Tag Archives: hormones

Concluding Hormonal Treatment; Pushing the Bipolar Button

My second jaunt down Hormone Road this week ended relatively the same as the first (two-three weeks ago). By day six I was experiencing so much anhedonia I couldn’t eat or sleep. I had become completely engulfed in a tidal wave of pointlessness and self harm fantasies, so much so I could be seen walking up and down the street in the rain like a zombie, frowning for no real apparent reason.

Honestly, I pretty much expected this (since it already happened once two weeks ago) but I was holding on to some faint hope that I might be able to avoid surgery for the odd and still somewhat unknown abdominal problems I have developed. I’ve never had surgery (well, just a wisdom tooth extraction), and never even stitches, so the idea of anyone slicing me open (even a little slice) makes me exceedingly nervous.

Despite my inability to talk with the nurse over the phone in a polite or straightforward manner I am pretty proud of myself. She suggested I see the surgeon the same day I was calling to let her know about my reaction to the hormones, but somewhere in the back of my mind a little voice reminded me that I couldn’t figure out how to use the shower the day before (the same shower I have been using for the last six moths). If I couldn’t figure out how to make hot water come out of a tap (with only two options, left and right) it might not be the best idea for me to talk with a surgeon and make important decisions about the most invasive procedure I will have ever had up to this point. I told her it would be better to meet with him next week, and I am glad I did because it would be another 24 hours before I could smile for the first time in days.

One thing I have found relatively interesting from this whole hormonal excursion is that the first round (on a higher dosage of hormones; desogen) triggered an extremely agitated mixed state where I was depressed, but also very aggressive (not unlike my experiences triggered by corticosteroids). The second round (lower dosage, microgestin) provided a straight-up triggering of intense hopeless depression. Even after I stopped taking the drug (after waking up completely depressed) the depression worsened for 48 hours before the symptoms began to recede.

As usual, I feel compelled to point out that my body (for whatever reason) has become extremely sensitive to pretty much any and all medications I’ve tried, usually with some very poor results. Though it is probably not typical for people to have these sorts of reactions to hormones, it irks me somewhat that most bloggers and internet articles have now taken the stance that hormones never cause mood issues. Of course, this was also the stance of the first nurse who ever gave me hormonal birth control (when I was 18) -which promptly landed me in a psychiatric facility because of a sudden intense mixed episode.

Do hormones cause people to have mood problems? Maybe not most people, but I believe that anyone making broad sweeping generalizations about how safe and effective a treatment is (hormones never cause mood problems, vitamin supplements never cause side effects) are usually trying to sell you something. The truth is that even though hormones might not cause mood problems in most people, nobody ever mentioned them potentially triggering episodes for people who already have abnormally behaving moods.

Frankly, going into this second round of hormones I guessed (with probably 90% certainty) that I would not be able to tolerate them. This guess was not based on anything I read on the internet, but based on my own experience with hormonal treatments I previously encountered (prior hospitalizations, prior depression triggered by hormones, etc.). Having tried a multitude of medications in the past few years (and finding myself reacting to them in unusual ways) has taught me that the best thing anyone can do when starting a new kind of treatment is pay attention. Get to know what is typical for you; a typical headache, a typical bipolar episode, even your typical aches and pains. Without knowing how my body and mind normally act, it becomes incredibly confusing and maddening trying to discern side effects from the normal mood cycles I experience.

And most of all? Don’t forget about your doctor. If something is feeling off, or if I feel much more miserable more quickly than I normally would (like this week)… that’s when it is time to say something. I know that I tend to get incredibly anxious about contacting my doctors after starting a new treatment because I don’t want to appear to be a hypochondriac, but working with people I trust has meant that they also trust my judgment, and I know they want the best for me.

As frightening as surgery sounds to me, after 7-8 months of extreme pain I am ready for this issue to be addressed… and if hormones are not going to be the way to do that, I am ready to take whatever steps I need to in order to improve this situation. Though I can rule out episodes triggered by hormonal therapies at this point, the pain I have been experiencing is significant enough to trigger episodes as well. In the end, all of the healthcare I have been seeking is ultimately tied to improving my mental health as well, less pain -> less stress/distress -> more sleep -> more stable mood. I am hoping that if I can get my body to a relatively happy place, my mind might follow suit.

A Clockwork Trigger

It is said that during pregnancy and postpartum a woman with bipolar disorder is at the greatest amount of risk.

Hormones can be rough, even for the most mentally healthy woman, but what kind of role do hormones play for your everyday bipolar woman?

Estrogen‘s effect on mood is in its ability to increase serotonin and beta-endorphins which are associated with positive mood states. It helps maintain serotonin, dopamine, and nor-epinephrine levels by decreasing levels of mono amine oxidase (MAO), the enzyme responsible for inactivating them.

When estrogen levels are too low in the body, symptoms of depression, anxiety, and mood swings can occur. There have also been studies that link decreased estrogen levels to panic attacks.

Progesterone is a female hormone that prepares the lining of the uterus for a fertilized egg, but in too high of levels can cause depression, irritability, and mood swings.

PMS occurs when hormones change levels before menstruation, and the imbalanced hormones are what cause premenstrual symptoms.

I found a surprising amount of information on how to tell the difference between PMS and bipolar disorder. I had no idea that was something that people were confused about, but apparently there are women who go undiagnosed because they have continuously been told that their mood swings are linked to premenstrual disorders.

One way to tell the difference? Bipolar symptoms can happen at any time. If PMS symptoms show up anytime other than 3-5 days prior to your period, and/or if they last greater than 10 days, then it is more likely to be bipolar disorder.

Several articles said even if a woman’s bipolar disorder symptoms are well taken care of with medication, it is possible for these women to have breakthrough episodes (episodes disrupting a period of stable mood) when PMS would normally occur.

So yes. Our hormones can be a big trigger.

Even worse, there have also been studies that show that severe premenstrual symptoms in bipolar women were an early indicator when those women had more episodes of depression and worse symptoms the following year.

 

Considering what imbalanced hormones can do on their own, you may want to very seriously consider your choice in birth control methods.

I want to make it clear that I believe every woman has the right to pick whatever birth control method(s) she chooses, and I know several women who take hormonal birth control (but are abstinent) simply because it helps balance out their hormones.

For me, hormones have always been a trigger, but I was caught completely off guard after getting the DepoProvera birth control shot in 2004 and having my second hospitalization shortly after. And at that point, the hormones were stuck in my system, and took three months to be depleted.

Progestogens (found in many hormonal birth control methods) increase MAO concentration, thus producing depression and irritability even moreso than natural progesterone. Pure progestogen treatment without estrogen, such as DepoProvera is known to worsen depression in women who already have a tendency toward or clinical signs of depression. Of course, the doctor who administered this shot to me didn’t inform me of that, for whatever reason.

If you are speaking with your primary care provider about your options, be vigilant. I’ve had countless doctors tell me I would be fine after receiving whatever hormones I was given, and that was almost never the case. If you do your research and are firm with your doctor about what kinds of hormones you are/aren’t willing to take you are much more likely to avoid an unintentional hormonal triggering of your mood swings.