ask: can mania be triggered by pmdd or pms???

Hi Anonymous,
My first thought is, we ALL have these every so often and perhaps it is only due to certain things going on in your life perhaps and not necessarily that it is abnormal. Did you return to the doctor this time around? Did they prescribe you medication again?

I am just curious as it appears that there is quite a bit of time in between episodes.

Thank,
Missie

First off--whomever diagnosed you with bipolar type 3 definitely made a misdiagnosis. There is no "bipolar 3" (though I have it on my charts too, go figure). What they may have been referencing is cyclothymic disorder, but that disorder involves major depression and hypomanic cycles with no full fledged mania episodes. If you have been diagnosed with an actual episode of full fledged mania the diagnosis would be bipolar type 1. I personally would NOT go back to that doctor, especially if they are just an MD. I suggest finding a qualifed psychiatrist who can help make an accurate diagnosis and identify treatment options.

Second--this is just personal experience, no DSM approved knowledge here. But for the most part the only time I get hypomanic/manic symptoms is right after my period, lasting 3-5 days. It's not every month that it becomes severe enough to be qualifed as hypomania, but tracking for 5 months now there is consistently a "high" after the PMDD wears off and my cycle actually starts. I don't know that there is an "official" documentation of this scenario, but talking with my psychiatrist the theory in my case is that my brain simply tries to overcompensate for the depressive cycle and ends up sending me too far in the other direction. Upping my lithium during that time period and monitoring so I can avoid potentially destructive manic behaviors has diminished the effects, we're now trying birth control to see if we can possibly prevent the major depressive cycle altogether.

Hormones absolutely affect brain chemistry. There is no doubt about this, there are receptors for hormones on brain cells, and it is also well known that neurotransmitters (like serotonin) fluctuate along with reproductive hormones throughout the menstrual cycle. So what you're describing is well within what could potentially be expected if you have a tendency to mania.
Why it happens is much more difficult to say, because there are so many interactions and variables and unknowns.
I hope that is helpful.
Best,
Dr. Daniel Heller

I've also been diagnosed with bipolar type 3, go figure. As a PP stated there is no such diagnosis in the DSM. I was correctly diagnosed several years later as bipolar type 2, with the possibility of moving to bipolar type 1 should I have a manic episode lasting one full week. My highs tend to be on the less severe side and last only 3-4 days and, big surprise, I also experience a high as my menstrual cycle ends (after severe debilitating lows in the days before). My psychiatrist has theorized that it's simply a readjustment as I realize I'm not depressed and am excited about finally being baseline, but concedes that my behavior does put me in the very-close-to-manic state.

Second the PP who said find a psychiatrist, quick. I would venture to guess you are experiencing much less severe cycles over a period of time, you may want to track your moods to see if you notice other patterns (I love moodtracker.com myself). You may actually be able to control symptoms just with birth control, we tried using it to wipe out my period in hopes of eliminating the suicidal ideation during PMDD episodes, unfortunately didn't work for me but it may for you!

Reading the post above, I realize I left out something important. While PMDD and PMS, particularly severe PMS, can cause mood problems; and hormone fluctuations can cause manic-type symptoms in susceptible women, bipolar disease symptoms are NOT a feature of PMS or PMDD. So true manic or sub-manic type of symptoms aren't truly a part of PMS or PMDD and should be treated as bipolar disease, not as PMS or PMDD, and certainly shouldn't be treated with oral contraceptives alone.
In my 16 years of practice, I have seen patients with bipolar disease improve with natural therapies and without medication, but they are definitely the exception. Most bipolar patients do better on medication, and then using natural health supporting therapies to keep themselves healthy.
Best,
Dr. Daniel Heller
www.pmscomfort.com
www.drdanielheller.com

The challenging question is "Am I *misdiagnosed* as bipolar, or am I bipolar and *misdiagnosed* as PMDD. How exactly does one define "true" manic symptoms? This is why I think it's *vital* to see an actual psychiatrist, because a general practitioner may not be able to identify the subtle differences--and frankly some psychiatrists simply aren't attentive enough to do so even if they have the knowledge and experience. I absolutely agree that "true" bipolar disorder isn't going to be controlled by an oral contraceptive, but would theorize that if the symptoms go away while on oral contraceptive (or pregnant/breastfeeding) then it may in all actuality *not* be bipolar disorder at all. Especially if the initial treatment only lasted 4-5 weeks (and what was the initial treatment--an SSRI or mood stabilizer/aytpical anti-psychotic?) and then was discontinued with no further symptoms for 4 years--while bipolar is obviously episodic it doesn't seem to fit the standard symptomatic pattern for bipolar disorder.

For me the question is not am I or am I not bipolar, but what type of bipolar am I. I'll have full fledged manic symptoms, but they only last a couple days (again, typically those 2-3 days after my menstrual cycle, though they do happen at other times to a lesser extent) but lean more toward the depressive side of the cycle. Then other times I seem to be in a mixed mood state or rapid cycling on an almost hourly basis. So hard to pinpoint if it's type 1 or type 2, though we have ruled out type 3!

Love the balanced approach of medication & naturalistic treatment options. I could probably manage on naturalistic options alone (have done so for years at a time), but medication makes it so much easier it's definitely worth the side effects/cost/stigma/etc. I am lucky to have a psychiatrist who is a big fan of supplements (Omegas in particular) and diet/exercise, healthy relationships, even spirituality as a means of reducing and controlling symptoms. Had to go through 14 others to find him, and his wait list is nearly 2 years out at the moment.

Am still trying to figure out how to *not* be anonymous! ;-)

Great post, Anon. Hope you get a name soon!

I am definitely a fan of using omega-3 fatty acids from Fish Oil along with any psychiatric treatment. EPA and DHA appear to simply improve brain functioning no matter the condition. I had one bipolar patient whose family could literally tell whether she'd taken her fish oil that day! Most supplements work slowly, but not in that case.

Another thing, in case anyone reads this who is new to this information: SSRIs and anti-depressants, even St. John's Wort, will not work for bipolar and have the potential to make it worse. Even psychiatrists make this mistake sometimes, since bipolar can be so hard to diagnose.

And, I'm going to have to disagree with you about breastfeeding, which is very physiologically powerful. I would not be surprised if it put someone with bipolar disease into temporary remission. The body and mind are wonderful and mysterious, even when there is a health condition going on.

Dr. Daniel Heller
www.drdanielheller.com
www.pmscomfort.com

It seems there is very little information available about PMDD treatment options. For years, many women were simply told that they have more severe cases of PMS and would just have a battle through it. Finally, after years of knowing this was not the case, there is new medical information that can help diagnose PMDD in women. pmddBut, this was just the first step in a long process to find relief. In general, PMDD can be diagnosed if there are multiple severe symptoms of PMS at any given time. Commonly, if you exhibit three or more of the symptoms of PMS at any one time, chances are you have PMDD. www.womenshealth123.com

ALL ARE NOT EQUAL AT THE HEALTH CARE GATE!

Agitated depression and anxiety disorders including anxiety,panic attacks, phobias, and obsessive compulsive disorder are frequent concomitants of Temporolimbic Epilepsy that often show catamenial(i.e., menstrual cycle–related) patterns of exacerbation and favorable response to hormonal treatment with progesterone or clomiphene. ( Andrew G. Herzog,Psychoneuroendocrine Aspects of Temporolimbic Epilepsy ) (PMDD is a lie)

Don't confuse the pill with natural progesterone.
The natural and synthetic progestins are not equivalent because natural progesterone is metabolized to allopregnanolone, which has very potent GABA-a mimetic and anticonvulsant action, whereas synthetic progestins are not metabolized in this way.. ( from: Klein P and Herzog AG. Endocrine aspects of partial seizures)

If you have tried a contraceptive and it made it worse or go for longer, think about this what does the pill do? It stops you from ovulating so you make no progesterone of your own! Thats why they make it worse, you were never offered a real alternative when you said this is hormonal.
PMS progesterone makes you depressed( the pill SSRI,s will work.)
PMDD is menstrual related seizures
researchers keep mixing these women together not drawing a clear line
Natrual progestorone works on a hormone imbalance
if you do not have an imbalance, get the right anticonvulsant! epilim makes you hairy SSRI,s and the pill will not work on epilepsy
all doctors do is make money out of the untreatable dumb women who trust them I got this imformation from

http://menstrualpsychosispmdd.weebly.com/

you watch this post come down in a hurry they can not make money from the well

AND I AM WELL bipolar has no known organic course.