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Q:
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?
Thanks,
Kat
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
(jimp@psycheducation.org) and tell
me how this turns out in a month or two, would you?
Dr. Phelps
Published December, 2003
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