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Q: Severe PMS or Bipolar Disorder?
My 33 year old daughter will not even discuss the posibility that she
has a medical problem--but it has been apparent to her family for many years.
For awhile we thought it was severe PMS, but now--Bipolar--what are the
differences in determining which problem it is? A marriage and young
child's happiness are at risk, Please help. thank you
Dear Ms. S' --
Severe PMS, or Bipolar? Well, this isn't really a "this, or
that" question, because these are related conditions. In fact,
technically, if "PMS" symptoms show up anytime other than 3-5 days
prior to menses, and certainly if it's greater than 10 days, then the condition
is technically "perimenstrual exacerbation of an underlying
condition". What underlying condition? Well, if it meets
diagnostic criteria for bipolar disorder, then that's what we'd call it.
Anyway, the point is not to confuse you further (pretty easy to do, no?
with all these "related, but different, but similar" type
distinctions) but to emphasize that, in my view at least, the diagnosis is not
as crucial as the decision about treatment. If you want to hear me really
go off about this, try this soapbox essay about a similarly difficult
distinction,
bipolar
versus "borderline
personality disorder": the
point is the same.
Now, uh, where were we... oh yes: so, it comes
down to treatment. PMS is being treated these days with serotonergic
antidepressants, with remarkable results (although there's some evidence that
exercise might be effective, with less risk and more benefit). However,
those antidepressants can make bipolar disorder worse. So, the real
question is, is she going to be offered an antidepressant like Prozac (now
dubbed "Sarafem" for this purpose) or Zoloft or Celexa? Or is
there enough reason to suspect "bipolar disorder" to go straight to mood
stabilizers? You may already have read my site on
Bipolar
II, which goes on at some length about that controversy.
I hope this reply or that website may be of some use to you with your question
and your understandable concern.
Dr. Phelps
Published December, 2001
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