The question was submitted
11/14/2008
Subject: Effect on Norethisterone or other hormonal drugs on mood
Hi,
I have bipolar disorder, depressive phases being more common than my hypomanic phases, and lamictal seems to be preventing my frequent slides into mixed states. This medication also seems to be more effective than the other mood stabilizer (valproate), which I used to take in the past, in alleviating my depression to a more manageable level.
However, I also have some form of menstrual disorder. The attempt by the doctors at KKH to put me on Norethisterone in the past seem to have caused me to slide into severe depressive/mixed episodes whereby I turned highly suicidal though it manage to acheive the desired physiological effect. Nonetheless, because of my severe mood condition, it was decided by both my psychiatrist and the doctors at KKH to stop norethisterone. However, due to this, the menstrual problems returned.
My psychiatrist thinks it is better for me to stay on psychiatric medication (lamictal being the only mood stabilizer/medication that she is trying) and not take any other hormonal drugs for the time being as my mood never seems to have stabilized. She remarked at one point of time that I seem to have an exaggerated response to hormonal medication. While the O&G doctors at KKH conceded that my mood condition is important, they did mention that they have to monitor my menstrual problem and that they might have to use hormonal medication to induce the periods (which seems to be perpetually missing!) and that such has to be done for health reasons.
Previous attempts to put me on Yasmin years ago has also not helped as I detest oral contraceptives and I'm also not sure whether my depressed mood then is caused or worsened by Yasmin as I was very depressed and dissociating a lot during that year.
This ongoing O&G problem which has started since I was 16 years old is driving me nuts and I have at one point of time (recently) became very depressed over it. Talking to my psychologist and psychiatrist has done little in alleviating my worries (and they have other concerns with regards to me such as my existing mental health problems) and it seems to me that the doctors from both specialties are stuck. I see the specialists at two different hospitals, the O&G doctor at KKH and my psychologist and psychiatrist at another hospital.
I also have several questions
1) Is norethisterone the culprit or even a contributing factor in worsening mood problems in a person with an existing mood disorder?
2) I am very tired of these confusion that I have been having and am trying to ignore it, in order to reduce my anxiety (I have anxiety problems that comes along with my mood problems). Yet seeing other woman with children gnaws at me, as I am afraid I may be barren though I am still young (am in my early 20s) and unmaried. The doctor at KKH has indicated that I may be having annovulatory cycles. I am so frustrated that I feel like screaming at the O&G doctors and feels very helpless and useless. Yet I seem to be unable to communicate my frustration (at least to the O&G doctors).
I don't know what to do except to pretend that problems don't exist though I am confused and angry, especially during my followups at the KKH clinic when I envy pregnant women who goes there for their checkups.
And the last question is: Should I just ignore everything?
Answer from DepNet
Hi,
You certainly have been through quite a lot, and your frustration is understandable
I would like to state that many of your questions will not be simply answered, as a full and extensive detailed assessment of both your psychiatric and gynaecological problems is needed, with consideration of their interplay, before your concerns can be addressed.
Generally, the female hormone progesterone is depressogenic - this is the hormone that females have in predominance premenstrually, and contributes to the PMS phemonenon of irritability and emotionality. So norethisterone, being a man-made progesterone, would have a similar effect. Whether it is a direct or contributory cause of your mood problems is difficult to say without full assessment. But it does seem like you have stopped the norethisterone already, and your mood difficulites have persisted, so that makes it not likely to be the main cause. It is more likely that having bipolar disorder, your mood state is more vulnerable to hormonal variations of the menstrual cycle.
May i suggest you try to list down some of your questions, and clarify your concerns with your OG doctor. Do try not to let your spirits be drowned by these worries, as you cannot solve the problems if your frustrations get the better of you. Belief that you are not helpless: you can practice communicating your queries, and if you feel that you need a second opinion, you can seek consults from other OG services at either SGH or NUH, or just ask for another doctor at KKH. Do talk to your psychiatrist and your psychologist about your fears and concerns about whether you can have children - they will surely be able to help you deal with some of these struggles, which are indeed not uncommon.
As it does sound as if you have done all you can to solve these problems, and your doctors have all tried to adjust your treatments to the best option, perhaps it may well be that "ignoring" the situation may be something that can benefit your wellbeing for now. So instead of dwelling on this, and letting your frustration get to you, you may want to focus on finding some comfort and fulfilment, in taking up a new talent or new hobby, or getting some regular exercise. Challenge yourself to do something exciting eg. rollerblading, or learn a new language or meet new friends. You'll find that as your general sense of wellbeing improves, your mood state will be better controlled, and some of your worries about the future will fade away.
Take care, and take heart.
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Depnet
The answer was published on DepNet
11/15/2008