability from this condition. Thanks for all your help on this website!! I really appreciate all the info you put here.
 

Dear Ms. P'  -- 
If we suppose you don't really have bipolar disorder as such, but clearly do have PMDD; and then compare how the treatment approaches for that would look to those which we'd arrive at assuming you did indeed have "bipolar disorder"; I'll be they'd look pretty darn similar -- let's see.  Taking the first diagnostic position first...

Treatment of PMDD for people who should not take an SSRI:  Wellbutrin has not been shown to be effective for PMDDEriksson and would still be a bad idea on the bipolar side of things given your history, in my view.  Buspar might be a candidate though the data are not as strong as for SSRI's.Freeman There is the one study supporting the use of calcium that in my view always seems to be overlooked in favor of the SSRI's. Thys-Jacobs, Douglas Here is a review of the evidenceFugh-Berman for other "alternative medicine" approaches  (a funny phrase that in my view means "no good evidence", since if there was such evidence, why would traditional medicine hesitate to use them, and then they wouldn't be "alternative" anymore?). 

Suppose you did have bipolar disorder.  You'd have all of the above options, none of which (except Wellbutrin, which we ruled out anyway) are known to my knowledge to potentially worsen bipolar disorder, though chaste-berry hasn't really been looked at much), plus mood stabilizer approaches not yet tried -- if there are any of those left for you:  Fish oil?  Low-dose combinations of things that were duds but didn't bother you?  

Sounds like you manage somewhat well without medications.  Have you maximized exercise, precise sleep management (no late nights, no late lights, regular rise (makes a man healthy wealthy and wise...)? 

Good luck with the process!

Dr. Phelps


Published November, 2004
 

 

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