anger,postpartum,depression, etc

  Hi,  I am currently 19 months postpartum.  I began medication of Zoloft
  June 98 to help with my obsessive cleaning and repetative thoughts of
  hurting my baby.  Slowly I started coming around.  At my worst I would
  become rage filled against my daughter. Yell, swear put my hand on her
  face. I was psychotic.  Well it seems with every passing menstral
  cycle I start getting agitated a week before my period then a day or two
  before it starts till it ends I am VERY aggitated and I scream alot at
  the kids for minor things that they should not be yelled at for.
  I am basically normal the other 2 weeks out of the month.  I am
  getting scared that I am drowing in mental illness.  My dr up'ed my
  zoloft to 200mg a day but the whole week I was anxious and sleepless.
  So I dropped down to 150mg.  I just want another thoughts on medication
  and possible things that are wrong with me.  Can Zoloft be taken with
  something else. Why isn't the anger going away.  It is intense.
  Please help.
  Lyn

[HFHSMD-TB]

_
Dear Lynn,
Although the history that I have is limited, the symptoms you are describing could be compatible with what is called premenstrual dysphoric disorder(PMDD).  Premenstrual dysphoric disorder is characterized by symptoms such as markedly depressed mood, anxiety, mood lability, persistent anger or irritability, physical symptoms such as breast tenderness and headache and changes in appetite and sleep, among others.  These symptoms tpically begin one to two weeks before menstruation and begin to lessen within a few days of the onset of menses.  
The fact that you basically feel "normal" the other two weeks of the month is compatible with this diagnosis.  Forty percent of women have at least mild symptoms of this disorder and two to ten percent meet criteria for the disorder.  
Antidepressants are the treatment of choice for PMDD although not all are equally beneficial.  Zoloft is an antidepressant in a class called selective serotonin reuptake inhibitors.  This group of antidepressants, especially Zoloft, Paxil, Prozac and a related one Anafranil have been found to be most effective.  If someone does not respond to one, another should be tried.  In some studies, alprazolam(Xanax) was also beneficial.  
I would recommend that you discuss your symptoms with your mental health professional and do not make any changes in your medication without first checking with your physician.  If you wish to make an appointment with a mental health professional at Henry Ford Hospital, please call 1-313-874-6680.  I hope that this information has been helpful.  It is for educational purposes only and should not replace consultation with your physician.