PMDD irritability

[JoannaBrooks]

Hi. I have had severe PMS since my teens. Taking an antidepressant (sertraline) really helps and gets rid of the black moods before I come on. I had PP after my first child and took olanzapine. Last year I was diagnosed bipolar. I have been well in terms of that for some months so have yet to try aripiprazole (mood stabiliser) which my psychiatrist suggested. However my PMDD (severe PMS) just gets worse with age. As mentioned not the depression because of the SSRI helps that but the irritability is so intense. Lasts 2 weeks sometimes. And I get terrible headaches. Does anyone find aripiprazole helps their PMS irritability pls? Thanks

[Jocelyn_at_APP Partner APP]

Hi JoannaBrooks,

Thanks for reaching out to us.

Unfortunately I don't have any experience of aripiprazole, I did find the following information on the Mind website:

Https://mind.org.uk/information-sup...

Have you talked to your psychiatrist in more detail about it?

Sorry I can't be of more help!

Jocelyn

[Beth2609]

Hello JoannaBrooks,

I have had experience of Aripiprazole and now get it as a monthly injection. I find that it increases my rationale and is able to help me think more clearly as before I was completely suspicious and paranoid. As for irritability it has helped as well as has helped my mood swings and distorted mood to calm so that has calmed as well. I started on the tablets but didn’t take them due to being unwell so I find that the injection is helpful as you don’t need to worry about taking a medication every day but I understand it’s not everyone’s preference. Hope this helps. If you have any more questions please feel free to ask

Beth

[JoannaBrooks in reply to Beth2609]

Thank you. Has it increased your weight?

[Beth2609 in reply to JoannaBrooks]

Just a little bit but not majorly

[cjk43]

Hi Joanna, as someone who experienced PP after the birth of my son, I recovered but my PP became PND and then I was left with severe PMS. I was lucky because in the early nineties, hormonal treatments such as progesterone therapy (Cyclogest) were more popular and have really helped me, although it is not considered a first line choice now. You are right as you get older PMS symptoms often worsen but they tend to change in presentation, mine are more physical than before. I am in the perimenopause.

There is NICE guidance around treating PMS which you may find helpful. Diet is critical and may really help with the headaches and irritability. If you crave sugar like many women do in the latter two weeks of your menstrual cycle, then eating complex carbohydrates such as potatoes, rice, bread, cereals within an hour of waking, three hourly during the day and within an hour of going to bed will help balance your blood sugar and reduce PMS symptoms. You need to do this all month long and this should be alongside a balanced diet. Second line treatment for PMS are SSRIs antidepressants which you are already taking, Third line recommendation is referral to Gynaecology and fourth line to specialist PMS clinic. There is a specialist Female Hormone Clinic at the Maudsley and the psychiatrist there is Dr Michael Craig but you need a specialist referral. However, I think diet could really work for you and does for many women. If you want to know more about diet and PMS, there is a good book called Once a Month by Katharina Dalton you may find really helpful to understand your symptoms and how you may be able to manage them. My view is knowledge about PMS and why it occurs is powerful. I know numerous women who have changed their diets and reduced PMS symptoms. Katharina Dalton's around PP and PND with hormonal treatment is not favoured (but it saved my life) but she used to run a NHS PMS Clinic in London. Hope this is helpful.

[JoannaBrooks]

Thank you. I have really changed my diet over the years. And it does help. As above. But not enough to stop the PMS irritability. Will look into the practitioner at the Maudsley. Can you tell me more about Katherine Dalton’s work in terms of hormones- is it cyclogest? I took that in my 2 pregnancies for the first trimester due to a history of miscarriages (4). Am perimenopausal I suspect now too Am 45. Thanks

[cjk43 in reply to JoannaBrooks]

Most psychiatrists I know are not a fan of her in respect of PND/PP (PND is not all biological) but then hormones are not really their area of speciality. Dr Katharina Dalton got interested in PMS when she was a A&E doctor and saw the same women present at the same time of the month with asthma and epileptic seizures and wondered if she treated with progesterone (Cyclogest) their conditions would improve which they did. She went onto to specialise in PMS, PMDD and recognised the correlation between PP and PND with PMS (women start to recover from PP/PND and are left with PMS but if women have PMS before childbirth, it does not mean they will get PP or PND, although PMDD is indicator of developing a mood disorder after birth). She has written numerous books, including when PMS goes to court and has acted as an expert witness for the defence.

Katharina Dalton's work is around use of Cyclogest (from day 14 of menstrual cycle til menstruation). It can be via injection or pessary. I have been on Cyclogest for the past 27 years since the birth of my son, it's changed my life and given me a quality of life I would never have had on psychiatric medications. I am not on any psychiatric medications but if they take the hormone treatment away I have always relapsed and headed downwards into depression and then symptoms indicative of developing another psychotic episode. I wish there was more research being done into hormones but no-one seems that interested because the pharmaceutical companies make the most money out of new drugs.

You must have to maintain adequate blood sugar for Cyclogest to work, hence the importance of the three hourly starch diet. Her book which you can get on Amazon for £7.00 gives more detail with lots of vignettes of women's experiences. People I have recommended it to, it's changed their life and understanding of PMS and how to help themselves. The book covers the relationship between PMS and the menopause. I hope it is helpful to you.

[JoannaBrooks in reply to cjk43]

Thanks very much. Very interesting. I tried a natural progesterone once in my cycle. But it helped for that fortnight. But I then felt bad for the next 2 weeks before ovulation. I only tried it once. And it wasn’t cyclogest. I will look into the book. Many thanks

[coffeemom2]

Hi, I did not do well on aripriptazol- abilify. I took it for 2 months it made me restless. I’m in seratraline- 100mg - and love it. I too get bad pms, since my daughter (now almost 4) was born. I was thinking of trying the mirena, so maybe I won’t get a period? I’m on a copper iud. Other than that I try to just remember if I’m grumpy at that time, that that is probably why, and to be nicer to myself and others - drink my favorite Starbucks or go for a walk. I was thinking of asking for another drug specifically during pms.

[JoannaBrooks in reply to coffeemom2]

Thanks. My irritability is so bad. I can’t help it. All my nerves vibrate with irritability for up to 2 weeks. I think I do probably need a mood stabiliser too along with the SSRI. When I took olanzapine with the SSRI it was a lot less. But I got v fat! Lost it all but don’t fancy that again!

[JoannaBrooks]

Or whether anyone finds a mood stabiliser generally helps their PMS irritability? Thanks

[Ellie_at_APP Partner]

Hi all,

I just wanted to write on this thread, just for the benefit of anyone else reading, to give some more information about what you have written cjk43, about Katharina Dalton's progesterone treatment in relation to PP, just in case anyone who is reading the thread is wants to know more information the current research about it in relation to postpartum psychosis.

Though I know this post is asking about PMS, which is obviously different so this isn't really relevant to your question JoannaBrooks.

APP’s clinical experts say although hormonal changes may well play a role in PP we need more research to understand this better. Katharina Dalton advocated the use of progesterone therapy for prevention of postpartum mood episodes a number of decades ago, and reported a number of positive case studies. However, there is still a lack of good evidence for it helping and there may in fact be a higher risk of depression in the group treated with progesterone. At present, there is not enough evidence that treatment with oestrogen is beneficial in PP or for maintenance of mood stability after PP. The key clinical guidelines in the UK and around the world (e.g. NICE, SIGN) do not recommend oestrogen in the treatment or prevention of PP. More research in this area would be very helpful.

Thanks all,

Ellie

[AAP10]

I went through the same. After trying many antidepressants alone ....... what worked for me was the addition of lamotrigine. I never tolerated any SSRI because my irritation grew worse. Other mood stabilizers affected my thyroid. Wellbutrin sr and lamotrigine was the trick. Everyone’s body is different and it constantly changes. Keeping a daily journal in addition tracking symptoms of your pmdd is good too. The app Moody is great. I have to say after a year of psychiatric medications it toke a toll on my body. My doctor and I worked on getting off them. I have seen surprisingly a better outcome with lifestyle changes. Healthier diet and exercise. Plus adding a great pre and probiotic, Sam E for my mood, and Vitanica Women's Phase I™ Premenstrual Support -- 60 Vegetarian Capsules. At the beginning phase of transition I also toke myo d-chiro inositol. I hope this helps.

[JoannaBrooks]

Thanks a lot. Am taking various supplements too. Don’t know that company though in the UK. Their formulation looks great. Are you in the US? Will contact them and try it. Thanks