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Any Advice for Stable Bipolar Woman who is hitting the Menopause?

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Any Advice for Stable Bipolar Woman who is hitting the Menopause?

Post  Admin on Mon Oct 29, 2012 10:58 am


Question posted by our Facebook member:





Post your suggestions here.
Thanks

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Re: Any Advice for Stable Bipolar Woman who is hitting the Menopause?

Post  Admin on Mon Oct 29, 2012 1:30 pm



Hi Gill,

Thanks for asking this important question. Here is my take on this topic, everyone is encouraged to post there experience here and correct me if wrong.

Emerging data states that menopausal transition age women with bipolar disorder experience a greater proportion of clinic visits with depressive symptoms compared to similarly aged men, and younger women and men with bipolar disorder.

Treatments needs to be chosen with careful consideration for the different stages of the menopausal transition, as well as safety, tolerability, and impact on Quality of living.
Menopausal-related symptoms can be treated with hormonal therapies, antidepressants, and herbal supplements, but a critical window of opportunity may exist for these interventions.

Bipolar disorder presents differently in women than in men and may require different medication.
For instance:
* In women lithium may be less effective for patients who have rapid cycling
* Adjuvant antidepressant medication may be required with valproate or carbamazepine
* Lamotrigine may also be effective.

Note: Most of the medications that are standard treatment for bipolar disorder affect bone mineral density, and the risk for impaired Quality of life should be considered when choosing medication for women during this period.

Estrogens have a mood-enhancing effect in postnatal depression and the depression in the transitional phase of the menopause. A balance is often necessary between three hormones: Estrogens, progestogen and possibly testosterone.
The problem is the progestogen (as these women are often progestogen-intolerant). Progestogen should be used in the lowest dose and for the shortest duration necessary to prevent endometrial hyperplasia or the return of premenstrual syndrome-type symptoms if the women are progestogen-intolerant.
It is possible to add transdermal testosterone which will improve mood, energy and libido.
The use of estrogens for depression in these women does not exclude the use of antidepressants.

Note: Hormone-responsive depression cannot be diagnosed by measuring hormone levels but can only be diagnosed by a careful history relating depression to the menstrual cycle, pregnancies and the perimenopausal years.

Insufficient information is available, however, to assess the best strategy to treat women with bipolar disorder and depression as they age.

Source:
Marsh WK, Ketter TA, Rasgon NL. Increased depressive symptoms in menopausal age women with bipolar disorder: age and gender comparison. J Psychiatr Res. 2009 May;43(Cool:798-802. Epub 2009 Jan 19. PubMed PMID: 19155021.

Studd JW. A guide to the treatment of depression in women by estrogens. Climacteric. 2011 Dec;14(6):637-42. Epub 2011 Aug 31. Review. PubMed PMID: 21878053.

Soares CN, Taylor V. Effects and management of the menopausal transition in women with depression and bipolar disorder. J Clin Psychiatry. 2007;68 Suppl 9:16-21. Review. PubMed PMID: 17764380.

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Re: Any Advice for Stable Bipolar Woman who is hitting the Menopause?

Post  Admin on Mon Oct 29, 2012 3:56 pm


Please post your experience with medications and if possible doses that you have used.

Thanks

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