Friday, April 3, 2009

Mental health, female health (my health)

More on female hormonal issues ... so if the subject makes you squirm, this is a post to skip! Sorry, this IS my journal, after all, not a carefully edited selection of spiritual reflections or agricultural policy papers meant to edify the masses. Maybe someone out there will learn something useful ... these particular problems are not well enough studied or understood yet.

PMDD = pre-menstrual dysphoric disorder. It's pretty much defined as PMS taken to a debilitating degree, not so much the physical symptoms but the mental/emotional ones. It's not depression, exactly, although I can get briefly weepy. It's acute tension, and a total inability to concentrate on anything. Hard to define. I'm in a grey fog, and I just want to curl up in a ball and rock myself until my period comes and it all clears up again for a couple of weeks. I can't get to sleep at night, or I wake up at 3 A.M. and that's it for the night. I often get migraines this time of month, occasionally as much as every day for a week. I crave dark chocolate, sweet-tarts, and alcohol, and I feel very fatigued, and physically weak. I've been sitting in this chair pretty much all day, and I tried but failed to finish a job application that closed today. Anyway I feel like I could never function well in a job (specially not an office job, with the concentration problems) when I'm like this. And I'm like this half the time!

So I went to a shrink yesterday. A psychiatrist, because I wanted someone who can prescribe meds, unlike a psychologist or other mental health professional. The SSRI I was taking was helping somewhat, but PMDD is still kicking my butt -- less, but I'm still VERY aware when I have ovulated. (SSRI: anti-depressant that works on the neurotransmitter serotonin, the most common type of med prescribed for PMDD). But the shrink said that this particular SSRI, Serzone, has fallen out of favor because it can cause irreversible liver damage or even death, so he hasn't prescribed it for years. I was taking it because I wanted to try an SSRI for the PMDD, on the recommendation of a psychologist, I used to take this one for depression with good results, and my general practitioner didn't hesitate to prescribe it. So the shrink recommended that I taper off it and instead prescribed, not another SSRI, but an anti-psychotic mood stabilizer called Abilify. Anti-psychotic! Not another SSRI because I had tried most of them and ended up switching to Serzone, years ago -- mostly because of problems related to sex, and although I told him I am celibate now so that's irrelevant, he paid no attention and went straight to Abilify.

I took the prescription to the pharmacy, and dutifully halved my dose of Serzone last night. Then today I started googling Abilify and PMDD. WTF?? Not. I mean, I gather that it's a lot better than older anti-psychotics, but honestly, if the Serzone is working, why not switch to another drug in the same class? Abilify is prescribed for bipolar disorder (and schizophrenia), but these mood swings are clearly tied to my monthly hormonal cycles, this is NOT bipolar disorder. And anyway, if I took Serzone for years with no problems, am I not unlikely to develop problems now? It's not like it's been pulled off the market, and in googling it I don't find any more prominent scary warnings than most drugs carry. So I'm going to tell the pharmacy to please cancel the Rx for Abilify, go back to my regular dose of Serzone, and try to find an OB/GYN who knows something about PMDD. Oh, this is frustrating. It's not like, oh, I don't know -- a toothache, you know exactly who to call for that, and the dentist knows exactly how to treat it. This is just total trial and error.

Anyway ... meanwhile, I've ordered Estroven PMS over the internet (couldn't find it locally). It's an herbal supplement that has rave online reviews from users, including those diagnosed with full-blown PMDD. If it seems to help, then I may try tapering off the Serzone and see if the herbal supplement works well alone. Anyway, the Estroven PMS is quite inexpensive compared to the Rx, and since I may not have such terrific health insurance any more after August, that's something to think about. I did mention it to my nurse-practitioner and she thought it sounded good and safe. Fingers crossed!

OK, well it was pouring rain this morning but now the sun's out and it's like 70F out there, I think I will go curl up in a ball at the picnic table in the sun instead of in here at my computer......

yours truly
Regina Terrae


  1. Hey, Regina... I'm glad you are writing about these things. I am with you: I think not enough people talk about them. Mental health, women's health, and where the two intersect are issues that no one wants to admit to or listen to. But they are HUGE! Take the case of Andrea Yates, or millions like her who just needed the proper mental health care. It drives me nuts that people pretend these illnesses don't exist.

    I have first hand experience with depression, the sort that gets painfully worse with each cycle (plus the PMS migraines too, I guess those have to do with estrogen levels dropping during certain times.)

    I have taken Wellbutrin for 8 years... ever since my son stopped nursing and I was able to treat the post-partum depression. It's worked well for me, but there are certain months when I may have to double up during PMS.

    As for the new drugs: be REALLY careful. I know the docs have a lot of incentives to "push" the new drugs on patients. They, literally, get HUGE bonuses for getting patients to try the newest versions. That makes you, essentially, a guinea pig. If you need to try a different drug, try one of the older ones (with somewhat proven records) first. New drugs should be your last resort because we still don't know just what they do.

    At least, that's my approach to the issue. I hope that helps.

  2. Hi, Lisis. Thanks for the comment. It is really a good thing to connect with others who can relate with our experiences.

    I tried Wellbutrin once, but not for long and I don't remember if it was for depression or ADD, or maybe I just tried it because it showed some promise for both. I am now on Strattera for the ADD -- a new drug, but worth it because most ADD drugs are amphetamines, "controlled substances" that you have to go to the doctor for each month, get a new written prescription and take it physically to the pharmacy. No refills, no phone-ins. Pain in the neck. I am liking the Strattera.

    I'm also on Serzone for the PMS, and it seems to be helping somewhat -- oh, I guess I said all that in the post. No change, except that I now have an appointment with a reproductive endocrinologist (a hormone specialist). Not until May 14, unfortunately. I will report back.

    I am hoping not to be in very intense PMS when (if) I get called back for a second interview for the job I want....