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Dr. Bob is Robert Hsiung, MD,
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Posted by ihatedrugs on July 10, 2010, at 22:22:33
In reply to Re: PMDD and estrogen therapy? » dusty rhoads, posted by janejane on July 9, 2010, at 11:31:07
Hi,
I'm so glad this topic is being discussed in this forum. I too am suffering from PMDD and have been trying to understand how to manage it. I went to a gynecologist who advertised his expertise with menstrual disorders, only to find out he was a jerk and dissed my condition as purely emotional. I left his office in tears. I have tried the ssri route but with minimal benefit. I am now increasing my intakes of B vitamins and especially B-6. Your explanation about the different types of PMDD makes so much sense. I too believe suffer from type D. My main complaint during the 10 days before menstruation is severe depression that disappears a couple days after my flow starts. When I asked the "jerk GYN doctor" about checking my hormone levels, he dismissed it as an inconclusive test and a waste of time.
I am also leery of hormone treatment as I had a transient ischemic attack a couple of years ago. However, I was tested by a hematologist to see if I was having a clotting problem and she found absolutely nothing wrong and came to the conclusion that the ischemia may have been an isolated incident. But I am still afraid to even consider any hormone treatment as it could potentially create a cardiovascular situation. So at this point, I'm exploring any options but not much is out there, at least in the mainstream medical community. I'm curious about green tea since I just purchased some Matcha tea, which is touted as a super antioxidant and has neuro-protective properties. I hope it doesn't lower my levels. I also wanted to add that the low estrogen theory makes so much sense to me because I remember feeling amazing during both of my pregnancies when estrogen levels were at an all time high.
I'm still going to look into having my hormone levels checked. I need to find someone who believes in it as a diagnostic tool.
Please keep us posted about any new information you may find or websites I can look into.
Posted by SLS on July 11, 2010, at 5:45:07
In reply to Re: PMDD and estrogen therapy?, posted by janejane on July 9, 2010, at 17:09:46
What about Yasmin?
- Scott
Posted by janejane on July 11, 2010, at 6:30:00
In reply to Re: PMDD and estrogen therapy?, posted by SLS on July 11, 2010, at 5:45:07
It's a good suggestion, Scott (especially since it's FDA-approved for PMDD), however, as I mentioned above, the problem with yasmin (and yaz) from my experience (I've taken both), is that there are blank days (no hormones so you can have a period). Those were always the worst days, for me. Depending on which week is dusty's good week, it might be a problem for her, too. She did mention trying BC pills, so it'd be interesting to learn whether she took yasmin/yaz or some other brand. It might make a difference.
Because of my own experience, I think that continuous birth control might be better for PMDD than traditional pills like yasmin. I'm sure it's possible to take any brand continuously, but I'm not sure how it works with insurance coverage since they usually only allow one 28-day pack per month. I do know that seasonique is marketed for continuous use, but I don't know what the estrogen-progesterone ratio of that one is, whether it'd be appropriate for PMS type D or not.
Of course, there is always risk associated with using synthetic hormones. This is why I recommend bioidenticals, and why I think dusty was looking into them.
Posted by janejane on July 11, 2010, at 7:25:14
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 10, 2010, at 22:22:33
I'm glad this topic is being discussed too. :-) If you haven't already, try doing a search of the archives here. I remember reading through a bunch of threads when I started looking at this stuff last spring. Google of course will bring up a lot of info too. (Just remember to be a critical reader and don't necessarily believe everything.)
Have you had a chance to read more about the different PMS types yet? (Sorry I don't remember which sites were better than others. If you find good ones, be sure to put links for others, though.) I wouldn't automatically assume you have D since A is apparently so much more common, and can be associated with depression and moodiness too (not just anxiety). It's important to know which kind you have because if you try to raise the wrong hormone, you may get a worsening of symptoms.
As for getting tested, I do think your best bet is to try googling "bioidentical hormones" and your zipcode (or town, whatever) to see what docs come up. It took me a while to find someone who I felt I would be comfortable with who also took my insurance. (It turned out that she was less experienced than she claimed, though.) You might also want to just search for holistic/integrative docs generally because they are usually more open-minded and will probably be at least familiar with bioidenticals. Another option is online sites that sell saliva testing kits. (You'll have to research which ones are most reputable because I don't know.) I would think it'd be hard to get reimbursed by insurance for those, but I haven't looked into it. Many experts say saliva is better than blood, but others seem to disagree.
I love matcha tea too. I really do feel that it calms me and helps me to focus. (I tried taking a theanine supplement and didn't get the same effect.) I used to drink matcha every day (sometimes twice a day) for a while, in addition to drinking a lot of iced green tea (it was like water to me). Then I came across a study that found that women who are heavy green tea drinkers have 13% lower circulating estrogen than non-tea drinkers. The caveat is that those women were post-menopausal, so it's possible that the results are not be relevant to us. (Interestingly, they theorized that Asian women have a lower incidence of breast cancer because of tea drinking.) I quit drinking green tea for a while to see if it helped, and didn't feel any better, so I'm not sure it makes a difference, for me. (I mentioned green tea in my last post since it's a possible issue, but I probably should have been more thorough in my discussion of it.) If you like matcha, and don't have a worsening of symptoms, I say go for it. I've been drinking more green tea again lately, though not as much as before. I might try drinking grapefruit juice during my down times as dusty suggested, to see if it makes a difference. (I'm not on meds right now.)
You mentioned B vitamins, but are you taking other supplements, such as magnesium? As you probably know, magnesium been known to help with PMS, anxiety, constipation, and a bunch of other stuff. (It's supposed to be involved in over 300 biochemical reactions in the body.) Most Americans are deficient, and because it's bulky, multis typically don't have 100% of the DV, so it's something you'd most likely have to take separately. If you want to add it, avoid magnesium oxide since it isn't well absorbed. If you have heart problems, magnesium taurate/taurinate, I believe is often recommend. I take glycinate myself, though I used to take citrate. It (citrate) seemed to help with my sleep at one point, but doesn't seem to anymore. Not sure why. Citrate is apparently more likely to cause diarrhea than others, but whichever kind you take, start low and titrate up slowly to avoid having an unpleasant reaction. I know others prefer different types (e.g., malate, orotate), and if you do a search of the archives here, you'll find a lot of posts about preferences, and many examples of people touting the benefits of it.
How about fish or krill oil? It seems to help a lot of people with mood, and I do find them useful for menstrual cramps. If you happen to cholesterol problems, it might help that too, as you probably already know. (A McGill study showed krill to be very effective for reducing LDL and triglycerides and raising HDL.) I don't tolerate either one very well, but I think I'm an anomaly. Just one gelcap is enough to give me stomach problems and make me anxious. They say that the SEs go away after a while, but if I take either one for more than a few days, my face turns into an oil slick and I get acne. I also have unusually high HDL ("good" cholesterol), and there was a Swedish study that suggested super high HDL might be bad so I'm cautious about taking something that might raise it. (Most docs think over 60 is great, but mine is over 100 which is kind of freaky, I think.)
When I have cramps, I take a product by now foods called super omega 3 6 9 that includes a little fish oil as well as borage and flax. I don't take it at other times since I don't think it does much for me otherwise. Borage of course is supposed to be good for PMS too, as is evening primrose, if I recall correctly. I just found a bottle of borage in the cupboard that I forgot I bought (luckily hasn't expired yet) so I might try it plain next month. I will have to look up whether it affects hormones.
If you haven't already done a trial of fish or krill oil, I'd recommend you try that first (before taking the supplement that I do), because there is a lot of good evidence that it helps with mood. (As I said before, I think I'm a bit of an anomaly in my reaction, though I've seen anecdotal reports of others with similar experiences.)
Krill is a bit more expensive than regular fish oil, but you wouldn't have to take as much of it, and it contains something called PS (sorry too lazy to look up the full spelling) in addition to EPA/DHA that's supposed to improve cognitive function, and possibly mood. I really wish I could tolerate it because there is so much good stuff that it's supposed to do, but I just don't. Everybody's different, though. Oh yeah, fish/krill can apparently thin the blood, so if you think clotting might be an issue, it might be good for that, too.
I assume you're taking a daily multi that includes zinc? If not, it might be something to start since you'll get your other bases covered that way. Zinc in particular is often touted as good for PMS. You'll want to balance it with copper, though, so I think a multi is the best way to get it. Lots of people just take extra zinc, but I'm a bit more cautious since I've got this weird serum copper deficiency so I can't take too much zinc without worrying about my copper going lower (apparently it's rare, but it doesn't hurt to be careful about megadosing in any case).
Posted by janejane on July 11, 2010, at 7:32:06
In reply to Re: PMDD and estrogen therapy?, posted by SLS on July 11, 2010, at 5:45:07
By the way, Scott, it's good to see you on the alt board! We could use your expertise. I don't have much of a biology or chemistry background so I get lost in all the sciency stuff. What do you think about the PMS typology?
Posted by dusty rhoads on July 11, 2010, at 15:31:42
In reply to PMDD and estrogen therapy?, posted by dusty rhoads on July 9, 2010, at 2:45:06
Thanks for all the great postings! Janejane, thank you so much for your thoughtfulness in taking the time to provide a lot of useful information that I didn't previously know about. I feel for all of us PMDD sufferers, and can honestly say that the more I've doggedly pursued effective treatments, the more I've found. Sharing info and ideas with others going through similar symptoms is invaluable.
So I looked into over-the-counter estrogen creams, and ordered a bio-identical estriol cream that I found on amazon.com. From what I've been reading, estriol or E3 is the gentlest of the three types of estrogen (it's the type that peaks only during pregnancy) and taking it through a skin cream makes the cancer risk much lower than taking it orally .. it is even associated with a reduction in the size of cancerous tumors, and also improvements in skin tone, mood, sexual function, bone density, and all the other things that estrogen is good for. It is usually taken by postmenopausal women so I'll do a bit more research and perhaps talk to my naturopath to make sure it's safe for a woman who still has a monthly cycle and would like to have kids one day. I ordered "bio-identical" instead of "natural" estriol because I read in that book on menopause that natural hormones can come from all kinds of animal sources and can differ chemically from the hormones found in the human body. Janejane, I'm sure you know this already, but the "bio-identical" ones are usually derived from plant-based sources and are safer and more effective because they're chemically identical to the hormones that our bodies naturally produce.
To answer a couple of your questions ... I have tried Yaz and Yasmin. Yaz made me feel better and worse at the same time, if that makes any sense .. I felt happier and more confident, but got angry and cried at the drop of a hat, like a little kid - which became a problem at work, not to mention life in general. These effects were throughout the month, and then I'd actually feel slightly relieved during the week when I stopped taking it. I stuck with it for 3 months to see if my body would adjust, but ended up just feeling a different kind of crazy than before the pill, so I switched to Yasmin, which gave me less of the happy/volatile feeling and actually made me feel more depressed. I then researched birth control pills that have lower progesterone levels (I think one was Lutera or Mircette) but those also made me feel depressed, so I just gave up on birth control pills entirely.
I have tried a handful of herbs. Herbs that help: evening primrose oil (calming), chamomile tea (calming), schisandra (calming, energizing). Herbs that did not help: vitex (more irritable), rhodiola (tired, depressed), st. john's wort (sunburn after 10 minutes of sunset). My jury's still out on dong quai .. I think it calms me, but upsets my stomach. Are there other herbs that folks would recommend? Janejane, thanks for the word on black cohosh .. I picked up a bottle and am going to give it a try.
It's very interesting to hear about the PMS types. I'll have to look more into that. Although it seems that I'd fit into PMS-D (Depression) because of my low estrogen, I feel like my worst symptoms are irritability and anxiety. Maybe I'm a rare type of a rare type. :)
As for soy, I did find some articles on PubMed that found that soy could either raise or lower estrogen levels. I've decided to steer clear of it.
To answer your question about my hormone test, it was a saliva test around day 24. (Because my cycle ends around day 30-32.) My estradiol was 2.9 and the reference range was 1.2 - 8.4. My progesterone was 267.2, reference range 99.1 - 332.6. I got the test through my naturopath, and none of it was covered by insurance, unfortunately .. but I'd gotten to the point where I wasn't going to let cost stand in the way of hunting down my lost sanity.
On a tangent about doctors ... the vast majority of doctors out there haven't a clue about PMDD, and even the specialists have limited knowledge, at least in my (perhaps unlucky) experience. My naturopathic doctor (N.D.) has been so much more helpful than any of the gynecologists, psychiatrists, and endocrinologists I've seen. In my view, PMDD is one of those whole-person problems that can't be addressed through a single discipline .. it's hormonal, emotional, nutritional, lifestyle, energetic, cognitive, etc. I highly recommend that anyone with PMDD look for a well-reviewed naturopathic or holistic doctor. Definitely get your hormones checked as well as your neurotransmitters, and ask them ahead of time if they'll do hormone and neurotransmitter testing, so you're not wasting your time. My norepinephrine was high, along with some other neurotransmitter imbalances which my N.D. explained was directly related to my irritability, anxiety and depression. Based on this, she recommended that I try taking taurine, L-theanine, and fenibut .. all of which have been pretty calming, but they're still in the trial phase with me. Taurine gives me a headache and might make me more depressed, and fenibut can cause withdrawal symptoms if taken habitually. However, I've noticed that since trying them, I do feel calmer - less anxious/irritable. My N.D. also gave me a pretty amazing liquid herbal concoction that is calming and energizing at the same time .. I have to ask her what's in it exactly, and will post her answer.
Did I mention melatonin? If you think you might have PMS-D and don't have an autoimmune disease, you should consider melatonin - you can buy it over the counter. It made me feel noticeably happier and calmer, and improved the quality of my sleep. However, I have an autoimmune disease (a mysterious type of arthritis which may be fibromyalgia) and the melatonin made my arthritis worse, so I had to stop taking it.
Sorry for the super-long response! I'll close with a few links that I've found interesting:
Soy can have an anti-estrogenic effect: http://www.ncbi.nlm.nih.gov/pubmed/19235040
PMDD women have low estrogen (depending on how they define PMDD, they may be talking about PMS-D): http://www.ncbi.nlm.nih.gov/pubmed/17956950
PMDD women produce less melatonin, and later in the sleep cycle (another reason to get a full night's sleep every night!): http://www.ncbi.nlm.nih.gov/pubmed/9104690
Posted by ihatedrugs on July 12, 2010, at 0:25:21
In reply to Re: PMDD and estrogen therapy? » ihatedrugs, posted by janejane on July 11, 2010, at 7:25:14
Thanks for your reply. I do take Krill oil and tolerate it pretty well and also take a calcium-magnesium formula in liquid form which I believe has helped some. I had my vitamin D levels checked and it was very low 16 ng/ml, so my doctor put me in supplements and it went up to 34ng/ml, however according to various studies, optimum levels should be closer to 50-100 ng/ml. The irony is that I live in Florida and my brother who lives in South Beach, Miami also had very low levels of vitamin D. So we may have an issue with absorption more so than intake. I also take B complex, and a good multivitamin. This month I am attacking PMDD with Lexapro, and all the vitamins and supplements recommended and I'm going about it faithfully, so I will see if I see any improvements. I am looking for a doctor who would test my hormone levels and have found several in my area. I did find this website http://www.premierhormonebalance.com/dr-michael-borkin.html but how legitimate this guy is I don't know. Anyways we will continue on our quest and try to find some answers. Thanks so much for your time.
Posted by SLS on July 12, 2010, at 5:34:52
In reply to Re: PMDD and estrogen therapy? » SLS, posted by janejane on July 11, 2010, at 7:32:06
I don't know where you got the idea that I had any kind of expertise, but I'll take that as a complement. You ain't too shabby yourself.
:-)
> What do you think about the PMS typology?
From your explanation, it would seem to make sense to make a nosological distinction between the two types of PM disorders, so long as the Anxiety and Depression subtypes should be so consistently associated with their respective hormonal abnormalities.
- Scott
Posted by janejane on July 12, 2010, at 8:31:52
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
I don't have time to write more right now (darn work), but I did want to urge you to do more reading on black cohosh before starting it. Several sources I saw online suggested that it's estrogenic, but when I dug a little more deeply (not much), the picture got more complicated. I wish I could be more helpful, but biology was never a strong subject for me so I tend to get lost when it comes to the nitty gritty. Let us know what you find out.
Posted by Phillipa on July 13, 2010, at 0:16:18
In reply to Re: PMDD and estrogen therapy? » dusty rhoads, posted by janejane on July 12, 2010, at 8:31:52
I'm postmenopausal and using bioidentical hormone creams. I have blood work done twice yearly and the compounding pharmacy gives me the right dose of estrogen, progesterone, and testosterone. Google componding pharmacies in your araa. The ones I've google also provide a name of the docs that do hormone testing and a lot of the pharmacies that compound also do saliva testing with a script. So also google anti aging doctors as mine is one and he does the blood testing. I went from way low postmenopausal to pre menopausal. New studies I've read are now saying low doses of bioidenticals are safe or relately safe. Phillipa
Posted by janejane on July 14, 2010, at 13:16:12
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
Hi dusty. Sorry for the delay.
So an estriol only cream is OK, then? Is it converted to estradiol in the body, and if not, does it not matter? Since estradiol is the kind they usually test for, I assumed it was the most important, but I never read too much about the different types. What kind of dosing schedule are you using?
It's interesting that your naturopath considered your estrogen low even though you were within range. (My doc would not make that leap.) From what I remember anxiety and irritability can be part of type D so I wouldn't worry too much about them being bigger issues than depression. I would think it would make more sense to go by the numbers more than by symptoms, anyway, in determining what you should supplement.
High norepinephrine makes sense with your symptoms, from what I understand about neurotransmitters. (I've read mixed things about the utility of neurotransmitter testing so it's interesting to see that your results do seem to match your symptoms. How were your serotonin and dopamine levels?) I know I read something about how hormones affect various neurotransmitters but I don't remember the relationships. Oh darn, I just found the link I was thinking about, and it sort of contradicts the idea of estrogen helping you if your NE is high. See here:
http://www.digitalnaturopath.com/cond/C52281.html
Quote:
"Estrogens appear to affect mood by suppressing type A-monoamine oxidase (MAO) while enhancing type B-MAO. These enzymes are involved in the oxidation of biogenic amines - norepinephrine, epinephrine, dopamine, and serotonin - which have significant effects on mood and behavior. The net effect of estrogen on these MAOs is to increase the levels of epinephrine, norepinephrine and serotonin (all normally deactivated by MAO-A) and decrease the levels of dopamine and phenylethylamine (both normally metabolized by MAO-B).
The effects of these changes on mood and behavior are well documented: epinephrine triggers anxiety; norepinephrine, hostility and irritability; serotonin, at high levels, nervous tension, drowsiness, palpitations, water retention and inability to concentrate and perform. Dopamine is believed to counteract these three amines by inducing a feeling of relaxation and increasing mental alertness. It is of interest to note that a decreased dopamine level in the hypothalamus is also believed to be central to the hormonal imbalances found in polycystic ovarian disease.
Estrogens also affect mood by competing for pyridoxal-5-phosphate binding sites, stimulating hepatic tryptophan pyrolase (shunting away from serotonin synthesis), and decreasing glucose tolerance."
Hmm... I'm not sure it's a reliable website, but it sure stinks that it suggests that estrogen increase NEs. You'll have to ask your naturopath about that.
Oh, here's another article on estrogen I just found:
http://www.medscape.com/viewarticle/406718_2
Scroll down to see the section on mood. It confirms the idea that estrogen increases NE and serotonin. However, it also says it increases dopamine and opioid and endorphin production, which seems to contradict what the other site said. Lovely. (I give more credence to the medscape article since it has cites, though.)
Oh goodness. Looking at more articles just makes me more confused... there are a lot of contradictory claims. If were well enough, I'd try to take some biology classes to get a better handle on this. But of course, if I were well, I probably wouldn't care about trying to understand it anymore.
I'd definitely be interested to know what's in your herbal concoction so please do ask about that, too. As for the other supplements you're trying, I hope one or more of them work for you. I tried taurine a couple times and didn't notice much. Theanine, I think I already told you about (prefer matcha)... phenibut is familiar but I never explored it. Right now depression is more of a problem for me than anxiety, though dread and irritability are a big part of my monthly woes. My diagnosis is major depression on top of dysthymia, by the way. My symptoms appear to be exacerbated by PMS and SAD (winter blues, which I'm not looking forward to in a few months). I'm 39 and have lived with this since I was a teenager.
Have you not tried tryptophan or 5-HTP? I don't remember if you said you were a responder to SSRIs or ADs in general, just that you didn't like the side effects.
I've thought about seeing a naturopath, but cost is definitely a concern. May I ask how much yours charges, including for tests and supplements? How often do you see her? (If you don't want to say publicly, you can send me a babblemail by clicking my username at the top of this post.)
Melatonin? I know I tried it and decided not to continue, but I can't remember why. I want to say it didn't help with sleep, and maybe me spacey or gave me a headache or something (guessing). I'm pretty sure I've read of some people complaining that it makes them more depressed. Maybe I should go find the bottle and try it again. Sunlight is also supposed to help with melatonin production, is it not? I do notice that I get really tired if I'm in the sun for a long time.
Is hypoglycemia a problem for you at all?
When you tried rhodiola, what brand did you use?
OK, I'm going to stop now before this gets even longer. ;-)
Take care,
jane
Posted by janejane on July 14, 2010, at 13:43:42
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 12, 2010, at 0:25:21
Sounds like a plan. Please keep us updated on everything you decide to try, and how each affects you. Thanks!
P.S. Have you just started the lex? Any side effects?
Posted by janejane on July 14, 2010, at 19:38:23
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
Found this reference that suggests that pomegranate reduces "depression" and bone loss in mice who had surgical menopause, presumably due to the estrogen it contains:
J Ethnopharmacol. 2004 May;92(1):93-101.
Pomegranate extract improves a depressive state and bone properties in menopausal syndrome model ovariectomized mice.Mori-Okamoto J, Otawara-Hamamoto Y, Yamato H, Yoshimura H.
School of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan. okamoto-junko@spu.ac.jp
AbstractPomegranate is known to contain estrogens (estradiol, estrone, and estriol) and show estrogenic activities in mice. In this study, we investigated whether pomegranate extract is effective on experimental menopausal syndrome in ovariectomized mice. Prolongation of the immobility time in forced swimming test, an index of depression, was measured 14 days after ovariectomy. The bone mineral density (BMD) of the tibia was measured by X-ray absorptiometry and the structure and metabolism of bone were also analyzed by bone histomorphometry. Administration of pomegranate extract (juice and seed extract) for 2 weeks to ovariectomized mice prevented the loss of uterus weight and shortened the immobility time compared with 5% glucose-dosed mice (control). In addition, ovariectomy-induced decrease of BMD was normalized by administration of the pomegranate extract. The bone volume and the trabecular number were significantly increased and the trabecular separation was decreased in the pomegranate-dosed group compared with the control group. Some histological bone formation/resorption parameters were significantly increased by ovariectomy but were normalized by administration of the pomegranate extract. These changes suggest that the pomegranate extract inhibits ovariectomy-stimulated bone turnover. It is thus conceivable that pomegranate is clinically effective on a depressive state and bone loss in menopausal syndrome in women. Copyright 2004 Elsevier Ireland Ltd.
PMID: 15099854 [PubMed - indexed for MEDLINE]
I dug further and found this, which talks about the different kinds of estrogen it contains:http://www.pomegranatehealth.com/blog/index.php/2010/03/should-you-be-scared-of-estrogen/
(Note: they're selling pomegranate supplements, but it was still an interesting read. They actually suggest that the type of estrogens in pomegranate protect against breast cancer. Sounds too good to be true, doesn't it?)
Can't decide whether to try pomegranate or estriol cream now. Pomegranate supplements (not from the site above) are cheaper, and seems to have other benefits.
Posted by janejane on July 14, 2010, at 19:47:15
In reply to pomegranate supplements as a source of estrogen? » dusty rhoads, posted by janejane on July 14, 2010, at 19:38:23
Dusty, I forgot to acknowledge that you already mentioned estriol being associated with breast cancer remission. The article also mentioned 17 apha-estradiol as being protective. I wonder whether cultures who eat a lot of pomegranates have a lower incidence of BC and menopausal symptoms.
Posted by ihatedrugs on July 14, 2010, at 23:49:49
In reply to Re: PMDD and estrogen therapy? » ihatedrugs, posted by janejane on July 14, 2010, at 13:43:42
> Sounds like a plan. Please keep us updated on everything you decide to try, and how each affects you. Thanks!
>
> P.S. Have you just started the lex? Any side effects?Yes, I started the Lexapro but I'm still apprehensive about it. I have taken so many meds, Lexapro included and although some provide mild relief, the side effects drive me crazy, especially the weight gain. So I may stop it and give L-Tryptophan (good quality non-contaminated) a try. I have been reading up on it and found a couple articles that sparked my interest. I know is a long shot but at this juncture, all I can do is try it and if it fails, I'll dump it in the wastebasket along with all the other failed trials of medications, vitamins, herbs, shakes, magnets and God knows what else. I included below the links to two interesting articles on L-Tryptophan.
Also I read in Prevention magazine that White button mushrooms prevent the synthesis of estrogen.
http://www.naturalmedicinejournal.com/clinical_janci_gaby_insert.html
Good luck
Posted by janejane on July 15, 2010, at 10:59:28
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 14, 2010, at 23:49:49
I think tryptophan (or even 5-HTP) is definitely worth trying, especially if you're an SSRI-responder and your depressive symptoms are more of the anxious type rather than the lethargic type (you'd want to look at tyrosine/phenylalanine for the latter).
Do you ever get side effects such as anxiety or headache on SSRIs? If so, I'd watch for those. (I think weight gain is a less of an issue, and in fact, you might experience less hunger and fewer carb cravings.) My problem with 5-HTP and tryptophan was that I developed anxiety and headache after a while, as well as loss of efficacy (probably because I lowered the dose to reduce the SEs). My theory is that after being on prozac for over 10 years, some of my serotonin receptors were altered enough that I now get SEs from really small doses of serotonergic substances and it's hard for me to find an effective, SE-free dosing schedule. I also think that it's possible that increasing serotonin availability in the brain globally might not always work well since there's a chance that you might unwittingly hit some receptors that are associated with SEs such as anxiety. (Again, it doesn't seem to happen to everyone, and I think mine are sort of messed up so I still encourage you to give it a go, especially if you haven't used the same SSRI for as many years as I have.)
From what I've read, it does seem that tryptophan is probably safer than 5-HTP, by the way, since it doesn't bypass the rate-limiting step that keeps serotonin out of the blood (the reason 5-HTP is given with carbidopa in Europe), and since the contaminated batch was just that -- contaminated -- and not typical of most production. It is also less likely to cause GI upset than 5-HTP. That said, I don't think the heart issues that were supposed to be a problem with 5-HTP ever really materialized and Americans have been taking it without carbidopa for a while now. Because some people seem to do better on one or the other, if tryptophan doesn't work, I wouldn't rule out 5-HTP, though I'd be more cautious with it.
You probably know this already, but remember to start modestly with tryptophan (like maybe 250 mg -- you can get tablets and a pill cutter, which is easier than opening capsules) and take it on an empty stomach. You can have a carb snack to try to increase absorption (like a small amount of fruit juice), but you want to avoid protein for at least an hour afterwards. The idea is that the insulin spike will clear competing aminos so the tryptophan can cross the blood brain barrier (it has the least affinity for the large neutral amino acid transporter). I read one article that said it doesn't help to do this, but a lot of experts recommend it, and I don't think it would hurt (especially if you've consumed other protein recently). I think competition with other aminos is less of an issue if you take it first thing in the morning, though some people like to take it at night to help with sleep. (Some take it up to three times a day, if I recall correctly.) Remember to dose any competing aminos at other times of the day. For example, if you also wanted to take tyrosine, you might do that in the morning, and tryptophan at night. (You don't have to worry about this stuff with 5-HTP which makes it a bit easier to take.)
Oh yeah, you might want to take P-5-P (active form of B-6), too. (Hopefully this will already be in your multi or b complex, but not all contain P-5-P so you'll want to check.) And make sure you're getting some B3 everyday so the tryptophan does not need to be converted into it instead of serotonin. (Something to think about... people who don't get enough B vitamins or other supporting nutrients might not have the other building blocks they need to make tryptophan work. Meaning that, for instance, Bs might be the deficiency rather than tryptophan, if the problem is low serotonin.)
Of course (and here I will bring this back on topic), you can also try to increase serotonin by using bioidentical estrogen or other supplements like SAM-e/TMG or herbs. Personally, I think that if low estrogen is the problem, it seems logical to try to take care of that first, since it's more upstream. Then again, the appeal of something like rhodiola is that it normalizes estrogen (according to some sources), balances the HPA axis, and increases depression-related neurotransmitters in different parts of the brain. (Too bad it wasn't enough for me; works for some, though.) I think the holy grail is probably different for each of us, but I'm glad that we have a place to come and compare notes.
Posted by morgan miller on July 15, 2010, at 23:09:22
In reply to pomegranate supplements as a source of estrogen? » dusty rhoads, posted by janejane on July 14, 2010, at 19:38:23
Isn't pomegranate extract an aromatase inhibitor, which would mean it could suppress the production of estrogen?
What about eating ground flax seed?
Posted by morgan miller on July 15, 2010, at 23:11:28
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 14, 2010, at 23:49:49
O.K. I just realized that you might be trying to reduce estrogen production. If you are, pomegranate extract might be a good choice.
Posted by ihatedrugs on July 16, 2010, at 0:45:27
In reply to tryptophan » ihatedrugs, posted by janejane on July 15, 2010, at 10:59:28
Hi,
Thanks again for the great info. I think I messed up and took too much tryptophan. Last night I took 1000 mg which actually helped me sleep. Then this morning instead of Lex, I took 500 mg.
About 5 months ago my Psych dr put me in Nuvigil since I wasn't responding to anything. The last thing we tried was the Emsam patch and to be honest I don't feel like anything really works. I have been on this roller coaster for so many years, I'm at my wits end. My depression is the of the weepy, unmotivated, type. My personality however, is of the gregarious, go-getter, love people type. Throughout the years I was able to hide it but the illness caught up with me. Now nothing excites me. My husband and I are soon going on vacation and he makes such an effort to pick the nicest hotels, go to the best restaurants and I have to pretend I'm looking forward to it so he doesn't feel bad. My doctor decided to put me on Nuvigil and that worked for the first time in years but 12-14 days before my period I go back to the dark place. So I really enjoy a few days of normalcy. So I asked the doctor to try Lexapro again. Now my other problem is all the weight I have gained since this nightmare with meds began. I figured if Nuvigil was working, then perhaps I could try adderall to help with weight loss. So now I'm taking adderall, exercising, and of course not eating much but making sure I take my vitamins and what little I eat must be nutritious. I have lost a little weight but I have noticed that when I take the Lexapro the weight loss stagnates which is the reason I'm hesitant to continue. Also the crashes of Adderall are for the most part bearable but today was not a good one. This is why I think I may have messed up with Tryptophan and taken too much. I broke down crying and was so overwhelmed by everything... new meds, trying to figure out what to take and what not to take, exercising everyday, weighing myself everyday, trying to feel better by telling myself everything is going to be fine, reading up on anything I can to try to help my situation, getting ready for a dreaded vacation, going to doctors and coming out sobbing because they make you feel stupid...Anyways I think I'm not even making any sense anymore and I apologize for the rant. I'm just so frustrated. Hopefully, I will feel better tomorrow. Thanks again for all your help and kindness.
Posted by janejane on July 16, 2010, at 5:54:43
In reply to Re: pomegranate supplements as a source of estrogen?, posted by morgan miller on July 15, 2010, at 23:09:22
Morgan, did you read the abstract and article? The idea is that pomegranate contains weak estrogens, which could help with menopausal depression and bone loss (at least as demonstrated in rats), while also protecting again breast cancer. If I'm on the wrong track, please let me know. This sciency stuff confuses me, but that's the take-home message I got. Thanks!
Posted by janejane on July 16, 2010, at 10:01:23
In reply to Re: tryptophan » janejane, posted by ihatedrugs on July 16, 2010, at 0:45:27
I'm sorry you're going through a tough time. I do hope you're better today.
It's interesting that you had a weepy reaction to tryptophan because I had a similar reaction to DL-phenylalanine and my theory was that the increased dopmamine ended up making my serotonin plummet even more, when I needed it to be raised. I'm wondering if you had the opposite thing happen to you.
Have you considered the possibility that you're low on catecholamines, endorphins, and/or GABA rather than serotonin? That might explain the low motivation, weepiness, and feeling overwhelmed as well as the partial response to nuvigil. Does the lexapro help you with mood at all? Have you ever tried PEA or DPA? Do you ever self-medicate with chocolate? Do you ever have depression not associated with PMDD?
Have you ever taken one of those quizzes that help you try to assess what neurotransmitter deficiencies you have? If so, what did you find? I have to admit that I find it difficult to distinguish between some low serotonin and low dopamine/endorphin symptoms. Weepiness is why I thought DLPA might help me, but it clearly was the wrong thing to do on my worst PMS day. (I actually think I might be low in a number of NTs, but trying to do a balancing act with aminos was difficult. I got a partial response to tryptophan, but it was short-lived and I was unable to find a workable dosing schedule. That's why I started to look at other things.)
Hmm. It also occurs to me that you might be right about simply taking too much tryptophan. Julia Ross says that the time to stop taking 5-HTP (which as you know is related to tryptophan) is when your symptoms start cropping up again after you've felt well for a while. I could see a similar thing happening with taking too much at once since there is this idea of topping off too much, if you know what I mean. (I wish I had remembered that paragraph in her book when I tried 5-HTP because I got myself into a horrible state by increasing my dose in an effort to relieve worsening symptoms.) It's also possible that you indeed need more serotonin, but it's just not going to the right places in your brain to make you feel better, and may be going to some of the wrong places, especially with a too-high dose. (I think that was also part of my problem, which I think is the phenomenon Patricia Slagle alludes to when she lists paradoxical agitation as a side effect.)
I wonder if we should start a new thread since this is getting off the topic of estrogen. Speaking of which, are you going to do some testing?
Posted by Hombre on July 17, 2010, at 3:09:53
In reply to PMDD and estrogen therapy?, posted by dusty rhoads on July 9, 2010, at 2:45:06
The liver's cytochrome P450 enzymes are involved in the production and breakdown of estrogen. Estrogen also inhibits CYP1A2, the same one inhibited by fluvoxamine. This also cause caffeine to be broken down at a slower rate. Yet other psyche drugs can induce certain CYP450 enzymes.
There must be a link somewhere between estrogen, the enzymes, and the neurotransmitters, but it would take some serious digging to find it.
http://www.psychotropical.com/Cytochrome_P450_enzymes_1A2.shtml
Posted by ihatedrugs on July 17, 2010, at 18:50:08
In reply to Re: tryptophan » ihatedrugs, posted by janejane on July 16, 2010, at 10:01:23
<<Have you considered the possibility that you're low on catecholamines, endorphins, and/or GABA rather than serotonin? That might explain the low motivation, weepiness, and feeling overwhelmed as well as the partial response to nuvigil. Does the lexapro help you with mood at all? Have you ever tried PEA or DPA? Do you ever self-medicate with chocolate? Do you ever have depression not associated with PMDD?>>
To be honest I don't even know what helps me anymore. But I have the feeling that dopamine is involved because of my lack of enjoyment in things I used to enjoy (painting, gardening, entertaining,cooking). The other day after taking Adderall and going to the gym, I called my husband to tell him how wonderful I felt and I don't mean euphoria but relaxed contentment. I even enjoyed the sunset which I haven't enjoyed in years. (I used to envy the people who would gather up in Mallory square, Key West enjoying looking at the sunset) I can tell you that Nuvigil and Adderall have made more of a difference than Lexapro or other Ad by itself. I haven't tried PEA or DPA. I don't even know what they are (amino acids?) if so where do you get them? I do have depression not associated with PMDD, it is just that it worsens when my period is around the corner. In fact, the one time I had to be hospitalized, I spent a week as an inpatient and was practically despondent for the first three days, when I met with my psych on the fourth day, upon walking into his office, I smiled and said good morning, he commented on how much better I looked and seemed to be in better spirits, then proceeded to explain that it couldn't have been the meds because we had just switch them a day ago. I shrugged my shoulders and said that I couldn't explain it but the only thing I could say was different was that I got my period. My official diagnosis upon leaving was Major Depressive Disorder and PMMD. (That was 13 years ago).
I have an appointment with my psych dr on Monday and will talk about all this some more. She is really nice and listens and perhaps can recommend a dr or place to get my hormones tested. I do feel that I have had two concomitant disorders and that PMDD given my age 46 is getting worse.
Also I wanted to ask you about this product called Amberen. The ingredient list look like nothing for PMDD and apparently is manufactured in Russia. Some women swear by it but others think is just another scam.
http://www.amberenonline.com/?gclid=CNGFovC376ICFRYaswodFnxzjA
Posted by Hombre on July 18, 2010, at 11:41:35
In reply to Re: PMDD and estrogen therapy?, posted by Hombre on July 17, 2010, at 3:09:53
Following up on my train of thought concerning liver enzymes, I decided to see if Chinese medicine addresses estrogen and depression in a direct manner. If anything, I hope it provides some leads to follow up on. Unfortunately, discussions tend to focus on menopause. I'm not so sure how relevant that is to PMDD. Please keep in mind that most educated discussions of Chinese medicine also include awareness of the Western model of the physiology.
Oh, why the liver. The liver is considered the primary culprit in depression. Perhaps when the liver cannot do its job correctly, hormones are not regulated properly.
o "Estrogen and Herbs" by John K. Chen, PhD,
PharmD, OMD, LAchttp://www.aaaomonline.info/ameracu/V34P16-Estrogen_and_Herbs-Parts1and2.pdf
Where's Part 3, John?
o This article discusses some of the issues around estrogen, cancer and herbs that may or may not elevate estrogen levels.http://www.itmonline.org/arts/estdep.htm
o In TCM, Essence (Jing) in part refers to the steroid hormones. The importance of Essence is such that it is considered the root of the body's energy:http://www.acupuncture.com/newsletters/m_feb09/menopause%20chinese%20medicine.htm
"Stored by the Kidney, Essence is the origin of all Yin (Blood and Moisture) and Yang (Qi and Warmth). Loss of libido, stamina, hearing, and vision, lower back pain, sore hips or knees, apathy, despair, dull mindedness, memory problems, vaginal dryness and atrophy, thinning of bones, and deterioration of teeth and gums are all symptoms of deficient Essence."
"When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of Qi produces fatigue, weakness, dull thinking, melancholy, and decreased motivation. Deficiency of Blood leads to weak vision, dizziness, night sweats, irritability, and restless sleep. Lack of Blood deprives muscles, tendons, and ligaments of sufficient nourishment and suppleness, so they become tight and inflamed, leading to muscle cramps, joint pain, and neck tension. The organism responds to this state of scarcity with anxiety and lability, for lack of Blood disrupts the smooth flow that preserves elasticity of tissue and emotional flexibility. As Kidney Essence declines, a domino effect engenders down line deficiencies that eventually impact the Liver, Heart, Spleen, and Lung."
"In sum, labile emotions and unpredictable surges and lapses of physical and mental energies result from the attrition of Yin and Yang Essences of the Kidney, causing the Qi of the Liver, Heart, and Spleen to become erratic and insufficient. Many women have signs of both Kidney Yin and Yang depletion. But because hot flashes, sweating, agitation, and dryness (Kidney Yin Deficient symptoms) are more attention-getting, herbs that treat Kidney Yin deficiency are often overemphasized at the expense of those that restore the true Yang of the Life Gate, an equally important goal."
o http://www.chineseherbacademy.org/articles/menopause.shtml"According to Subhuti Dharmananda, in his paper, "The Endocrine Effect of Chinese Medicine", "Chinese herbs act by stimulating the production of hormones, altering the condition of hormone receptors or changing the rate of catabolism of hormones, rather than by providing the hormones or hormone analogs that function the same as hormones."11 Many of the ingredients in formulas may have little or no hormonal effects, although the effect of the whole formula will substantially increase hormone levels. Chinese herbs work by improving the function of aging organs and glands."
"The Chinese Journal of Traditional and Western Medicine, 1991, reported a study of 2 months administration of Rehmannia 6 Formula to relieve menopausal symptoms in early post-menopausal women. The study showed an increase of 20% in estrogen, a decrease by 1/2 in FSH, and a decrease in LH to pre-menopausal levels; the number of estrogen receptors in leukocytes more than doubled. The Chinese Journal of China Materia Medica, 1993, reported a study of aged rats, in which Rehmannia 8 Formula increased estradiol in females and testosterone in males. The Journal of Traditional Chinese Medicine, 1992, reported a study of 58 patients with osteoporosis, using Chinese herbs for 10 to 12 weeks. Bone density improved an average from 4.0 to 0.9 (0=normal). A three month course of treatment for osteoporosis can be successful in increasing bone density back to near normal levels, and as long as the patient is following a good diet, exercises daily, and avoids harmful practices (smoking, etc.), they probably will not need further treatment, unless they become sedentary from illness or injury. If that occurs, then he or she might need a follow-up course of treatment. In many cases, the patients are instructed to continue herbal therapy at a much lower dose in pill form for long-term tonification, (for example, Rehmannia 6 or 8 Formula).
It is significant that high levels of herbs are being prescribed in these studies, equivalent to 25 to 75 grams of raw herbs or 18 to 27 grams of freeze-dried herbs per day. It is more common for American patients to have difficulty digesting large amounts of herbs. Sometimes it is necessary to work on improving the digestion first, and to start off with a lower dose of herbs and work up to a higher dose."
* Rehmannia 6 = Liu Wei Di Huang Wan
Rehmannia 8 = Ba Wei Di Huang Wan/
Jin Gui Shen Qi Wan (more common)"Formulas that are commonly used during menopause are prescribed according to how the symptoms present. The following is a list of formulas that can be useful:
1. LIVER QI DEPRESSION WITH OR WITHOUT HEAT - Symptoms could include: irregular or short cycles, clots, fatigue, anger, frustration, depression, mood swings, cold extremities, PMS, breast tenderness or lumps. When there is stagnation (liver qi or blood stagnation), it is very important to treat the stagnation before or along with the tonic formulas for the kidney. The classic base formulas are Xiao Yao San and Jia Wei Xiao Yao San.
2. KIDNEY AND LIVER YIN DEFICIENCY - Symptoms could include hot flashes, night sweats, palpitations, thirst, weak knees and low back, chronic vaginal infections or cystitis. The classic base formulas I use are Rehmannia 6 (You can add phellodendron and anemarrhena for heat) or Left Restoring Decoction (Zuo Gui Wan).
3. KIDNEY YANG DEFICIENCY - With floating yang due to deficiency. Symptoms could include heat, dryness, upper body distress, severe hot flashes, insomnia, severe fatigue, teeth or bone problems. These women really need hormonal support and are frequently already on HRT. The classic base formula I use is Two Immortal Decoction (Er Xian Tang), to which I often add placenta and tortoise shell.
4. QI AND BLOOD DEFICIENCY - Symptoms could include dry skin, vaginal dryness, dizziness, insomnia, fatigue, digestive symptoms, muscle weakness, dry eyes or poor vision, scanty menses or excessive bleeding. The classic base formulas I use are Tang Quei and Peony (Dang Gui Xiao Yao San) or Ginseng and Longan Formula (Gui Pi Tang).
5. HEART FIRE -Symptoms could include forgetfulness, fear, anxiety, nightmares, hot flashes, palpitations and irregular periods. The classic formulas I use are Zizyphus Combination (you can add polygala, oyster shell, semen biota or albizziae.), Rehmannia 6 plus anemarrhena and phellodendron (Zhi Bai Di Huang Wan), or Heavenly Emperor's formula (Tian Wang Bu Xin Tang).
To these formulas, you can add sedating or cooling herbs to improve the treatment.
Herbs to calm the heart and sedate the spirit and for uprising qi include: oyster shell, dragon bone, magnetite, tortoise shell, fu shen, polygala, zizyphus spinoza, uncaria and schizandra. Heat clearing herbs include: phellodendrom, anemarrhena, coptis, moutan, raw rehmannia and tortoise shell.
Substances which can be added which have a stronger hormonal effect include: placenta (the strongest effect), ginseng, deer antler, lithosperum, epimideum, psoralea, centipede and astragalus seed. (These herbs should be avoided when treating someone with cancer, an estrogen-dependent tumor or endometriosis.) Other herbs in the category of strong hormonal effect include cynamorium, schizandra, lycium fruit, rehmannia, licorice and cyperus.17
I have found in my practice that these formulas can be very effective. They can take the place of using the natural or synthetic hormone replacement. Even if a women is already using hormones, she can benefit from using Chinese herbs for the symptoms which don't respond to HRT, to treat the underlying imbalance, or to help her get off of HRT. The synthetic hormones have side effects, especially liver qi stagnation and blood stagnation. I generally use freeze-dried herbs, at least 9 grams per day. Sometimes I use more if I decide to use two formulas at the same time, rather than adding or subtracting to the base formula for each patient's special needs. I treat with acupuncture once a week, emphasize a good diet with mineral rich leafy greens and seaweed, exercise, stress reduction and supplementing with vitamins, minerals and essential fatty acids."
Posted by sbarger on February 23, 2015, at 8:16:01
In reply to Re: PMDD and estrogen therapy?, posted by Phillipa on July 13, 2010, at 0:16:18
I know this is an old thread but it is the closest thing to my issues that I can find. How did the estriol supplementation go? Has anyone found relief in any form?
This is the end of the thread.
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