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Mental Health (Expert Forum)
PMS, PMDD, or Depression?
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
PMS, PMDD, or Depression?
by 2yearSearch, Sep 20, 2002 12:00AM
I had taken Ortho Novum 1/35 for almost 18 years for birth control and I was told that my body was used to this hormone. When my husband had a vasectomy, I stopped taking the birth control pills. Within 2 years, I developed a menstrual cycle with 33 days in between and mostly every other month. I was very blue and hopeless, cried much, experienced withdrawal symptoms, had a high stress/high profile job that I both loved and hated due to a controlling personality conflict with a superior. I had suicidal thoughts but no action.
At my primary physician, depression was queried. Then a gynecologist, PMS was queried as well as depression. Due to embarrassment, I paid cash for a private psychologist for 3 sessions- PMDD was the diagnosis along with stress associated with my employment. I enjoyed flying airplanes recreationally, so would not succumb to anti-depressants. Since I smoked, my gynecologists would not give me a birth control pill due to my age of 36. The gyno agreed with PMDD and prescribed Sarafem. When I spoke with my flight doctor said he would not revalidate my medical if using Sarafem. I had a high stress job, I lost my recreational livelihood, and my health was in question at age 36. After deciding to try the Sarafem, I experienced many of the usual severe headache side effects but mostly a constant mono-tone tingling feeling and don't care approach with absolutely no highs or lows and no sex drive. None.
After 6 months and discussing these symptoms with the gynecologist, he agreed that Sarafem was not the solution and I discontinued use and was told to go to another Dr., because, unless I quit smoking, the liability of giving me birth control pills was too great because of increased risk of stroke. I stopped seeing the gyno. I returned to give this information to my primary care Dr., in tears. He immediately prescribed Ortho Novum 1/35 & Wellbutrin for smoking cessation coupled w/ possible depression. Amazingly I improved. My entire lifestyle changed for the better during the day but I was exhausted in the evenings and had sleep deprivation when I took an afternoon or evening dosage of the Wellbutrin. I saw a new gynecologist and he did no blood test much like all the other Drs. He changed my hormone pill to 1/20 due to statistics on cancer related illnesses associated with long term use of hormone pills. In addition, since my severe panic attacks and crying episodes were exceeding menstrual timeframe, he prescribed non stop use of this Loestrin 1/20 everyday with no interruption. I improved in the area of PMDD. Since I could not sleep without using Tylenol PM, I personally decided to do without the evening dose of Wellbutrin so I could sleep. Life was better for awhile, then the current new symptoms began to develop. I have damaged relationships with my best friend, mother-in-law, and working superiors. However, I have increased and deepened other respectful relationships due to the awareness I have with my symptoms. I do not feel like I am taking any medication, i.e. I don't feel "over medicated" like I experienced with Sarafem. I still have none to little sex drive. In the good side, I no longer have suicidal thoughts like the very beginning of these problems 2 years ago. I now experienced agitation and rage in both my personal and working environments a times. This includes loud arguing and then crying when angry or frustrated. I don't have much tolerance for anything at this point. I currently take Loestrin 1/20 and Wellbutrin 150sr. at 7:30 am everyday. What recommendation would you make for improvement of symptoms, re-diagnosis or change?
At my primary physician, depression was queried. Then a gynecologist, PMS was queried as well as depression. Due to embarrassment, I paid cash for a private psychologist for 3 sessions- PMDD was the diagnosis along with stress associated with my employment. I enjoyed flying airplanes recreationally, so would not succumb to anti-depressants. Since I smoked, my gynecologists would not give me a birth control pill due to my age of 36. The gyno agreed with PMDD and prescribed Sarafem. When I spoke with my flight doctor said he would not revalidate my medical if using Sarafem. I had a high stress job, I lost my recreational livelihood, and my health was in question at age 36. After deciding to try the Sarafem, I experienced many of the usual severe headache side effects but mostly a constant mono-tone tingling feeling and don't care approach with absolutely no highs or lows and no sex drive. None.
After 6 months and discussing these symptoms with the gynecologist, he agreed that Sarafem was not the solution and I discontinued use and was told to go to another Dr., because, unless I quit smoking, the liability of giving me birth control pills was too great because of increased risk of stroke. I stopped seeing the gyno. I returned to give this information to my primary care Dr., in tears. He immediately prescribed Ortho Novum 1/35 & Wellbutrin for smoking cessation coupled w/ possible depression. Amazingly I improved. My entire lifestyle changed for the better during the day but I was exhausted in the evenings and had sleep deprivation when I took an afternoon or evening dosage of the Wellbutrin. I saw a new gynecologist and he did no blood test much like all the other Drs. He changed my hormone pill to 1/20 due to statistics on cancer related illnesses associated with long term use of hormone pills. In addition, since my severe panic attacks and crying episodes were exceeding menstrual timeframe, he prescribed non stop use of this Loestrin 1/20 everyday with no interruption. I improved in the area of PMDD. Since I could not sleep without using Tylenol PM, I personally decided to do without the evening dose of Wellbutrin so I could sleep. Life was better for awhile, then the current new symptoms began to develop. I have damaged relationships with my best friend, mother-in-law, and working superiors. However, I have increased and deepened other respectful relationships due to the awareness I have with my symptoms. I do not feel like I am taking any medication, i.e. I don't feel "over medicated" like I experienced with Sarafem. I still have none to little sex drive. In the good side, I no longer have suicidal thoughts like the very beginning of these problems 2 years ago. I now experienced agitation and rage in both my personal and working environments a times. This includes loud arguing and then crying when angry or frustrated. I don't have much tolerance for anything at this point. I currently take Loestrin 1/20 and Wellbutrin 150sr. at 7:30 am everyday. What recommendation would you make for improvement of symptoms, re-diagnosis or change?
Doctor's Answer
by Roger Gould, M.D., Sep 23, 2002 12:00AM
, Sep 23, 2002 12:00AM
My basic recommendation would be to think less about shifting medications around( although that is important) and more about the stresses in your life that make you so vulnerable re your mood change, anger, crying etc.
Seeing a therapist is a good idea. If you can't do that soon, then start online at masteringstress.com.
Your medication sounds like its balanced about right now...wellbutrin should help you with the sex drive as well as depression and smoking.
Seeing a therapist is a good idea. If you can't do that soon, then start online at masteringstress.com.
Your medication sounds like its balanced about right now...wellbutrin should help you with the sex drive as well as depression and smoking.
I have an appt with psychologist end of October and
have started Celexa. I am happier when I take it. I have
put out Resumes for new employment and or a transfer in my current company. I have registered for a graduate class and will return to try to complete a degree. I started doing house work again since I had increased energy and complete one thing at a time. I had to take care of my grandmothers funeral this week, that was tough. I am having some anxiety symptoms and sweats and cannot sleep without ambien. I will make this
life better. I am determined to move forward and be less overwhelmed. Your website has helped tremendously. Although many articles are not related, I have been comforted to know that others have these types of issues and are seeking help instead of letting it control them. We are in control of our own happiness but sometimes need a little help.
All the best.