23 replies to this topic

[Lilac]

An npdoc thought I had PMDD, was treating w/herbs and progesterone cream from ovulation to menstration, but then my "moods" seemed to shift and were no longer always so nicely lined up w/my cycle, and eventually I stopped all the stuff this doc had me on and quit seeing her (over a silly comment she made, I admit).

Just 2 weeks ago I was d/o as BPI. Right now, I'm just a few days out from starting my period. The past 3 days I've been slowly ramping up the anxiety/irritability/anger cycle, and yesterday I had some tearful moments, and today I'm having moments of rage followed by tears.

How can I tell if this is "just" pms, or if the Abilify isnt' doing what I'd like it to, or just what is going on?

I'm guessing the answer will be to chart my moods and cycles more closely (and I am, someone gave me a link to moodtracker website and that looks very helpful) but I'm really hoping that instead of needed patience, someone has an answer RIGHT NOW! (asking a lot, I know)

[GardenGirl]

Hi Lilac,

I know what you're going through -- it's so overwhelming when you have PMS / hormonal stress underlying your seasonal moods, and then to have Bipolar on top of that...be very, veeerrry gentle with yourself.

It will take time to notice your cycles, your reactions to meds, what works, what conflicts. As a rule, go for a sense of balance overall. (Rather than a cessation of x symptom). Mood stabilisers do make your hands shake & stomach upset, headaches too, but it will go away in time (about a month).

If you ditch your drugs before you've given them a chance, you'll end up feeling worse & will end up on a higher dose, or different drugs. The less drugs you have to try the better. Drugs are less effective the more you try.

Some people know right away if a drug is good or bad for them. Personally I find it pays to wait it out for at least 1 month, so you can get an idea of how it really does impact you (your menstrual cycle, hormones, sleep cycle, appetite, to see if side effects abate etc.)

If you see even a 10% improvement in your mood overall, this is success & you will likely experience an improvement over time. We don't plant a seed and immediately throw our hands up when it doesn't turn into a tree right then & there. (No offense to you.)

Also, you will feel like this is so awful & unbearable, but try to soothe yourself & ride it out for another hour, another day. It will get better, I promise!

[Anna]

Could be either, could be both. It's a bit early to tell.

I am pretty clearly BP, don't get terrible PMS symptoms, but my cycle does impact my moods, somewhat. For instance, right before my period, sleeping gets a little more difficult, etc.

You need to stay on the abilify for awhile, and give it a chance.

The idea of tracking your moods and cycles is a good one, and really, it's going to be the best way to know what is going on. You could have both conditions, co-morbid, you could find that mood stabilizers really take care of a lot of the hormonal shit, even if you have a touch of PMDD, etc. You're just going to have to give it some time (sorry).

Anna

[DrSara]

I honestly don't distinguish - it doesn't really matter. My moods do go with my cycles too.

[Lilac]

I'm feeling better in general today, and today it's so much easier to find patience.

Thank you both.

I think I've read too much about Abilify. I felt so icky on 5mg, and now still so shaky and sedated most of the day most days on 2.5mg (and I am taking it at night) PLUS the past few nights all the night time mental chatter is back (oh how it sucks for body to be sedated, mind racing = laying in bed trying to get mental chatter to stfu and wishing for sleep - blah!).

I really really wanted my first med to work, but I know I'm going in to pdoc tomorrow and asking to try something else. I gave Abilify a full 2 weeks, but I just don't think I can give it any more. Everything I've read seems it either really works, or really doesn't. It *has* totally gotten rid of my self-harm desires. But I need something to help tame the rage (mania?). Maybe I just need something WITH the Abilify instead of dropping it. Will discuss all w/pdoc.

And, a great big gushy I am soooo thankful for this board, knowing that whatever happens tomorrow in that office, I have a board of experienced peers to discuss them with.

[beek]

You may do better on a mood stabilizer like Lithium or Lamictal. Abilify did not play nicely with me personally either.

Naturopathy did fuck-all for my mood issues. Homeopathy, herbs, progestin cream, acupuncture, massage, meditation... I tried everything.

Keep a mood journal and investigate other meds.

[shiny]

I just wanted to chime in that I am also Bipolar 1 with severe PMS. I have done the whole charting thing and sometimes it lines up and sometimes not. I started on Lamictal about 4 weeks ago and last week was my PMS week ... except I didn't have any (I actually forgot my period was due and was unprepared - that has never happened in my life and I'm 37!). I know it's only the first month but I am really hopeful about this drug. It's taken me 20 years of meds to find it but I think this may be "the one" for me. Also, even though I'm not up to full dose, my nighttime mental chatter is all but gone, I'm up at 6am ready to start the day and completely crash at night without a second thought. Good luck to you on finding the right one, don't give up, it's out there.

[Lilac]

Oh, shiny, that sounds wonderful!

Here's hoping I can find some balance like that in the coming months.

[Lilac]

Update - we're sticking w/Abilify (because the self-harm thoughts are GONE, and I lost 4lbs -could stand to lose 10x that). Adding Cogentin for the shakes and akathisia-like leg bouncing thing I was doing when I was on 5mg. Back up to 5mg for the next month, 1mg Cogentin at night w/the Abilify, a 2nd dose during the day PNR.

Also a referral to a tdoc she likes. Need to call him and start the appt process.

Pdoc is pretty sure that I'm just on too low a dose right now of Abilify to be getting all the benefits, since 15mg is the PI sheet dose for bp.

She doesn't think PMDD had a thing to do w/my issues earlier, but suggested (gently) that dealing w/my family may have had some impact, hence the tdoc.

[Lilac]

Thanks for checking in on this thread, sorry it took me so long to get back.

Well, I'm not sure still if anything is hormone related or not, but I'm really leaning toward not, even though my MOST EVEN days are while I'm bleeding, I think I just take care of myself better during that time (and 5 days of steady isn't very long, imo).

I did have a horrible freak out a week ago SUnday (Dec 27th) where I got in a fight w/h, decided to hit a wall (idiot) and tried other means of si (h stopped me and had to just bear hug me for a bit, poor guy).

After that, pdoc upped my abilify to 10mg. That was a week ago today. Right now I'm still in the feeling sedated all day phase. I was a dork and instead of taking 7.5mg for a bit, I went straight from 5 to 10 (felt I needed to, though)and have been feeling just...drugged..for the past week. Hopefully that will pass as I adjust to this dose. So far so good, again.

Oh! And cycle notes, I just started my period today (have longish cycles, last one finally started Dec 5th, so 31 days between).Although I do seem to peek w/engergy/UP about a week before, then dive to normal or depression for a week, then start bleeding. I wonder if my body just can't deal w/ovulation hormone changes? Something to talk to gp about, maybe.

[aerialiste]

I realize this is pretty much a dead thread, but I keep thinking about the same issue—whether PMS/PMDD is more related to depression or BPI/BPII. Then today I saw this:

http://www.amenclini.../images-of-pms/

...and it intrigued me that some women receive treatment with an AD, some with a mood stabilizer, depending on their brain patterns. I wonder if someday it'll be found that there are two kinds of PMDD....? And corresponding kinds of treatment. Interesting....

[Lilac]

Very interesting - especially to me, to see that because the SYMPTOMS are the same in PMDD and BPI, that the treatment is the same. Also interesting to me is that it seems BPI and the PMDD scans show increased activity in the same parts of the brain.

So, it doesn't matter. The brain is ill, the meds to treat an ill brain are the same no matter the "why" of an ill brain, and I'm actually happy to hear that. Today at least

[aerialiste]

I'm glad you dig it! I thought so, too (obviously), especially this:

One pattern is focal increased deep limbic activity often accompanied by temporal lobe hypoperfusion that correlates with cyclic mood changes. When the limbic system is more active on the left side it is often associated with anger, irritability and expressed negative emotion. When it is more active on the right side it is often associated with sadness, emotional withdrawal, anxiety and repressed negative emotion. Left-sided abnormalities are more a problem for other people (outwardly directed anger and irritability), while right-sided overactivity is more an internal problem. Focal deep limbic and temporal lobe findings, worse during the premenstrual period, often respond best to lithium or anticonvulsant medications, such as Depakote, Neurontin, Lamictal or Tegretol. These medications tend to even out moods, calm inner tension, decrease irritability and help people feel more comfortable in their own skin.

The second PMS pattern that I have noted is increased deep limbic activity in conjunction with increased cingulate gyrus activity. The cingulate, as we will see, is the part of the brain associated with shifting attention. Women with this pattern often complain of increased sadness, worrying, repetitive negative thoughts and verbalizations (nagging) and cognitive inflexibility. This pattern usually responds much better to medications which enhance serotonin availability in the brain, such as Zoloft, Paxil or Prozac.

So now I keep wondering: is this why the standard PMDD treatment (with SSRIs) has never, ever worked for me? I'm geared up to ask the new pdoc next week about Tegretol (which was prescribed for me a year ago, by another pdoc, and I was too dumb/scared/in denial to take it, argh—what's that Latinate word Jerod always uses? ah yes: anosognosia)—also the case studies of women who responded to lithium and divalproate—neither of which, as far as I know, are FDA-approved for PMDD.

I do feel hopeful today.

[Lilac]

I don't know enough about Topamax to even guess, but man, that must be annoying, I'm so sorry!

As for me -my period started today. I have been ramping up for over a week, finally told tdoc today I thought I was manic (and I haven't slept well at all, too many racing thoughts, the past several nights) and he called in pdoc (so nice to be in same office) and she handed me some Zyprexa to get me though.

So I still don't know if it's PMDD making me feel manic, or bipolar being effected by hormones making me manic...but the bottom line is the same - I'm manic and need to come down!

[papertrees]

I do get irritable days before my period.

I attribute that to hormones and not BP as it's been happening for as long as I can remember.

If it subsides when you get your period, then I think it's the hormones, and not BP.

[Lilac]

Well I'm ON my period now, for the past 3 days, and still didn't sleep all that well last night even w/the Zyprexa (although better than the days before without it).

As for birth control pills - no, they didn't really help when I was on them, and as a bonus, they guaranteed migraines for me. But all that was 10 years ago. At the time, I'd been mostly on tri-cyclin, and was trying a lo-estren pill, but got pregnant the first month on it. Haven't gone back to hormones since, unless you count pregnancy, and I felt pregnancy leveled me out more the best.

I think I may just be cycling fairly fast, like every 5ish weeks, so some months, the mood lines up with ovulation (like it did first few times I saw a nautropath) and we say "ah ha! it's hormonal" but then, since my cycles are only 30 days long, some months, like this one, the mood lines up with my period instead. So I'm leaning toward "hormones may be playing a role, but the big man behind the curtain is BPI".

[Blue Heron]

If your moods are stable when you're on both the Pill and Trileptal, but are more unstable when you're only taking Trileptal, I would assume the irritability is hormone-related. If you were never taking both the Pill and Trileptal at the same time, then it'll be tough to determine the cause and effect.

Could you go back on the Pill, or do you need to be off of it? It's interesting that you liked the Ortho Tri-Cyclen; my gynecologist told me that women with mood disorders are better of taking a birth control pill with a stable dose of hormones, rather than a triphasic one.

[hammer of dusk]

Just wanted to bump this topic and fish for any additional info anyone might have.

I have pretty much the same question. I go absolutely batshit suicidal before my period. Or sometimes I have bleeding when I'm not supposed to (I take birth control pills and I'm usually regular on them), and I go batshit a few days before that happens.

My pdoc is sticking to the BP NOS dx and pushing for lithium.
My gynocologist recommended holding off and trying taking the Pill continuously to just not have periods. He thinks it's ovulation that makes me nutzo.

I don't care what it is I just want to fix it. I took prozac during my period for a few months and it worked immensely well, but then I started getting really apathetic and making solid plans to ditch my job and run away to Europe, etc. so my pdoc axed it.

I tried to go IP a few days ago, it was that bad. And that's a very, very last resort.

[tigs]

Without the pill I have the irritability and headaches the week before my period. That has always been the case.

However, the two birth control pills* I ever tried both sent me into a VERY nasty depression, combined with bouts of throwing with things and all of that as PMS. Oh and a total lack of sex drive, which made them very effective I stopped taking them when I made the link.

* Those would be Microgynon-30 (Ethinylestradiol 30 micrograms, levonorgestrel 150 micrograms) first and Femodene (Ethinylestradiol 30 micrograms, gestodene 75 micrograms) second. I wasn't on any other meds at the time.

/just fyi

Edit: for the record, I am diagnosed with bipolar

Edited by tigs, 03 August 2012 - 01:23 PM.

[VAL]

The only way I know if it was hormones or illness is once my period starts. The joys of being peri-menopausal. I feel a depression coming on and I've been doing great for a long time. Either I'm not going into an episode, just a blip on the screen, I am going into an episode and Saphris isn't working anymore or I'm suddenly going to have a period.