Severe PMS or Bipolar Disorder?
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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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