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
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
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.
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
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!
Published November, 2004