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PMDD VS Bipolar Disorder

Q: I was diagnosed with depression 2 years ago and have been on many of the popular antidepressants. They work for a few weeks, and then poop out entirely. Several weeks ago, I stopped taking birth control pills and antidepressants at the request of my Naturopath. The St. Johns wort seemed to have worked up until 4 days before my period. I'm a raging lunatic -- crying hysterically and fits of rage within minutes of each other.  My suicidal and homicidal thoughts are what's most frightening. My doctor today mentioned I may have Bipolar, which just doesn't ring true with me. Your site has made me think it's PMDD.

Where can I go for the best treatment and evaluation for this disorder? For two years I've been hardly living my life and I want to get back on track as soon as possible. Is there a way to measure my hormones throughout the month? The only reason I went on birth control was because my PMS was so out of control, but in the past year, the pills didn't really help anyway. Please help,

-- A.M.

Dr. Donnica:
I am not usually able to answer individual emails immediately or directly, but I am VERY concerned about your message because you mentioned having suicidal and homicidal thoughts. You must take this VERY seriously and get to a board-certified psychiatrist ASAP. If you don't know who to see, go to www.AMA.org, where you can find physician recommendations based upon your zip code and their specialty.

Based upon what you told me, it does sound like you have PMDD, not bipolar disorder.  When you call to make an appointment with the psychiatrist, ask if this particular doctor has experience with PMDD.  A psychiatrist can probably tell you in one visit if they think you have PMDD or bipolar disorder and is much more qualified than a naturopath to make that diagnosis.

Low dose birth control pills are often helpful to reduce the symptoms of PMS, but they cannot treat PMDD.  There are many medicines that can treat PMDD very well and you should discuss this with the psychiatrist.  Be aware, however, that the first medicine you try may not be the right one, the right dose, etc. Sometimes it takes a few months to get everything sorted out.

St. John's wort, by the way, can decrease the effectiveness of several other antidepressants and birth control pills and in some cases, it can have negative reactions with other antidepressants, so I'm glad you went off the prescription medications before trying St. John's wort.  In general, St. John's wort is effective for mild and sometimes moderate depression, but once you have suicidal or homicidal thoughts or feelings, prescription medicines are generally far more effective, along with psychotherapy.  Many antidepressant medicines take a few weeks to work well and sometimes a few months to work up slowly to the correct dose.

Good luck.  Please let me know how you are doing in a month or so.  I'm pulling for you.

With best regards,
Donnica Moore, MD

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Created: 6/5/2001  -  Donnica Moore, M.D.

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