OCDPMDDHELL

March 14, 2012 11:00 AM

How does obsessive-compulsive disorder interact with premenstrual dysphoric disorder?

I've had OCD since I was a small child, and it has gotten a lot worse in the past year or so. Coincidentally or not, I've also developed PMDD in that same time frame. I went from having almost no PMS symptoms, to going through crazed phases of panic, hypochondria, and near-suicide ideation, that usually magically dissolves after my period starts.

My OCD can be pretty hair-raising anyway, and it seems to be exacerbated by my menstrual cycle. I tend to have freak-outs when I ovulate, and in the week before my period -- and my cycle is a bit shorter than average, about 24 days. Sometimes I'll get a break, and I won't suddenly collapse in fear of obscure transmissions of rare diseases, just because of the time of the month. But I can and do get hysterical over my fears during those parts of my cycle.

My therapist also has PMDD, and she describes her emotional state before her period as "paranoid". I concur, in the non-psychotic sense of the word. This week I FREAKED because I became certain there were bats in our house somewhere, despite that 1) We've never seen a bat or any evidence of bats, 2) We have cats, who I can't imagine ignoring a bat in the house, and 3) My husband and roommate are completely unconcerned because of 1 and 2, and perceive my obsession to have come out of nowhere (probably correctly).

I've done a bit of googling, and I've read some anecdotal accounts from women who say, "Yeah, my OCD gets worse before my period" and "I have OCD and PMDD and it's so awful". God, I feel that way too, but it doesn't really hit at what I want to know: Do medical professionals consider PMDD to exacerbate OCD? And if so, what I am supposed to do to combat this insanity? My psychiatrist is tinkering with my medicine dosage (Lexapro), and I am in therapy. Is there anything else?

Thanks!

posted by Coatlicue to Health & Fitness (14 answers total)

So you are treating the OCD with the Lexapro; are you talking with your GYN about treating the PMDD itself with any medication designed to reduce the hormonal fluctuation in your cycles (or even getting off the ovulation track entirely for a while)?
posted by Sidhedevil at 11:13 AM on March 14, 2012

There's evidence (but not great evidence) that taking vitamin B6 can help with PMS/PMDD symptoms. The dosage is 50mg or so taken throughout the menstrual cycle. Since B6 is pretty harmless (it's water-soluble so your body will flush out what it doesn't need), it might be worth trying.
posted by needs more cowbell at 11:34 AM on March 14, 2012 [1 favorite]

It's generally accepted (per my psych and gyn) that OCD/mental health issues are exacerbated by hormonal changes.

During one of my worst bouts with these two issues, my gyn discovered I also had a calcium deficiency which has been proven (lots of links in google) to make PMS symptoms worse, including the psychiatric aspects. Taking a calcium supplement did help me, but getting my OCD symptoms under control helped me more.
posted by Katine at 11:57 AM on March 14, 2012

Wanted to mention also, that most hormonal birth control is counter-indicated for people with OCD. In case you are on something, or thinking of taking hormonal BC, make sure your gyn knows your OCD history.
posted by Katine at 11:59 AM on March 14, 2012

Best answer: Yes, pmdd can exacerbate ocd, one reason being that in the last days before your period estrogen drops precipitously, and that drop is thought to affect your serotonin, which plays a role in OCD.

You might like this book, about psychiatry and hormones, written by a couple of female psychiatric professionals (one at Harvard): Women's Moods.
posted by feets at 12:12 PM on March 14, 2012

Oh yeah and what to do for PMDD:
--for sure tell your psychiatrist about it and discuss interventions with him/her
--exercise, lay off alcohol/coffee, take calcium, multivitamin, magnesium and a b supplement, do stress reduction stuff (relaxation/meditation)
--w/assistance of your doctor, consider supplements (vitex) or meds (spironolactone).

And for the OCD, I assume you've seen Brain Lock, but if not it is really worth checking out.
posted by feets at 12:31 PM on March 14, 2012 [1 favorite]

Response by poster: Thanks for everyone's help so far. I see my psychiatrist tomorrow, and I will run this all by her.

Here is some added information:

--I used to take birth control pills, and they didn't play well with my mental state. I'm not 100% opposed to taking them again, but I am wary. I had never heard that having OCD could be a contraindication for BC pills, though I am not surprised.

--I have a multivitamin with a decent amount of B vitamins, and I'm pretty sure I get enough calcium. Is that sufficient?

--I once had and lost a copy of Brain Lock. A friend of mine is going to mail hers to me, it's in my future.

--I never drink alcohol, but I could stand to cut out some caffeine.

Thanks again for everyone's advice. This is helpful to my poor addled self.
posted by Coatlicue at 1:29 PM on March 14, 2012

I don't have OCD but do have chronic depression & PMDD. I'm on a low dose pill because I can't handle much at all, and I take it continuously - meaning no sugar pills. As a result, no period. I still get a bad PMDD every now and then, but not as frequently. It may not work for you & OCD but maybe it is worth exploring w/r/t the hormones.
posted by evening at 1:42 PM on March 14, 2012

Best answer: For those with PMDD, it is not uncommon for a doctor to try upping your regular daily dosage of Lexapro for a week or two before you get your period. Since SSRIs are supposed to be cumulative, logically it doesn't seem to make sense that a higher dose for a week or two helps, but it seems to:

SSRIs appear to work much faster for relieving PMS-related depression than when used in major depression. These drugs are typically prescribed with either continuous (daily) dosing throughout the month or an intermittent dosing regimen. With intermittent dosing, women take the antidepressant during the 14-day premenstrual period of their luteal phase.

I would suggest asking your doctor whether or not upping your dose before your period might work or whether a completely different SSRI during that time might be an option.
posted by eunoia at 1:47 PM on March 14, 2012

Best answer: I have some hormone books at home and I'll look up the B and calcium recommendations for PMS when I get home (unless someone else beats me to it). In the meantime, here's the guts of "Brain Lock," courtesy this website:

QUICK SUMMARY OF THE FOUR STEPS
OF COGNITIVE BIOBEHAVIORAL SELF-TREATMENT FOR OCD

Step 1: RELABEL
Recognize that the intrusive obsessive thoughts and urges are the RESULT OF OCD. [i.e., "These ideas about bats are an obsession rather than a reality.]

Step 2: REATTRIBUTE
Realize that the intensity and intrusiveness of the thought or urge is CAUSED BY OCD; it is probably related to a biochemical imbalance in the brain. ["The bat-idea is caused by OCD and doesn't have much to do with 'me,' either.]

Step 3: REFOCUS
Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes: DO ANOTHER BEHAVIOR. ["So I'm going to go take a walk/get back to work/pet the cats/whatever."]

Step 4: REVALUE
Do not take the OCD thought at face value. It Is not significant in itself. ["And I'm not going to spend a lot of time trying to figure out WHY my brain is conjuring up bat obsessions.]

I read Brain Lock several years ago and as I remember it, they tried this technique on a bunch of people with OCD and had very good results (almost as good as meds, I think).

With respect to evening's comment, I have read that estrogen therapy is good for PMDD with the one major caveat being that if/when you stop (i.e. for a sugar pill week, or whenever) you have a precipitous hormone change again. Worth discussing with your doc.

Hope you feel better soon, Coatlicue!
posted by feets at 3:56 PM on March 14, 2012 [2 favorites]

Sorry for the slow return. According to Geoffrey Redmond, MD, in the book "it's your hormones," the best calcium for PMS is citrate with vitamin d, 1000-1500 mg dose. He says B-6 may be good too, though you should not get more than 100 mg/day. And be sure to take your multi! Hope some of this brings you relief. :)
posted by feets at 10:58 AM on March 16, 2012

(Also, Dr. Redmond says high doses of B6 can cause nerve damage, in semicontradiction to the comment upthread about it, so please discuss it with your MD before going over 100 mg/day total.)
posted by feets at 11:02 AM on March 16, 2012

Response by poster: In case anyone checks up on this:

When I saw my psychiatrist, she gave me three options if my Lexapro hasn't improved things in another month:

1) Add Zoloft to my pill regimen during my PMDD times
2) Add Abilify for everyday
3) Maybe adding Xanax or Klonopin

I am pretty wary of Abilify and tranquillizers. So maybe I'll go the Zoloft route. She had a student with her, who asked me how I felt about "homeopathic medicine". That kind of put me off.

Besides that, they both told me the same stuff you guys did -- take your vitamins (specifically mentioning B6), cut down on caffeine, don't drink, go outside once in a while.

My therapist says PMDD may be in the next DSM, which she thinks will help women get treatment for it more easily. I sure hope so.

Thanks for everything, everyone.
posted by Coatlicue at 4:44 PM on March 17, 2012

Response by poster: Further updates if anyone reads this in the future. There's not a lot of PMDD information around these parts, so perhaps this will contribute something.

1) My Lexapro dosage was doubled from 10mg to 20mg. This has eliminated the majority of my psychiatric symptoms for both PMDD and OCD. It took a few weeks, and initially I freaked out badly. My doctor told me that some people go bananas for a while when their dosage is raised, and apparently that's true for me. But it evened out, and I'm doing much better.

2) Brain Lock is, indeed, a bit down on medicine, but it's been EXTREMELY helpful as far as the OCD component goes.

3) I have cut back on caffeine, which has been a mixed bag. I'm less nervous and jumpy, but it's also harder to combat the Lexapro drowsiness. Also taking my vitamins, and that can't hurt.

Overall, I feel much more like a normal person and it's GREAT.
posted by Coatlicue at 6:48 AM on April 23, 2012 [2 favorites]