Ask The Doctor
PCOS, Anxiety & Depression
Questions (this Ask contains three questions): First, your website says it is not recommended to take your herbal formula [PMS Comfort] for PMDD while on birth control pills. But what can be done in a case where my teenage daughter, Dorothy, MUST take birth control pills because without it, she gets severe acne on her face due to PCOS diagnosed by our endocrinologist who put her on Orthotricylen Lo, Spironolactone, & Metformin (other symptoms she had for this PCOS diagnosis is hirsutism (excessive hairiness), high testosterone level, irregular periods, along with acne).
About two and one-half years ago, because her prescriptions don’t help with her emotional and cognitive symptoms, I took her to a naturopath who took her off the Orthotricyclen Lo and put her on natural progesterone cream. By 4-5 months, her face became densely covered with cystic painful deep acne. Needless to say she had to go right back on the Ortho which cleared up the acne within months but she had red scars for a long time and still has the pock marks on her face from it. I am afraid to ever have her come off that prescription ever again because her face can't take anymore. I fear it has already permanently damaged her pretty face for life. So if she is stuck on Ortho for acne, can she take your herbal formula? She is not sexually active and is not taking the Ortho for birth control.
My second question is about the timing of the symptoms. She used to have at least 2 better weeks out of the month but this past year, it has stretched out almost to the majority of the month and the symptoms are still always much stronger the week or two before her period. I don't know if the PCOS is contributing to her symptoms during the rest of the month or if it is all from the PMDD. I took her to a gynecologist who said to take her to a psychiatrist because if it's all month long, it's psychological. My daughter told the gynecologist she has everything she could ever want and that there is nothing bad going on in her life to cause so much sadness; that is why we believe it is hormonal. The gynecologist didn't believe my daughter's statement. He said there must be 'something' wrong in your life to make you feel so bad all month long. This was a big disappointment since we waited 3 months for that appointment. Plus it was very stressful for my daughter to have to talk about it with the doctor.
So my last question is, can PMDD expand beyond the week before the period? Your website says, "... the diagnosis depends on the timing: symptoms must occur only before the period, during the luteal phase (after ovulation), and resolve after the period comes. However, we have seen women whose symptoms are clearly premenstrual and are obviously "hormone dysregulation," but which begin before ovulation. Of course, when PMDD and PMS symptoms last longer than two weeks, it creates even more suffering."
It sounds like that above statement is saying two different things. Can it only be during certain weeks of the cycle but some women suffer beyond that period like my daughter? Could you clarify for me since I am a little confused in light of what the gynecologist said. Also I'd like to say that for my daughter, usually the symptoms lessen when her period starts but there have been times when it didn't let up even during her period.
I'd like to add that another reason we believe my daughter's symptoms are hormonal is because it all began when she started menstruating. Also, early on, before starting with the endocrinologist, we did spend several years at various psychiatrists trying to get my daughter some relief by trying about ten different antidepressants over the course of several years (4-6 month long trials on each). None of which did any good! It was all for nothing and was a lot of stress to put my daughter through considering they also insist you go see a psychologist simultaneously.
Before starting with the psychiatrists, I tried her on SAM-e (S-adenosylmethionine), St John's Wort, Vitex (I only gave her a low dosage for a month or two because I had no idea if that was the proper formula for her problem and didn't want to make things worse but there was no improvement on it.) I saw Vitex was an ingredient in your formula. I also gave her about 15 other supplements/vitamins/minerals that are said to help with these various symptoms. No great results from those either. Only peppermint tea helped with energy but she got sick of drinking it 3 times a day. I still give her some supplements like magnesium and C. Even though certain B vitamins are supposed to be helpful for a lot of her symptoms, B vitamins intensify her anxiety/jitteriness so I don't give her those anymore.
She needs help because the emotional and cognitive symptoms of PMDD have crippled her life. She couldn't finish school, can't get a driver's license, can't get a job. Some days it is as simple as not being able to go out to see friends for fear that she will start crying for no reason at all. There have been many times when plans have been cancelled because she wasn't feeling well enough. Luckily some days she feels good enough to fight past the symptoms, not enough to feel great but good enough to tolerate and hide the symptoms and get out with friends or go shopping with me (I call it shopping therapy; at least it gives her some temporary good mood and works far better than seeing a psychologist!).
These are her major symptoms, most of which I would say are severe:
- Depression and anxiety, and rare panic attacks
- Extreme mood changes such as feeling suddenly sad or tearful, or increased sensitivity to rejection, overly sensitive about everything
- Decreased interest in usual activities (school, work, family, hobbies) or social withdrawal , social anxiety
- Concentration difficulties, brain fog, memory problems, confusion , poor attention, forgetfulness (she was once an A and B student)
- Lack of energy, fatigue, lethargy, lack of motivation
- Sleeping too much (hypersomnia) or insomnia both!
- Feeling overwhelmed or out of control
- Avoidance of or withdrawal from social interactions
- Indecisive, impatient
- Some weird physical symptoms only during her worst times of the month: her scalp will become dry and a little dandruff-y where even dandruff shampoo doesn't help, and her underarm odor smells like ammonia or cat pee!
So you can see how this has totally disrupted her life. I'm sorry we are so far away on the east coast in the tri-state area. I apologize for the length of this email. Just to sum up, is there anything that can be done while a girl remains on birth control? Do you think the gynecologist was correct? I have no other ideas other than to take my daughter back to a psychiatrist and hope that a new antidepressant has come on the market that might help alleviate some of her symptoms.
~ Dorothy's Mom
Answer: PCOS (Polycystic Ovarian Syndrome) is a serious condition: a hormonal imbalance in which a girl’s or woman’s hormones are thrown off balance, and in which a pre-diabetic condition often occurs. From the perspective of your daughter’s endocrinologist, the only way to treat this is with powerful medications: birth control to replace her disordered hormones with the regulated hormones present in the oral contraceptive; Metformin to help her body react more normally to her own insulin; and the Spironolactone to block excess testosterone that causes male pattern acne and hair growth. In PCOS, there is too much testosterone relative to estrogen and progesterone.
This is not the only possible way to treat PCOS. Holistic and natural practitioners might prefer another, less drug intensive, approach. However, your daughter’s treatment is the only way most endocrinologists and MDs would treat this; it is certainly the standard of treatment; and for most women, it would be the most effective way with the least amount of work. In such a serious condition, the natural approach wouldn’t necessarily be simple or easy.
In a woman taking birth control for PCOS, PMS Comfort or any herbal treatment that addresses female hormones is not appropriate. A holistic practitioner might very well use a Vitex extract to treat PCOS, but not at the same time as birth control. And—lest you think you can replace birth control for PCOS with Vitex—don’t try it. Going off birth control when it is successfully controlling PCOS should only be done under professional supervision, and only extremely carefully.
Although you say you took your daughter to a naturopath, I hope that it was a lay naturopath—someone with unspecified training who attempts to use natural healing—rather than a licensed naturopathic doctor who is trained in all the same conventional sciences and diagnostics as a medical doctor. In any case, the results of that attempt at natural treatment, and discontinuation of medication that was working, were predictable, and unfortunately your daughter had to suffer the consequences.
Our herbal formula wouldn’t address her acne, which is caused by a combination of improper diet and excessive testosterone. The best thing to do in this case is a radical change in diet, including a trial of elimination of all food allergens, and a switch to a very low-glycemic or hypoglycemic diet that contains no refined sugars. This will help both her skin, and reduce, but not eliminate, the hormonal problem. This is not the kind of food plan that will make a teenager very happy! However, having PCOS is no fun either, and a natural alternative has to include big dietary changes.
As to the mood and emotional symptoms: although it could have been communicated more kindly and gracefully, the main point that the gynecologist made is true. PMS and PMDD are the right diagnosis when emotional symptoms are present only or overwhelmingly before the period, and almost always only after ovulation, and rarely or never or extremely mild by comparison, at other times of the month. What you describe, where symptoms exist nearly all month long and then get worse before the period, would best be described as a hormonal aggravation of depression or another mood disorder.
Unfortunately, we don’t hold up much hope that antidepressants, even one new to the market, will be a magic bullet for your daughter. The more science studies depression and antidepressant drugs, the less we know. Though this much is clear: antidepressant drugs are not all that effective, and no truly new antidepressant medication has been brought to market in over 50 years.
The fact that your daughter told the doctor that she is happy with her life, and has everything she could want, is wonderful. She sounds like a very special girl who has the wisdom to be grateful for what she has, and to appreciate that the glass is half full, or maybe more than half. However, she’s still a teenager, and may not have insight into the underlying psychological issues and motivations that cause her to feel sad and conflicted. Also, in spite of her excellent attitude, it would be a rare teenager indeed who didn’t feel at least a little discouraged by taking so many medications; by having bad acne; and by struggling with weight, as nearly every PCOS patient does. Also, all teenagers are buffeted by changing hormones. In a child susceptible to depression, this would be that much more difficult when faced not only with the hormonal problems of PCOS, but also the drugs that treat it, since they have many ripple effects in the body.
As to treating these complex and serious conditions yourself, you should be congratulated for trying, and for wanting to help your daughter. However, this would be a challenging case for the most qualified naturopathic or holistic doctor: it is certainly too much for almost any parent to figure out. You should do a search for a qualified naturopathic doctor (as opposed to a lay naturopath) or holistic doctor or health practitioner in your area. Given that you had to wait three months to see a gynecologist, it sounds like it wouldn’t be a terrible inconvenience if you had to drive a few hours to see a practitioner well versed in the use of natural therapies.
Also—it is notable that you mentioned many different natural pills and vitamins and herbs, but not food and diet. Food and diet is always the foundation for natural health and holistic treatment. The more daunting the case, such as your daughter’s, the more important diet becomes.
The list of emotional symptoms you mention would be typical of both depression and PMDD, but their month-long occurrence pretty much rules out PMDD. However, depression can be a symptom, not a disease, so it is important that a thorough workup be undertaken. While you are probably seeing excellent doctors, it is possible that your doctors didn’t look into other possible causes of the emotional symptoms, because they assumed everything is explained by a confirmed case of PCOS and that symptoms of depression in a teenager indicate simple depression. It’s important, though, that other medical problems that could cause depression are considered: tests for hypothyroidism should be performed; a vitamin B12 shortage should be ruled out; and autoimmune disease ought to be ruled out as well.
There’s something you can do immediately, though, without any medical consultations, that I’ve seen work in the most difficult and confounding cases, of depression, PMDD, and myriad other conditions. Read our articles on food allergies and DIY food allergy assessment, as well as on what not to eat and on hypoglycemia, and then help your daughter incorporate this valuable dietary advice. That may very well give her as much relief, and lift her mood, as much as anything else has to this point.
Yours in Health and Wellness,
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Last Modified: April 7, 2014