![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by AnneL on October 5, 2001, at 23:37:22
I have been diagnosed with Major Depression and have been on Effexor XR with pretty good results. I also have been diagnosed with adenomyosis and in the hopes of avoiding a hysterectomy at age 41, my GYN suggested I try the now available "Mirena" IUD which releases approximately 20 mcg. of the hormone Levonorgestrel daily.
My mood has markedly been more depressed since the IUD was placed, but I am reluctant to give it up because it has stopped the excessive bleeding. Is there anything I can do to counteract the effects of the progestin Levonorgestrel which I understand is a fairly androgenic synthetic hormone? The blood levels are supposedly very, very small in comparison with those found in combination Pills. I am on Effexor XR
225 mg. which was helping considerably. I am now back in the dumps so to speak. I would appreciate anyone's thoughts on the subject. I really don't want to have surgery at my age. Thanks Anne
Posted by SLS on October 6, 2001, at 18:44:49
In reply to Levonorgestrel IUD (LNG-20) and depression, posted by AnneL on October 5, 2001, at 23:37:22
> I have been diagnosed with Major Depression and have been on Effexor XR with pretty good results. I also have been diagnosed with adenomyosis and in the hopes of avoiding a hysterectomy at age 41, my GYN suggested I try the now available "Mirena" IUD which releases approximately 20 mcg. of the hormone Levonorgestrel daily.
>
> My mood has markedly been more depressed since the IUD was placed, but I am reluctant to give it up because it has stopped the excessive bleeding. Is there anything I can do to counteract the effects of the progestin Levonorgestrel which I understand is a fairly androgenic synthetic hormone? The blood levels are supposedly very, very small in comparison with those found in combination Pills. I am on Effexor XR
> 225 mg. which was helping considerably. I am now back in the dumps so to speak. I would appreciate anyone's thoughts on the subject. I really don't want to have surgery at my age. Thanks Anne
Hi Anne.Synthetic progesterones - progestogens - are known to cause depression. I think the first thing that makes sense is to increase the Effexor to 300mg. This is generally accepted to be the minimum dosage that assures that one is getting full benefit
- Scott
Posted by SalArmy4me on October 6, 2001, at 18:57:26
In reply to Re: Levonorgestrel IUD (LNG-20) and depression, posted by SLS on October 6, 2001, at 18:44:49
Stewart, Felicia H. MD. Depression and Hormonal Contraception. JAMA. 286(6):671-672, August 8, 2001:
"Depression and postpartum depression are common irrespective of contraceptive status, however, and a review of 400 peer-reviewed, published clinical studies involving 55 000 users of implantable levonorgestrel (Norplant, Wyeth-Ayerst) concluded that reports of mood disturbances, anxiety, and depression were similar to those reported by women using hormonal methods containing estrogen..."
Posted by AnneL on October 6, 2001, at 23:57:25
In reply to Re: Levonorgestrel IUD (LNG-20) and depression, posted by SLS on October 6, 2001, at 18:44:49
Hi Scott,
It's been a while since I've posted so I guess I forgot how to post. But, anyway, I want to thank you for your response. You've given me some hope.
I will speak with my Pdoc on Monday about increasing my dose. It makes a lot of sense and hopefully will help me stabilize my moods. If I can get my depression under control this IUD will spare me from a surgery I really don't want. At least not at this time. Would it be logical to assume that if I tolerated a jump from 150 to 225 without any problems (2 months ago - again due to hormonal problems, this time with the Pill) that I
might do OK going from 225 to 300 mg? What are your thoughts on this? Thanks again, Anne
Posted by AnneL on October 7, 2001, at 0:07:10
In reply to Re: Levonorgestrel IUD (LNG-20) and depression » SLS, posted by SalArmy4me on October 6, 2001, at 18:57:26
Hi Jason,
Thanks for the research info. All I can tell you is that for me hormonal therapy has been hell! Be it in combination, progestin and estrogen or a progestin alone, the results are almost the same,
a progressive worsening of depression. The problem is that my Pdoc seems to downplay the role of synthetic hormones and wants to send me to a colleague of his who is a pychopharmacologist because my Pdoc questions whether Effexor is appropriate for me or not. I guess at 225 mg. it would be difficult to answer that question. From everything I've read, I'am not even close to maxing out yet. What do you think about combination therapy and what might I expect from seeing a "psychopharmacologist". And exactly what is this specialty? Thanks, Anne
Posted by SLS on October 7, 2001, at 9:13:14
In reply to Re: Levonorgestrel IUD (LNG-20) and depression » SLS, posted by AnneL on October 6, 2001, at 23:57:25
> Hi Scott,
>
> It's been a while since I've posted so I guess I forgot how to post. But, anyway, I want to thank you for your response. You've given me some hope.
> I will speak with my Pdoc on Monday about increasing my dose. It makes a lot of sense and hopefully will help me stabilize my moods. If I can get my depression under control this IUD will spare me from a surgery I really don't want. At least not at this time. Would it be logical to assume that if I tolerated a jump from 150 to 225 without any problems (2 months ago - again due to hormonal problems, this time with the Pill) that I
> might do OK going from 225 to 300 mg? What are your thoughts on this? Thanks again, Anne
Hi Anne.Regarding a dosage increase, all we can say for sure is that we won't know for sure until we know for sure. :-) My guess is that you will tolerate it just fine, especially in light of your previous reaction to it. Some people actually need 600mg. I tolerated 450mg just fine. However, my doctor decided that it provided no more benefit than 300mg. I do lose this benefit when I reduce the dosage to 225mg.
Regarding progestins, I have encountered plenty of stuff in the literature to lead me to believe that they can indeed be depressogenic for some people. In fact, they might even have some potential as anti-manic agents. I have even read some suggestions that progesterone exert mood-stabilizing effects. Estrogen increases the excitability of neurons in certain areas of the brain (I don't remember which), and acts as a mild MAO inhibitor. By contrast, progesterone does exactly the opposite in both regards.
It is my impression that *natural* progesterone is less likely to induce depression than the synthetic progestins. Is there such a thing as equine progesterone? Would using a small amount of systemic estrogen reduce the effectiveness of the IUD? It might offset it with respect to mood.
Anyway, it probably makes sense to first try adjusting the dosage of Effexor.
I'll be crossing my eyes for you.
- Scott
Posted by Chloe on October 7, 2001, at 19:53:38
In reply to Re: Levonorgestrel IUD (LNG-20) and depression » AnneL, posted by SLS on October 7, 2001, at 9:13:14
>
> Regarding progestins, I have encountered plenty of stuff in the literature to lead me to believe that they can indeed be depressogenic for some people. In fact, they might even have some potential as anti-manic agents. I have even read some suggestions that progesterone exert mood-stabilizing effects. Estrogen increases the excitability of neurons in certain areas of the brain (I don't remember which), and acts as a mild MAO inhibitor. By contrast, progesterone does exactly the opposite in both regards.
>
> It is my impression that *natural* progesterone is less likely to induce depression than the synthetic progestins. Is there such a thing as equine progesterone? Would using a small amount of systemic estrogen reduce the effectiveness of the IUD? It might offset it with respect to mood.
Scott,
This is very interesting to me at the moment. I am going to the gyn this week to discuss changing my BC pill. I have never been able to tolerate estrogen in the combo pills, so years ago I was put on micronor, as low dose progestin pill that I take every day, even while I have my period. However, on this type of pills, cycles are known to be irregular, and lately, I have been getting 2 periods a month, with pms, cramps etc.So I want to try a combo pill because they make the cycles regular and predictable. Which I need now. But the estrogen always seems to make me a little paranoid and irritable. I am not sure if when i tried these combo pills years ago, if I was on a mood stabilizer like I am now...So, I want to give them a retry. Though I wish I knew what was the best combo for depression. Do you have any insight on this? You seem to know a great deal in this area, for someone who does not take these substances.
One last thing, the hardest part of the combo pills for me is the 3 weeks of hormones, and then one week off, to start the period. This is when I get SO depressed. I become inconsolable. So I am hoping my gyn will be progressive enough to let me take three month in a row with no break, and only have a period 3 or 4 times a year. May just be wishful thinking on my part.
Any insight appreciated. Does it matter if it's synthetic vs. natural hormone? I have tried life without hormones, and the pms is unbearable, unfortunately. I hate all these pills...
I'll stop now! Thanks
Chloe
Posted by Chloe on October 13, 2001, at 10:20:02
In reply to Re: Levonorgestrel IUD (LNG-20) and depression » SLS, posted by Chloe on October 7, 2001, at 19:53:38
> So I want to try a combo pill because they make the cycles regular and predictable. Which I need now. But the estrogen always seems to make me a little paranoid and irritable. I am not sure if when i tried these combo pills years ago, if I was on a mood stabilizer like I am now...So, I want to give them a retry. Though I wish I knew what was the best combo for depression. Do you have any insight on this?Well, I got a combo pill of 1 mg norethindrone and a very small amount 20 ug ethinyl estriadiol. I was reallly optimistic BEFORE I started it, that this could smooth out my cycles and mood. Well, the day after I took it, I was panicking about everything and unable to make the simplest of decisions. The second day, I became paranoid. I thought everyone was criticizing me or angry at me. The hardest part of it all, was that I truly could not tell what was real and what was not. My friend said "no, I am not mad at you," and I thought he was lying to me! I was so confused and scared.
What a nightmare that was. Can estogen really cause this irritable paranoid reaction? Or was I just on a bad combo of the pill? It did have a relatively high amount of progestin...
Does anyone have any insight on this problem? I really want to be able to take some estrogen for a regular, less crampy, less pms cycle.Any thoughts, insights suggetions would be greatly appreciated. If I could only take an antipsychotic, I think I could manage. But I can't, I get TD :(
AnneL, if you are still following this thread, I do hope increasing your Effexor has helped your situation. Hormones are such a tricky thing. Just know you are not alone!
Chloe
Posted by AnneL on October 14, 2001, at 0:14:23
In reply to Re: Loestrin 1/20 and paranoia, posted by Chloe on October 13, 2001, at 10:20:02
>
> > Dear Chloe,It may be possible to find a combination oral contraceptive that you may be able to tolerate, but it will take trial and error and acceptance that perhaps you just cannot tolerate hormonal contraceptives. Sometimes, it is the progestin (synthetic progesterone) that is the culprit (your last pill contained norinthedrone) and some woman react poorly to the synthetic estrogen.
I myself have tried every pill on the market containing 35 or less mcgs. of estrogen (due to my age - 41) The only pill that did not make me
extremely anxious was a brand-new Pill called Yasmin, which contains a brand-new progestin called drospirinone (related to a diuretic often used in heart failure patients called spironolactone or brand-name Aldactone). This is the first new progestin on the market in approximately 9 years. I really liked it until week 3 when I started crying and crying. The great thing about this Pill if it works for you(it contains 30 mcgs. of estrogen) is that it actually induces weight loss through its diuretic action.So you might want to give it another go. For me, my Levonorgestrel containing IUD is my only option prior to undergoing a hysterectomy. I will be speaking with my Pdoc about upping my Effexor to see if I can counteract some of the depressogenic effects of the progestin. Good Luck to you and keep me posted. Take Care, Anne
Posted by Kaysey on October 14, 2001, at 13:45:30
In reply to Re: Loestrin 1/20 and paranoia » Chloe, posted by AnneL on October 14, 2001, at 0:14:23
> >
> > > Dear Chloe,
>
> It may be possible to find a combination oral contraceptive that you may be able to tolerate, but it will take trial and error and acceptance that perhaps you just cannot tolerate hormonal contraceptives. Sometimes, it is the progestin (synthetic progesterone) that is the culprit (your last pill contained norinthedrone) and some woman react poorly to the synthetic estrogen.
>
> I myself have tried every pill on the market containing 35 or less mcgs. of estrogen (due to my age - 41) The only pill that did not make me
> extremely anxious was a brand-new Pill called Yasmin, which contains a brand-new progestin called drospirinone (related to a diuretic often used in heart failure patients called spironolactone or brand-name Aldactone). This is the first new progestin on the market in approximately 9 years. I really liked it until week 3 when I started crying and crying. The great thing about this Pill if it works for you(it contains 30 mcgs. of estrogen) is that it actually induces weight loss through its diuretic action.
>
> So you might want to give it another go. For me, my Levonorgestrel containing IUD is my only option prior to undergoing a hysterectomy. I will be speaking with my Pdoc about upping my Effexor to see if I can counteract some of the depressogenic effects of the progestin. Good Luck to you and keep me posted. Take Care, AnneAnne:
I am 43 and I thought I had heard of (and taken) every combination of every different compound of ocp, available. In fact I research the 'net frequently to see if there is something new. I haven't heard of Yasmin. Is it readily available all over the US? I have always been in search of something that would not interfere with my quality of life.
Like Chloe, the Loestrin 1/20 did a number on me. I have admitted this to only one person, but while on that, I was truly suicidal. If I have too much progesterone compound, I get depressed, and if I have too much estrogen compound I get extremely anxious (which are expected to some degree with each). The Loestrin 1.5/30, gave me constant yeast infections. Yes, I have tried the different compounds for each artificial hormone too. Certain ones created acne, others interfered with my blood sugar so much, I wanted to pass out. The irony of all this is, I don't take them for birth control. I take them for hormone regulation! This is actually better than when I don't take them at all! I have even tried "creating" my own by altering the size of the pill. I know that sounds crazy, but this has been a real problem--and it makes regulation of my ADs difficult too. Just when I find an AD compound that works OK, the combo pill adds something weird!
Sorry for the long story, but I can really relate to this, and would like more info on Yasmin...is there a website? I have taken norethindrone, levongesterol, norgestimate (now with OrthoCyclen, and previously with Ortho-TriCyclen). I don't really like the Ortho-cyclen, but I am 'just living with it.' The Tri-Cyclen produced a different 'me' every week that the concentration changed..Estrostep did the same thing. So varying the estrogen doesn't help and neither does varying the progesterone. Is Yamine monophasic?
Sorry for the long post. Obviously this really caught my interest.
I appreciate any info you can give. Thanks so much and take care.
Kaysey
Posted by Kaysey on October 14, 2001, at 16:44:41
In reply to Re: Loestrin 1/20 and paranoia » AnneL, posted by Kaysey on October 14, 2001, at 13:45:30
> > >
> > > > Dear Chloe,
> >
> > It may be possible to find a combination oral contraceptive that you may be able to tolerate, but it will take trial and error and acceptance that perhaps you just cannot tolerate hormonal contraceptives. Sometimes, it is the progestin (synthetic progesterone) that is the culprit (your last pill contained norinthedrone) and some woman react poorly to the synthetic estrogen.
> >
> > I myself have tried every pill on the market containing 35 or less mcgs. of estrogen (due to my age - 41) The only pill that did not make me
> > extremely anxious was a brand-new Pill called Yasmin, which contains a brand-new progestin called drospirinone (related to a diuretic often used in heart failure patients called spironolactone or brand-name Aldactone). This is the first new progestin on the market in approximately 9 years. I really liked it until week 3 when I started crying and crying. The great thing about this Pill if it works for you(it contains 30 mcgs. of estrogen) is that it actually induces weight loss through its diuretic action.
> >
> > So you might want to give it another go. For me, my Levonorgestrel containing IUD is my only option prior to undergoing a hysterectomy. I will be speaking with my Pdoc about upping my Effexor to see if I can counteract some of the depressogenic effects of the progestin. Good Luck to you and keep me posted. Take Care, Anne
>
> Anne:
> I am 43 and I thought I had heard of (and taken) every combination of every different compound of ocp, available. In fact I research the 'net frequently to see if there is something new. I haven't heard of Yasmin. Is it readily available all over the US? I have always been in search of something that would not interfere with my quality of life.
> Like Chloe, the Loestrin 1/20 did a number on me. I have admitted this to only one person, but while on that, I was truly suicidal. If I have too much progesterone compound, I get depressed, and if I have too much estrogen compound I get extremely anxious (which are expected to some degree with each). The Loestrin 1.5/30, gave me constant yeast infections. Yes, I have tried the different compounds for each artificial hormone too. Certain ones created acne, others interfered with my blood sugar so much, I wanted to pass out. The irony of all this is, I don't take them for birth control. I take them for hormone regulation! This is actually better than when I don't take them at all! I have even tried "creating" my own by altering the size of the pill. I know that sounds crazy, but this has been a real problem--and it makes regulation of my ADs difficult too. Just when I find an AD compound that works OK, the combo pill adds something weird!
> Sorry for the long story, but I can really relate to this, and would like more info on Yasmin...is there a website? I have taken norethindrone, levongesterol, norgestimate (now with OrthoCyclen, and previously with Ortho-TriCyclen). I don't really like the Ortho-cyclen, but I am 'just living with it.' The Tri-Cyclen produced a different 'me' every week that the concentration changed..Estrostep did the same thing. So varying the estrogen doesn't help and neither does varying the progesterone. Is Yamine monophasic?
> Sorry for the long post. Obviously this really caught my interest.
> I appreciate any info you can give. Thanks so much and take care.
> KayseyI looked up meds approved in 2001 and found Yasmin and its description...I am now going to Berlex to see if there is more information. If you have additional comments/suggestions, please feel free to pass them on.
Thanks again.
Kaysey
Posted by AnneL on October 14, 2001, at 18:07:42
In reply to Anne, I found a website, posted by Kaysey on October 14, 2001, at 16:44:41
Hi Kaysey,
I was just going to recommend that you go to Berlex's website and you found it, great! It was available for prescription on June 15, I believe.
It is 3 mg. drospirenone and 30 mcg. of ethinyl estradiol. In addition to the normal precautions for those who should not use the Pill are those women who take medications such as ACE inhibitors
(blood pressure/heart medications) or any medication that is potassium sparing. This may lead to potentially dangerous elevated serum potassium levels. Drosperinone as I said before is an analog of Aldactone which is a brand name of a potassium-sparing diuretic (water pill). If you are not on any of these types of medications there is no danger. It is monophasic, for other readers, meaning that the levels of the progestin and estrogen remain the same during the 3 weeks of "active" or hormone containing pills. This helps some women to remain more "even". Besides a crying jag and a worsening of my depression (those in themselves were bad enough) I did get daily headaches and unfortunately, this analog of Aldactone can cause headaches.You said you are 43 and need it for hormonal reasons and not for contraceptive purposes. Can you use hormone replacement therapy instead? May I ask why you need it for hormonal reasons? Anne
Posted by AnneL on October 14, 2001, at 18:14:20
In reply to Re: Loestrin 1/20 and paranoia » AnneL, posted by Kaysey on October 14, 2001, at 13:45:30
Hello Kaysey,
When you say you are "living with" Ortho-Cyclen, what symptoms do you have while on it? Although monophasic, over a 3 week period of active pills you are certainly getting more of the progestin, norgestimate. Ortho-Cyclen, Ortho-Tryclyclen made me very, very anxious, to the point of having nocturnal panic attacks. And I can certainly relate to how one certain Pill made you feel suicidal. I truly began to have great respect for the power of one very tiny pill (Pill) when I went from functioning to wanting to be institutionalized for my safety. Anne :)
Posted by Chloe on October 14, 2001, at 18:40:36
In reply to Re: Loestrin 1/20 and paranoia » Kaysey, posted by AnneL on October 14, 2001, at 18:14:20
Anne,
I was very interested in what you said about Yasmin. I wish I could take such a med, but 30 ugs of E.Estrogen I think would send me to the hospital. I am still reeling from my two day trial of Loestrin. The panic feelings have passed (I thought that was just me, panic can come from the pill?) but I have this awful resurgence of depression and very short fuse. I have snapped and lashed out several times in the last few days, something that was being controlled nicely by my Lithium. Now I am scared that I will not get my equilibrium back. How long does the estrogen stay in one's body after discontinuing the pill? I know some of it was still around, because I continued to be plagued by the headache I developed on Loestrin.I have decided to go back to the Micronor which is norethindrone .35mgs and no estrogen. I have been on this for years to decrease my heavy period, cramping and pms. However, I have developed heavy bleeding (common on Micronor, I hear) and my gyn thinks I need a regular pill. I DO NOT at the moment feel adventerous in trying other preparations, because I had the same reaction to combo pills about 7 years ago. I just hoped I had "changed"! Clearly not so.
Do you know anything about "natural" methods of controlling pms and heavy painful bleeding? I know some women use progesterone creams. And I see them advertised on the net a lot as the catch all "cure" for women. But are there side effects and are they effective? Does anyone know?
Sorry this is so long. Just wish I could find a good way to control my cycles without making my emotional problems worse. Trying a combo pill was extremely DEstabilizing, and I so hope that I will get back to myself soon. Now, I feel awful.
I hope you are hanging in there ok. I too hope you can feel better and avoid surgery :)
Chloe
Posted by Kaysey on October 14, 2001, at 23:38:52
In reply to Re: Loestrin 1/20 and paranoia » Kaysey, posted by AnneL on October 14, 2001, at 18:14:20
> Hello Kaysey,
>
> When you say you are "living with" Ortho-Cyclen, what symptoms do you have while on it? Although monophasic, over a 3 week period of active pills you are certainly getting more of the progestin, norgestimate. Ortho-Cyclen, Ortho-Tryclyclen made me very, very anxious, to the point of having nocturnal panic attacks. And I can certainly relate to how one certain Pill made you feel suicidal. I truly began to have great respect for the power of one very tiny pill (Pill) when I went from functioning to wanting to be institutionalized for my safety. Anne :)
Thanks for the additional information and relaying your personal experiences. Regarding my 'hormone situation,' as you can imagine this is a long story that I will make as brief as possible by giving you 'bullets' of info in a short timeline:
*History of extremely irregular periods from teenage years to adulthood
*Began bcps approximately a year before my husband and I got married (had tried them before but the Demulen made me sick and I didn't try them again until this time period)--Tri-Norinyl worked well for me
*Husband had vasectomy--I went off the pill--periods extremely irregular again (experienced amenorhhea for quite some time)
*With such a long time between periods, I was experiencing prolonged periods of PMS--distressing,especially to husband ;-)
*At this time I began having anxiety attacks and depression (thought it was just hormone irregularity and blood sugar problems--had not been examined for or diagnosed with anxiety/depression then
*Requested assistance from ob/gyn--he gave me ogen and another med that I can't remember now to try--didn't help either situation
*Ob/gyn put me back on pill--didn't help anxiety or depression--tried numerous types
*FINALLY went to pdoc who diagnosed me with anxiety/depression--put on meds and did pretty well for a while with the ADs and bcps
*Noticed higher estrogen pills exacerbated anxiety,--given Loestrin 1.5/30 first then 1/20--yeast infections/severe depression--severe acne
*After many trials of different types, ended up with Ortho-tricyclen mostly to relieve acne and depression (but this produced tremendous anxiety) and now Ortho-cyclen
This bcp starts out just fine--about half-way through the 21-day cycle of pills my face starts breaking out and I start craving sweets (just like I would mid-cycle without bcps). The fluid retention is terrible and until six months ago, when I finally went for an AD re-evaluation (long overdue), the PMS was just horrible--totally depressed,agitated, angry, etc.--was put on Effexor, which definitely helped this--but initially had problems with the bcps and the Effexor (and the hormone influence that Effexor can bring about--heavy periods, sugar-craving, even lactation during one cycle--thank God for this site--someone else had experienced this before, so I knew what was happening).
Also OrthoCyclen makes me lethargic, that too has been exacerbated by the Effexor (Wellbutrin was added three weeks ago--the 'jury is still out' on whether that is going to help things).
I know I really should be getting more frequent evaluations, but, on top of everything else, I am 350 miles from home (and husband), trying to finish a doctorate in chronic disease epidemiology--cardiovascular disease--I should have chosen psychiatric epidemiology as much time as I spend researching it! Point being I am trying to stay as mentally healthy as possible while also trying to get this out of the way! Therefore fatigue, excessive anxiety, etc. has made things difficult and don't contribute to doing this quickly enough--but I am trying to hang in there.
I know this is more than you bargained for, so I will cease this monologue. Thanks for inquiring and thanks for 'listening.' Have you been able to find something(s) that have been successful?
Thanks again.
Kaysey
Posted by AnneL on October 14, 2001, at 23:48:11
In reply to Re: Loestrin 1/20 and paranoia » AnneL, posted by Chloe on October 14, 2001, at 18:40:36
Dear Chloe,
Yes, feelings ranging from anxiety, nervousness, depression, etc. can be caused not only by the synthetic hormones commonly found in combination pills or "mini-pills" (Micronor, etc.) but natural changes in our menstrual cycle caused by either rising or falling estrogen or progesterone depending on the time of our cycle. The Pill actually shuts down ovulation through processes involving the pituitary gland, the ovaries and changes in the lining of the uterus (that's why "periods" are so much lighter on the Pill). Both the mini-pill and combination Pill are very well tolerated by many women. But, unfortunately I cannot count myself among them. I am ever hopeful, maybe to a fault, and that is why I continue to try out each Pill in hopes that I can tolerate one.
You might find Yasmin interesting. Ask any GYN and they will tell you that they really don't know which component any given woman will react to, either the progestin or the estrogen. It is usually just "educated guessing" or trial by fire!
As I mentioned before, Yasmin did not cause any nervousness or anxiety at all! I thought I had it made, until the depression kicked in. Who knows? I might have stuck it out a little longer if I wasn't so resentful about "having" to take my other AD meds, etc. I just wasn't prepared to wait out the side effect issue.I think you can safely try it with your GYN's approval of course. Within 48 hours of stopping the Pill, I was just fine. (A lot of that I'am sure was psychological, just knowing that I was not adding yet another medication to my system!)
One thing I can tell you is, that the water weight loss was phenomenal. My daughter who is 17 is currently on Ortho-Triclyclen and is very concerned about the water retention. She is going to try a cycle of Yasmin out and see how she likes it. Let me know how everything goes, Anne :)
Posted by AnneL on October 15, 2001, at 0:00:21
In reply to Re: Loestrin 1/20 and paranoia--more info » AnneL, posted by Kaysey on October 14, 2001, at 23:38:52
Hi Kaysey,
This sounds like a tough one. I too take Effexor XR at 225 mg. daily, but I don't find that it helps me with PMS one bit. The reason why I know that I was depressed on the Pill was the excessive fatigue. I would come home from work and fall asleep for about an 1 1/2. Since it sounds like adding to your family is not an issue, why not try seeing how you feel with adjusting your AD's, etc. and doing a trial off the pill for about 3 months? Maybe you will be able to find your happy medium without hormonal mediation. It really dosen't sound like it's helping you out. It is conclusive, the Pill does not alleviate PMS symptoms for the majority of users and therefore should not be prescribed for such. Suppression of ovulation would be helpful for heavy menses (menorrhagia), but IMHO you might want to try working out your AD combinations and see how you do without the Pill.
If you really want to try out another Pill, ask your GYN about Yasmin. Even though it has a higher level of estrogen (just 10 mcgs more), it really is the combination of the progestin and estrogen that make it either a success or a failure. You might like to give it a try. I understand that Yasmin may apply for a new indication in 2 to 3 years as a therapy modality for PMS due to its novel progestin, drosperinone.
Check out Berlix website for more info. Anne :)
Posted by Kaysey on October 15, 2001, at 0:38:46
In reply to Re: Loestrin 1/20 and paranoia--more info » Kaysey, posted by AnneL on October 15, 2001, at 0:00:21
> Hi Kaysey,
>
> This sounds like a tough one. I too take Effexor XR at 225 mg. daily, but I don't find that it helps me with PMS one bit. The reason why I know that I was depressed on the Pill was the excessive fatigue. I would come home from work and fall asleep for about an 1 1/2. Since it sounds like adding to your family is not an issue, why not try seeing how you feel with adjusting your AD's, etc. and doing a trial off the pill for about 3 months? Maybe you will be able to find your happy medium without hormonal mediation. It really dosen't sound like it's helping you out. It is conclusive, the Pill does not alleviate PMS symptoms for the majority of users and therefore should not be prescribed for such. Suppression of ovulation would be helpful for heavy menses (menorrhagia), but IMHO you might want to try working out your AD combinations and see how you do without the Pill.
> If you really want to try out another Pill, ask your GYN about Yasmin. Even though it has a higher level of estrogen (just 10 mcgs more), it really is the combination of the progestin and estrogen that make it either a success or a failure. You might like to give it a try. I understand that Yasmin may apply for a new indication in 2 to 3 years as a therapy modality for PMS due to its novel progestin, drosperinone.
> Check out Berlix website for more info. Anne :)Hi Anne,
Thanks again for the assistance, and yes, I have actually been considering going completely off the pill to see what happens, since I have never been away from it while on ADs. Probably will try Yasmin first.
I returned to your original post and re-read the information about your progestin-IUD. Were there any other options available besides this or hysterectomy (D and C? daily OGEN--progestin--suppositories?). I understand that even though the dosage is lower than pills, the progestin in the IUD is directly absorbed (doesn't have to go through the GI tract)and therefore is just as potent. Have you discussed the possibility of using natural progesterone either transdermally or vaginally? Though I have no personal experience with this, I understand that this can be quite effective for progesterone supplementation without the typical side effects--depression/water retention etc. I have actually considered this if I go off bcps. It may be that this won't provide enough continuous progesterone to subdue the adenomyosis, but it would be worth checking into. Otherwise, increasing the Effexor may be your best bet. I slowly titrated up to 300mg and am now back down to 225 (trying to balance with the Wellbutrin to see what works best). I didn't have any problems at 300mg, but as I mentioned previously, Effexor is extremely sedating for me, and I was trying to achieve some norepinephrine effect (I didn't and thus the Wellbutrin addition).
Let me know what you try with either the progestin or the Effexor (or both). Good luck and thanks again!
Kaysey
Posted by chloe on October 16, 2001, at 20:54:10
In reply to Re: Loestrin 1/20 and paranoia » Chloe, posted by AnneL on October 14, 2001, at 23:48:11
Anne,
I have been researching Yasmin, and am getting my courage up to as my gyn to try it. I am rather modivated at the moment, because I have had a lingering headache since my two day trial of Loestrin. As I mentioned, due to severe anxeity and "paranoia" I have switched back to micronor.
Since I have this headache, which I imagine is from the norethindrone, I was thinking of ditching bc pills all together. But, my pdoc doesn't want me to go off the (mini) pill though. She thinks it's stabilizing. But it does seem to cause some depression and headaches (a new problem) and at times, heavy continous bleeding.Do you think I can take Yasmin while taking Lithium? I am worried about the diuretic effect. Also do you think I could take Yasmin continously so I don't have that massive hormonal withdrawal every 3 weeks? My gyn prescribed Loestrin to be taken all month long and no withdrawal phase.
You mentioned you got very sad on Yasmin. This worries me! Do you think it was withdrawal, or were you still taking active pills? And lastly, you did NOT feel anxiety on yasmin? I wonder why that is. I felt anxiety almost instantly on the Loestrin. I just assumed it was from the estrogen...
What a puzzle this is. I hope I haven't overwhelmed you with questions. There is so little about mood and yasmin on the web. Yasmin is just so new.I hope you have increased your effexor and are feeling a bit better.
Chloe
Posted by AnneL on October 16, 2001, at 23:46:09
In reply to Re: Loestrin 1/20-Yasmin? » AnneL, posted by chloe on October 16, 2001, at 20:54:10
Hi Chloe,
First things, first. Progestins (synthetic) and progesterone (natural)are well-known to cause depression in some women. You may be familiar with Depo-Provera (the "shot"). This is a synthetic progestogen and literally can cause very severe depression not unlike the depression caused by Accutane (for severe cystic acne). The mini-pill is usually reserved for lactating women for purposes of contraception because it does not interfere with milk production or quality unlike combination pills. I don't know why any physician, Pdoc or otherwise would make a statement that the mini-pill is *stabilizing* (?!!) Progestin-only contraception is well known to cause depression. Combination Pills can cause all sorts of mood changes as well, and is dependent on the individual and the progestin that is used since the most common synthetic estrogen is ethinyl estradiol (I think I spelled that correctly). One big minus about POP's is that they must be taken exactly on time (or no more than a 3 hour margin) or else pregnancy can result. "Perfect use" I believe is 93% effective, actual use I believe is more like 87%.
Not too good considering all the other options available. Let's talk about my experience with combination pills and Yasmin in particular. . .Within 48 hours of taking any combination pill, (and I found Loestrin to be the absolutely worst for causing anxiety) I would feel very "nervous" 24/7. Awful, nothing I did would make it go away and caffeine of course made me miserable. Loestrin gave me nocturnal panic attacks. God-awful! Because the progestin in Yasmin is brand-new (drosperinone) I thought I might give it a chance. I actually lasted one month instead of 5 days. Absolutely no nervousness, no panic, but I did notice fatigue which I wondered was a precursor to a mood depression. Unfortunately, I did get weepy. Now, this may have gone away, maybe a little adjustment to my Effexor would have helped, who knows? But, even a little teary-ness was much more tolerable than terrible anxiety and yes, paranoia!
You really have nothing to lose in trying it out. You know that if you do have side effects that they completely disappear. Just think, you don't have to taper off of it! You can stop it cold turkey (just have to deal with a little withdrawal bleeding).
You can try to take it continuously. There is nothing wrong with taking Pills continuously. If you start having breakthrough bleeding, stop taking the Pill and let yourself have a full bleed and then begin a new pack by day 5. There is nothing mystical about taking Pills, as you probably know the monthly "period" while on bc pills is only due to the withdrawal of hormones on the week off. Women do not have to have periods every month. The benefit of letting yourself "have a bleed" if you start breakthrough bleeding is that you get it over with in 3 to 4 days and then can resume your Pill continuously on day 5. Give it a try and let me know how you like it.
Posted by AnneL on October 16, 2001, at 23:54:51
In reply to Re: Loestrin 1/20-Yasmin? » AnneL, posted by chloe on October 16, 2001, at 20:54:10
To Chloe and co-babblers,
I did not answer your question about Lithium and Yasmin. I have not read anything about any drug-drug interaction between the two. Since the progestin in Yasmin is an analog of Aldactone, a potassium-sparing diuretic, you would want to check with your pharmacist or consult a copy of the Physician's Desk Reference. Actually Yasmin is not even in the 2001 PDR yet since it was not released for sale until I believe June or July of this year. Maybe some of our brilliant co-babblers can research this for us? Take Care, Anne :)
Posted by AnneL on October 17, 2001, at 0:10:19
In reply to Anne, thanks and with regard to your situation... » AnneL, posted by Kaysey on October 15, 2001, at 0:38:46
Hi Kaysey,
From what I understand, adenomyosis is a fairly common condition in women in the 30's and 40's who have had children. Adenomysosis is just a slightly enlarged uterus that has endometrial glands (that produce the lining of the uterus) growing inside of the uterine muscle layers. Many women have painful periods (thank God I don't), but the big tip-off is heavy, heavy periods! (Did I emphasize heavy enough?!!) Diagnosis by a GYN who is very skilled with transvaginal ultrasound is usually very accurate.
But the wierd thing is that most cases of adenomyosis are discovered after the uterus is removed! So symtomatically and by transvaginal ultrasound we are making an assumption that I have adenomyosis. All symptoms disappear with menopause, but I think I have about 14 more years to go!! Oral contraceptives work in a minority of women to help control bleeding, but for the vast majority hysterectomy is a viable option if you don't want to keep having blood transfusions (just kidding - but I am very anemic!) The Mirena
IUD (LNG 20) is an off-label use for adenomysosis and/or women with menorrhagia (excessive bleeding). It worked with my first period! I hardly had one. You can see why I am loath to give this up. I don't have a Pdoc at the moment but I spoke to the hopefully new Pdoc today and we will arrange the appt. for next week. I am doing better on this than any other hormonal agent I have ever used and this has the smallest amount of systemic hormones of any other method including Norplant. The good thing about Mirena, is that the serum levels of levonorgestrel are even. There are no peaks and troughs like the Pill. Wish me luck and thank you for asking about me. :) P.S. Do you think you might try Yasmin? Anne
Posted by Kaysey on October 17, 2001, at 17:15:17
In reply to Re: Anne, thanks and with regard to your situation... » Kaysey, posted by AnneL on October 17, 2001, at 0:10:19
> Hi Kaysey,
>
> From what I understand, adenomyosis is a fairly common condition in women in the 30's and 40's who have had children. Adenomysosis is just a slightly enlarged uterus that has endometrial glands (that produce the lining of the uterus) growing inside of the uterine muscle layers. Many women have painful periods (thank God I don't), but the big tip-off is heavy, heavy periods! (Did I emphasize heavy enough?!!) Diagnosis by a GYN who is very skilled with transvaginal ultrasound is usually very accurate.
> But the wierd thing is that most cases of adenomyosis are discovered after the uterus is removed! So symtomatically and by transvaginal ultrasound we are making an assumption that I have adenomyosis. All symptoms disappear with menopause, but I think I have about 14 more years to go!! Oral contraceptives work in a minority of women to help control bleeding, but for the vast majority hysterectomy is a viable option if you don't want to keep having blood transfusions (just kidding - but I am very anemic!) The Mirena
> IUD (LNG 20) is an off-label use for adenomysosis and/or women with menorrhagia (excessive bleeding). It worked with my first period! I hardly had one. You can see why I am loath to give this up. I don't have a Pdoc at the moment but I spoke to the hopefully new Pdoc today and we will arrange the appt. for next week. I am doing better on this than any other hormonal agent I have ever used and this has the smallest amount of systemic hormones of any other method including Norplant. The good thing about Mirena, is that the serum levels of levonorgestrel are even. There are no peaks and troughs like the Pill. Wish me luck and thank you for asking about me. :) P.S. Do you think you might try Yasmin? AnneHi Anne:
I was wondering if the new vaginal ring (I know it has been FDA approved--uncertain as to availability) would also be an option for you? It is a combination device--is there potential exacerbation of your problem with the addition of estrogen? I am uncertain as to what the progestin compound is.
I am very interested in trying Yasmin. I will probably wait a month or two (when I know for sure whether or not I am going to get through this doctoral program) to ask for it. I am reluctant to start a new ocp right now, even though I am dissatisfied with Ortho-cyclen. It always takes me 2-3 months to see how compatible it is. I also read about another new ocp (Cyclessa)--but couldn't find out much about it. It is produced by Organon and is a degesterol (I think misspelled that)and ethinyl estradiol combination...the FDA page only had this not the dosage. But I read in a summary statement elsewhere that it is triphasic and the Estrogen component is 25mcg (which is different than all the others). I am going to try to find more about it--but if it is triphasic... I don't know.
Thanks again, and continue to let us know how you are doing and how the Effexor adjustment goes.
Kaysey
Posted by chloe on October 17, 2001, at 19:21:32
In reply to The new Pill Yasmin may be worth your while » chloe, posted by AnneL on October 16, 2001, at 23:46:09
>I don't know why any physician, Pdoc or otherwise would make a statement that the mini-pill is *stabilizing* (?!!) Progestin-only contraception is well known to cause depression. Combination Pills can cause all sorts of mood changes as well, and is dependent on the individual and the progestin that is used since the most common synthetic estrogen is ethinyl estradiol
Anne,
I really want to thank you for your informative posts. They are not only filled with useful information, but your personal experience is also greatly appreciated.
I did want to comment on the "stabilizing" issue. I think the progestins, although they have mood dampening side effects (among other bothersome ones!), they do suppress ovulation and pms. I tend to have very irregular periods with a tense ovulation, where I get very short tempered and hot under the collar. Then shortly after that I have pms where I am teary and so sad...I guess it's the variation in the cycle that is hard for me to deal with. I would rather feel dysphoric on a regular basis, than suicidally depressed, then ok, then short fused, then anxious, etc. I really crave to feel somewhat "even" if that is possible being a women.I am 35 now, and I got my period at age ten. I distinctly remember my first period. I was in 5th grade, and I recall the worst most painful menstrual cramps. I wondered how I was going to get through my day at school. It was about a year later that my emotional problems blossomed. So I know there is a huge connection between hormones and mental health. The key is trying to find a way to keep body and mind happy. I sure wish I could do it without meds or hormones!
I was on the depo shot for about 9 months about 5 years ago. After 1 month, my periods shut off, and I had a good stretch of emotional stability. However, I was on 100 mgs! of prozac and ritalin at the time. I never connected the two before. But maybe I needed all those AD's to counteract the depo. I decided to stop the shot because I had terrible vaginal dryness and no labido.
I talked to my gyn's office today. They called in a script for Yasmin. Yikes! I am so scared. I am so sensitive to the slightest changes in meds. Even though I have an awful headache from the Micronor, it's the devil I know. And I have never had success with estrogen combonations. But I do want to give it a try. It really has gotten good press about being helpful for pms, etc. I am planning to stop the Micronor tonight and wait till I get my period before starting the Yasmin.
Thanks for all your thoughtful posts.
Chloe
Posted by Brea on August 9, 2004, at 12:38:25
In reply to Re: Loestrin 1/20 and paranoia » AnneL, posted by Chloe on October 14, 2001, at 18:40:36
Hi,
I was doing some research on the net trying to find out what in the world is wrong with me when I found this website.
I am 22 years old and in my 2nd year of marriage. The first year my bc method was the nuva ring. The problem was that it caused me to throw up every month I was on it, and it gave me a decreased interest in sex.
Now my doc has me on tri-norinyl. This has made me totally nut's. I do not have a history of depression and am not currently on an ad-meds. After being on this pill for 4 months I am so paranoid. I find myself questioning things my husband does and things my family tells me. It's as if I have no trust for any one. I also experience panic attacks where all I can do is sit in the middle of the floor and cry hysterically.
My solution was to call my doc. His new prescription is Loestrin 120. Now I am afraid of what this one is going to do to me!!!!!! It seems to me that the only thing different about this one is that it is a lower dosage and it is not a tri- pill.I think my body freaks out because of the hormones in the pill and I am worried that even though the dosage is lower the effect will still be the same. Any suggestions as to what I can do???Brea
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.