This is a timely read for me. I have been experiencing severe PMDD for a year. My cycles are also long (~40 days).
I ovulate “on time” but get stuck in my luteal phase for 2 weeks. My depressive symptoms hit in the second week. The second I bleed I am back to normal. It is uncanny.
It’s really interesting to read about the current research and theories. Makes me hopeful for the future.
This a topic of intense interest to me. My wife gradually developed the symptoms of the most extraordinarily severe PMDD on lamotrigine 200 mg, first emerging after about 18 months on the drug. The symptoms reach near frenzy at 300 and then 400 mg. The drug being the cause is a near certainty, as halting it dramatically ended the syndrome.
At one stage she was treated with a contraceptive pill, which after the third dose caused a frenzy that sent her running half way across town. I found her raving and in a confused state. She was taken to hospital by ambulance, she became stuporous in the hours waiting for the doctor and then recovered in about 48 hours. This same scenario was repeated a second time once again after applying and estradiol patch and again resulted in an ambulance ride and recovery after about 48 hours.
My wife has a diagnosis of bipolar disorder, with a preponderance of dysphoric mania alternating with periodsof melancholia and stupor. SSRIs produce dramatic mixed states in her that border on frenzy, with a similar clinical picture to the state induced by the hormone treatments. She also responds in a similar way to some atypical antipsychotics (dopamine agonists). Additionally she seems particularly sensitive to developing akathisia.
Her pseudo-PMDD had a striking inner tension component, that is not dissimilar to akathisia. This inner tension caused unbearable anguish and she would tear at her flesh in agony.
I must confess, my experiences have made constantly question if there is not yet still some relationship between mixed states, akathisia and certain forms of premenstrual tension. Quotes from Brockington, Carroll, Coppen and Akiskal float about my head like that time Lisa (Simpson) needed braces. It's like there is something on the tip of my tongue, a peak at a reality I can't fully see. The flavour changes a little between triggers but there is something strikingly similar between the clinical pictures in her case, as if they all share an aetiology. And yes, I know the difference between akathisia and mixed states, my mother took haliperidol growing up.
The best explanation I've found to account for it is David Healy’s hunch about alkalosis and intracellular fluid retention. My hunch is my wife has a sodium channelopathy and that all of these drugs are acting on it, modulating it at times but more often disturbing it.
She's finally stabelised and is doing quite well on 25 mg if lithium orotate and a ketogenic diet. Although going off and on the diet causes hypomania during the polyuria phase. It seems to me the diet most noticeably prevents the stuporous pole. David would have a fit but I think he's stumbled upon a subtype of manic depression.
Ian Brockington is indeed an authority on this subject and proposes that ‘menstrual psychosis’ (brief psychotic episodes linked to the menstrual cycle) is part of the bipolar disorder spectrum
That is exactly what he told me. I had a very interesting conversation in which he told me that he originally set out to prove Leonhard right about splitting the cycloid psychoses and ended up full circle back at Kraepelin. He thinks the triggers can produce the different forms, which jibes with Max Fink's ideas about catatonia and Judd's comments on steroid psychosis. The thing is, Healy’s idea isn't half bad either, especially if you consider Gabrielle Sani's case study on acetazolamide in PMDD. People think David spends all his time talking about SSRIs, but he has a much wider variety of interests, and so far is the most knowledgeable expert I've spoken to. The man must spend every weekend reading case reports. He's well worth talking to if you're interested in this sort of thing. He always surprises me with his erudite responses and obscure case knowledge. I honestly think he might be the most novel theorist in psychiatry. I mean a somatic origin for akathisia is mind boggling and he's using laboratory tests to try and prove it.
From the point of view of a person who was predominately oestrogen based for 46 years, I enjoyed this post. From the point of view of a person who is now mainly testosterone based, I feel there is so much more to be said. But I'm no doctor, not even qualified in anything really. And as a transman, we get forgotten about.
As a transman, if not using medical therapy the appropriate biological sex literature applies. We have no evidence of different hormone states in trans individuals who don't use medical therapy.
If you choose to use medical therapy, then you choose the medical complications. Trans health is niche and optional, personally I wish you were forgotten more! This is about women's health, men (including trans men) need to accept that it's not all about you. Allow women to be the focus for once.
And yes, everyone has the right to safe healthcare. That means it's appropriate to focus on women here. Children aren't mentioned either, because it's the role of a specific subspecialty to attend to their health. Go harrass the trans health subspecialty team, don't push a (trans) men's health agenda onto a women's health space.
This is a timely read for me. I have been experiencing severe PMDD for a year. My cycles are also long (~40 days).
I ovulate “on time” but get stuck in my luteal phase for 2 weeks. My depressive symptoms hit in the second week. The second I bleed I am back to normal. It is uncanny.
It’s really interesting to read about the current research and theories. Makes me hopeful for the future.
Really nice item in the bag!
This a topic of intense interest to me. My wife gradually developed the symptoms of the most extraordinarily severe PMDD on lamotrigine 200 mg, first emerging after about 18 months on the drug. The symptoms reach near frenzy at 300 and then 400 mg. The drug being the cause is a near certainty, as halting it dramatically ended the syndrome.
At one stage she was treated with a contraceptive pill, which after the third dose caused a frenzy that sent her running half way across town. I found her raving and in a confused state. She was taken to hospital by ambulance, she became stuporous in the hours waiting for the doctor and then recovered in about 48 hours. This same scenario was repeated a second time once again after applying and estradiol patch and again resulted in an ambulance ride and recovery after about 48 hours.
My wife has a diagnosis of bipolar disorder, with a preponderance of dysphoric mania alternating with periodsof melancholia and stupor. SSRIs produce dramatic mixed states in her that border on frenzy, with a similar clinical picture to the state induced by the hormone treatments. She also responds in a similar way to some atypical antipsychotics (dopamine agonists). Additionally she seems particularly sensitive to developing akathisia.
Her pseudo-PMDD had a striking inner tension component, that is not dissimilar to akathisia. This inner tension caused unbearable anguish and she would tear at her flesh in agony.
I must confess, my experiences have made constantly question if there is not yet still some relationship between mixed states, akathisia and certain forms of premenstrual tension. Quotes from Brockington, Carroll, Coppen and Akiskal float about my head like that time Lisa (Simpson) needed braces. It's like there is something on the tip of my tongue, a peak at a reality I can't fully see. The flavour changes a little between triggers but there is something strikingly similar between the clinical pictures in her case, as if they all share an aetiology. And yes, I know the difference between akathisia and mixed states, my mother took haliperidol growing up.
The best explanation I've found to account for it is David Healy’s hunch about alkalosis and intracellular fluid retention. My hunch is my wife has a sodium channelopathy and that all of these drugs are acting on it, modulating it at times but more often disturbing it.
She's finally stabelised and is doing quite well on 25 mg if lithium orotate and a ketogenic diet. Although going off and on the diet causes hypomania during the polyuria phase. It seems to me the diet most noticeably prevents the stuporous pole. David would have a fit but I think he's stumbled upon a subtype of manic depression.
Thank you for sharing this experience.
Ian Brockington is indeed an authority on this subject and proposes that ‘menstrual psychosis’ (brief psychotic episodes linked to the menstrual cycle) is part of the bipolar disorder spectrum
That is exactly what he told me. I had a very interesting conversation in which he told me that he originally set out to prove Leonhard right about splitting the cycloid psychoses and ended up full circle back at Kraepelin. He thinks the triggers can produce the different forms, which jibes with Max Fink's ideas about catatonia and Judd's comments on steroid psychosis. The thing is, Healy’s idea isn't half bad either, especially if you consider Gabrielle Sani's case study on acetazolamide in PMDD. People think David spends all his time talking about SSRIs, but he has a much wider variety of interests, and so far is the most knowledgeable expert I've spoken to. The man must spend every weekend reading case reports. He's well worth talking to if you're interested in this sort of thing. He always surprises me with his erudite responses and obscure case knowledge. I honestly think he might be the most novel theorist in psychiatry. I mean a somatic origin for akathisia is mind boggling and he's using laboratory tests to try and prove it.
From the point of view of a person who was predominately oestrogen based for 46 years, I enjoyed this post. From the point of view of a person who is now mainly testosterone based, I feel there is so much more to be said. But I'm no doctor, not even qualified in anything really. And as a transman, we get forgotten about.
Very much this.
As a transman, if not using medical therapy the appropriate biological sex literature applies. We have no evidence of different hormone states in trans individuals who don't use medical therapy.
If you choose to use medical therapy, then you choose the medical complications. Trans health is niche and optional, personally I wish you were forgotten more! This is about women's health, men (including trans men) need to accept that it's not all about you. Allow women to be the focus for once.
And yes, everyone has the right to safe healthcare. That means it's appropriate to focus on women here. Children aren't mentioned either, because it's the role of a specific subspecialty to attend to their health. Go harrass the trans health subspecialty team, don't push a (trans) men's health agenda onto a women's health space.