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My daughter has been recently diagnoised with Bipolar. When she was 15 she had severly abnormal periods, we took her to OBGYN and they put her on BCP's. She was fine for three years and then went off BCP's 9-02. She went into a depressed state for three months, irreg bleeding and weight loss. She evened out for a few months and on 5-03 started with reckless behavoir, 45lb weight gain, facial hair and acne, no periods. It is now 11-03 and she has been commited to a mental hospital for Acute Bipolar hyper mania. She is on 1350mg of Lithium injections per day. She is not showing any sings of improvement. I am worried something is being overlooked. Like her elevated levels of DHEA. Where should I go for help? I feel my concerns aren't being listened to?



Dear Kat --
It may be that they hear you but nobody quite knows what to do with your insight. There is very little in the psychiatric literature about the relationship between reproductive
hormones and mood disorders, so little that I started a section by that title on my website and still have not much that really affects treatment. However, when you look over that website, you'll see a section on "polycystic ovarian syndrome" (PCOS). With the facial hair and acne and the weight gain and the "no periods", you've pretty much described that syndrome -- along with the weight gain.

Now, PCOS is not widely recognized to cause mood problems. But certainly taking steroid hormones is. And your daughter is possibly being exposed to steroid hormones -- in this case, "androgens" from the PCOS process, i.e. male hormones, thus the hair pattern -- which might have brought on this mood episode. Notice all the "mights and possibly's" in that sentence, please.

Then, there's a second way in which PCOS might cause mood symptoms, through a metabolic change associated with PCOS: "insulin resistance". This is the main problem in "metabolic syndrome" which is probably the more basic version of PCOS that even men can get. (If you get really interested you'll need to understand the difference between PCOS and Metabolic Syndrome.) Insulin resistance can somehow cause mood symptoms, it appears -- but that is a relationship that is just beginning to be explored, as you'll see summarized on my page about this (Metabolic Syndrome causes...?).

That's pretty much everything I know about the connection you've observed (including some other folks' experience in the cases reported on those links). Now, what can you do with this? You'll see the obvious question as to whether metformin (Glucophage) might help your daughter, an idea which most psychiatrists think will came from the moon. So you'll have to be very careful about how you talk with her doctors (take that link for some ideas on how).

Please write me ([email protected]) and tell me how this turns out in a month or two, would you?

Dr. Phelps

Published December, 2003


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