Archive for Mood Swings
The Basics of Dueling Mood Swings During Perimenopause
Posted by: | CommentsA perimenopausal woman who has teenagers in the house undergoing their own adolescent hormonal changes can feel like, on any given day, the family mood swings are all over the map. “There are times when I could honestly believe our family belongs in a tabloid because we’ve all been abducted by aliens and some other creatures are inhabiting our bodies,” said Tina. “My two sweet sons have become so selfish and sullen. And I come home from work on many days feeling like I want to start crying or yelling or both.”
The collision of teenage changes and the perimenopausal transition is enough to make us think the gods are playing a joke on us, and not a very funny one at that. I asked Tina what would happen if she and her teenage sons sat down so she could explain some of what she is going through. She grew thoughtful for a moment and said, “Yes, I could do that.” I told her that this conversation could be an opportunity for her to make a very valuable connection with her sons, by trusting them enough to let them know what might be happening with her hormones and how they could seem to play tricks on her body and emotions. She might even want to compare her own situation with the hormonal fluctuations her sons were going through.
Children can readily understand the concept of something in your body being out of balance, but it’s important to impress upon children that you aren’t ill. “You can tell your boys that the imbalance is something that can be restored, and describe what you’re doing to help that by eating differently and taking black cohosh. You can also explain that when your hormones, which are chemicals, are changing, there can be physical and emotional effects, like fatigue and irritability.”
I also suggested that Tina give her sons a role in helping her if possible. “You could ask one or both of them to take a walk with you, explaining that exercise helps keep your body in balance. If they’re at that stage where being seen in public with Mom embarrasses them, tell them you want an hour of peace and quiet every evening. Let them pick the hour, but make sure they understand that they aren’t to be fighting, playing the stereo or television, or interrupting you. Let them know that the time for you to unwind is very important for your health.”
Tina wasn’t so sure how it would be to talk with her sons about these issues. Like many mothers who focus their energy and time more on what the family needs than on their own needs, she wasn’t used to the idea of asking her children for anything. “But they’re thirteen and fifteen now,” I pointed out. “That’s a perfect time to give them more responsibility for the health of the family.”
“I was really proud of them,” Tina told me, when I asked her a few weeks later how the conversation with her sons had gone. “They seemed embarrassed at first when I started to explain that my hormones are changing. Maybe they thought I was going to say something really personal. But they both have deep voices now, so I just said they had each experienced something similar when hormones had changed their voices. My youngest son asked me if I was sick, you were right to remind me to be sure they understand that I’m not,” she said.
“They actually listened when I told them I was trying to eat differently and exercise to make my body feel more in balance, and that I was taking an herb. My youngest son was quite interested. He’s in an advanced science class and wanted to know if we could grow our own crop of black cohosh.”
The quiet hour in the evenings was also good for the whole family, Tina reported. “I can’t tell you how many times I would come home from work and yell about the noise, or the clothes on the floor, or a noisy argument they were having. But when I told them that it was important for my health that evenings not be chaos, it seemed like it made a different impression on them, not just Mom nagging again.
“Oh, I won’t say they suddenly started being quiet in the evening for an hour,” Tina continued. “They had trouble deciding at first what hour it would be and had to fight about that for a while, but I just let them work it out. Then my fifteen-year-old was calling it ‘lockdown,’ like in a prison rebellion, but I didn’t react. I just told them that I really appreciated that they were willing to make some changes that would be helpful to me.”
Then her sons started to use the quiet hour to get most of their homework done, which pleased Tina. “I don’t have to ask seven times if their homework is done. And I don’t have to compete with the television because we’ve agreed that it’s off during this hour. Sometimes the hour is up and they still are reading or studying, and no one turns on the TV for the rest of the evening,” she said.
The effects of Tina’s explanation and request to her sons actually reverberated throughout the family, which surprised her. “Now I can come home knowing that at some point during the evening I get to relax. It’s made a big difference in the way I feel.”
“It’s amazing what a discussion about balance and wholeness can do for the whole family,” I said.
The Basics of Mood Swings During Perimenopause – Depression
Posted by: | CommentsKaren is the midforties woman with the solid marriage, children she adores, and stable home life whose persistent feelings of depression both bewildered her and made her feel guilty, as if she should snap out of it. As I had recommended, Karen had a thorough physical exam. Her overall health was very good, and her hormone levels were just slightly below normal ranges, not low enough for her to want to take replacement hormones now. She also hesitated to take the antidepressant medication that her health care provider suggested.
“This may seem silly or like I’m in denial, but somehow I have this feeling that taking antidepressants is for people who are really much worse off than I am. I’d rather wait and see if these feelings will pass on their own, or take something less intimidating than antidepressants.”
Karen’s sister had given her a book on the herb St. John’s wort, which is reported to be very effective in treating mild to moderate depression. Like black cohosh, St. John’s wort has been well researched and is widely prescribed in Germany. Karen found the idea that an herb might help lift her depression appealing, and she called her health care provider to ask about it: “There was a little beat of silence on the other end of the phone. But when I said I’d like to try it for a couple of months to see if it made a difference, he said he respected my choice and didn’t see any harm in it. Actually I think he might be curious too.”
The active ingredient in St. John’s wort, a perennial plant, is hypericin. It was originally believed that St. John’s wort inhibited a type of brain enzyme called monoamine oxidase (MAO). Dampening MAO levels is the principle behind a very powerful group of drugs called MAO inhibitors. But as more research on St. John’s wort has been done in Europe, it appears now that this herb may inhibit serotonin reuptake.
You’ll remember that serotonin is the brain chemical with a significant influence on mood. When reuptake of serotonin is inhibited, the chemical’s “feel good” effects in the brain last longer. Drugs such as Prozac, Zoloft, and Paxil belong to the class of medications known as selective serotonin reuptake inhibitors, or SSRIs.
Karen started taking a standard extract of St. John’s wort (0.3 percent hypericin), beginning with the standard dosage of 300 mg three times daily. She took it with meals to minimize the possibility of gastric upset. “I feel good,” she said with enthusiasm when I called to see how she was doing a month later. “For one thing, I’m glad I had a physical so I can be assured nothing is wrong with me. It also gave me more of a sense of control to decide to try St. John’s wort first before I go on to anything else. Maybe I won’t need anything else, because I really do feel like there’s less of a cloud hanging over me. When I felt that way, there was usually nothing I could really put my finger on, but I just knew I wasn’t myself.”
Karen said she wouldn’t call St. John’s wort a miracle, but one measure of how it was working for her after only four weeks might be that her husband and one of her children noticed a change: “My husband said, ‘You seem more like yourself.’ I also heard my oldest daughter tell one of her friends on the phone that yes, maybe I would drive them somewhere, because I’ve been in a better mood lately.” She gave a slight laugh. “I guess the ultimate barometer of how I’m doing is my teenager’s assessment of my mood,” she said drily.
Because Karen has olive skin and very dark hair and eyes, she doesn’t have to be cautious about sensitivity to sunlight, which St. John’s wort causes in animals that graze on the plant. But even though photosensitivity has not been reported in humans, fair-skinned individuals with light skin and eyes are advised to avoid strong sunlight and other ultraviolet light when they are taking St. John’s wort.
While much of the attention focused on St. John’s wort examines its use to alleviate depression, this herb may be useful in reducing anxiety as well. As more is understood about the effect of St. John’s wort on serotonin levels and mood, we stand to see substantial increase in its application and use in this country. But I am somewhat concerned about branding St. John’s wort as the alternative to Prozac for two reasons. First, we don’t yet know that St. John’s wort will be effective in helping severely depressed people, it appears most effective in people with mild to moderate depression. Second, I am no more comfortable with widespread, cavalier, uninformed use of an herbal preparation than I am with such use of a prescription medication, so I worry about the idea that we can all take an herb, or a pill of any kind for that matter, and expect it to put our lives in order.
Black cohosh is used in connection with hot flashes and anxiety, among other perimenopausal symptoms. But the German research shows that this herb also reduces feelings of depression in perimenopausal women. When using black cohosh for depression, the dosage is two 40 mg tablets per day.
The Basics of Mood Swings During Perimenopause – Anxiety
Posted by: | CommentsI have had Nina as a patient for ten years; I first saw her when she was in her mid-thirties, when she came to me for help with premenstrual syndrome. At that time we devised a program for her then that included, along with balancing her diet and increasing her exercise, the occasional use of natural progesterone. I hadn’t seen her in more than a year when she came in again recently. She looked very troubled as she said, “I don’t know what’s going on. My PMS has gotten really bad, even worse than it was ten years ago. I’m so anxious, I literally feel like I’m jumping out of my skin. Nothing is working anymore.”
Nina is 44 now, and the grade-school children she had when she first came to my office are in college. She and I talked about how fluctuating hormone levels in the forties can manifest themselves as worsening PMS, particularly if a woman still has a regular cycle.
When Nina said “nothing is working,” she meant that she was avoiding sweets, alcohol, salt, and caffeine as much as possible and still maintaining a regular exercise routine. (She and her husband spend many weekends mountain biking, and she rides during the week.) Yet in spite of her efforts, she said, “I get this terrible feeling in the pit of my stomach. Sometimes I almost feel like I’m going to get sick. I’ve tried deep breathing, but I can’t seem to calm down.”
Nina shook her head when I asked if there were any unusual stresses or pressures in her life. “Not really. Nothing that hasn’t been there before. Money is really tight with two kids in college, but we’re managing.”
Since Nina’s primary goal was to get a handle on her anxiety, I suggested that she might want to try black cohosh to bring her moods more into balance. Black cohosh is used for a variety of symptoms during perimenopause, including hot flashes and insomnia, but it has also been shown to be useful in relieving anxiety. Nina had the option of taking black cohosh in several forms, either as a tea, as a fluid or powdered extract, or as a standardized product, Remifemin, which my patient Janice is also taking. Black cohosh is believed to suppress luteinizing hormone levels in the body, which may spike irregularly as estrogen levels fall.
I am comfortable recommending Remifemin to my patients who are interested in using black cohosh for several reasons. First, it is a standardized formula that has been studied for four decades in Germany.
Second, it has been shown to help alleviate a variety of menopausal symptoms, and some women prefer to take one preparation for broad symptom relief rather than individual herbs or vitamins targeted at specific symptoms. Also, with Remifemin it is easier for patients to monitor exactly how much black cohosh they are taking. I suggested that Nina begin with a dose of 40 mg per day and keep a chart of her symptoms to evaluate its effect on her symptoms for one month.
It usually takes about two weeks to begin to experience relief from perimenopausal symptoms with Remifemin. Dosage amounts range from 40 to 80 mg per day. I generally suggest that women begin at the low end of the dosage range and increase the amount if their symptoms are not relieved within two weeks. I do not recommend taking above 80 mg per day. When I saw Nina one month later she said 40 mg daily seemed to be adequate for her. She was experiencing less anxiety.
Use also found that black cohosh was very helpful in controlling palpitations that made her feel as if she were having a panic attack or, worse, a heart attack. A successful real estate saleswoman, Use almost left her job because she was having increasing episodes where her heart would race without warning. “I had appointment after appointment with this specialist and that specialist,” she told me. “I didn’t have heart disease, they told me. Someone finally called it anxiety disorder or something like that. I still have a prescription for an anti-anxiety medication, but I put it in my drawer and never filled it. It’s not that I didn’t want to take it, but I had this gut feeling that something else was going on besides anxiety.”
She found out about black cohosh from a friend of hers and tried it on her own. After using 160 mg daily (two 40 mg tablets morning and evening) for six months, she said that “black cohosh took care of the palpitations almost a hundred percent. I felt much better after using it for only two weeks.”