Jump to content
CrazyBoards.org

Recommended Posts

i have been diagnosed with PTSD, GAD and depression by different professionals. I'm taking Paxil 20mg. It helps me for the most part. The problem is that around my period/during PMS, I feel like it does nothing for me. I think I have PMDD. Every time I have my period, for the last 5 years, I feel like my PMS gets worse and worse. I don't know how to keep on holding down a job. my next period should be at the end of July. My plan is to call in sick with the flu. I'm seeing the doctor on Aug 3. But I can't call in sick for a few days every month. During PMS, I shake, have severe anxiety, chest pains, crying, fear of leaving the house,  I think basically I have nonstop panic attacks for 2-3 days.  I don't know how i was able to keep working during this. For some reason, last month I felt like this was it, another month of this and I can not work anymore. But i need to work to support myself. In the past i've been on birth control but it made me depressed. i need help/advice on what to do. How to make my doctor understand? She is not a psych, just a primary care doctor. i live in a small town and don't even know if there are any psychiatrists near by. 

Share this post


Link to post
Share on other sites
Posted (edited)
3 hours ago, BostonGirl123 said:

 i need help/advice on what to do. How to make my doctor understand? She is not a psych, just a primary care doctor. i live in a small town and don't even know if there are any psychiatrists near by. 

Does your primary care doc (PCP) prescribe your Paxil?.....

Tell your PCP about the symptoms you're having.....Maybe they could refer you to a psychiatrisr, or a psychiatric nurse practioner (PNP)......A PNP can diagnose PMDD, if that is what you have, and can also prescribe meds.

SSRIs like Paxil are often used for PMDD.......Your dose is on the low side at 20mg.....The maximum recommended dose is 50-60mg, if I remember correctly.

Edited by CrazyRedhead

Share this post


Link to post
Share on other sites

I'm sorry you're dealing with this, Bostongirl. Alternatively, what about your gynecologist? He/she's going to be more knowledgeable about PMDD symptoms and treatment than a pcp. Either way, if things are becoming really difficult I'd definitely see (or find) a gyn and/or a psychiatrist so that your treatment doesn't become "piecemealed"; it will be worth the drive and extra time. Psychiatrists can be found at www.healthgrades.com , and also at www.psychologytoday.com/us , both searchable by zip code.

I hope you're feeling better soon. 

  • Like 1

Share this post


Link to post
Share on other sites

Thanks for the replies. I guess I don't really want to see a new provider at this point because I don't want to have to explain my past abuse (that caused the PTSD). So I wish my PCP could just handle my treatment. But maybe this is not realistic. Maybe I should just bite the bullet and try to find a psych. The situation right now is that I either have to get help or stop working. At least that is how it feels to me.

Share this post


Link to post
Share on other sites

I am quite a bit older but used to have terrible terrible pms. At the time, I saw a GYN, who used hormonal treatment, which may have changed now so I won’t go into detail. But it saved me. I was like a new person—so do you have a GYN by chance?  For me, I needed one sympathetic to my severe symptoms. Pmdd wasn’t a diagnosis back then but I’m sure I had it. Anyway, I think it may work best to see an additional provider if yours can’t help, but maybe you can get help, or at least think if a GYN would work—and that might be your best bet. I hope you get someone knowledgeable, for me it was life changing to not be at the mercy of my hormone imbalance. 

Share this post


Link to post
Share on other sites

Thanks but i don't have a gyn right now. I looked for psych providers last night. I don't know. Im scared of seeing a psych and scared not to. Last time i saw a psych i had a bad reaction to a med and missed 2 days of work. My goal is not to miss work. Stressing out. What do you guys think?

I think i will give my Pcp a chance to help me. I will be completely honest about my symptoms. Then if she tells me i have to see a psych i will.

Share this post


Link to post
Share on other sites

I think psych vs. GYN is a tough call but maybe your current doc can help?  Worth a try. When I had my premenstrual craziness I didn’t have a pdoc but I can tell you now I have both GYN and pdoc (and FP) and the pdoc won’t deal with anything hormonal. So hoping your FP can meet your needs all around. It would help so hope it happens. 

Share this post


Link to post
Share on other sites

I think you have several  options, actually. You could opt for the psychiatrist option, explain which med caused issues and your concerns, and start any new meds on your Friday. They can likely ramp up your dose slowly and be extra vigilant using (or not using) the class of drugs that caused your last reaction. The vast majority of psychiatrists don't do talk therapy anymore, just medication reviews/changes, so you'll not need to go into any deep, significant detail about past trauma (and let them know you aren't comfortable with it right now).

For your own sake, tho, I suggest considering a therapist/social worker/psychologist that DOES offer therapy. Otherwise, you're only treating the symptoms and not the cause of the symptoms. Find one you feel you "click with", and again- let them know that you can discuss trauma when you're ready. Most are very patient and caring, and are there to help you and make you comfortable. No pressure. You can find one near you at www.psychologytoday.com.

Finally, I'm sure your pcp would script a few days worth of a benzo (Xanax, valium, etc.) or med of her choice that may patch you through the rough spots for a bit. This is the easiest option in the short run, but again, you'd like to address the likely cause of the symptoms in the big picture. I'm sure whichever option you go with, you'll feel a bit better just getting started!  : )

 

  • Like 1

Share this post


Link to post
Share on other sites

My best friend used to get completely deranged once a month. Like, seriously, just suicidal for a week. It was insane to watch. Now she gets DepoProvera shots (May have misspelled that) and she’s just fine. It’s like throwing a switch. She could never tolerate the Pill in any of its myriad forms. Made her crazy. But the Depro works like a charm. And your GP could do that.

Share this post


Link to post
Share on other sites
Posted (edited)

@BostonGirl123  Have you thought about maybe increasing the Paxil (even just during your luteal phase)? It sounds like a dosage issue (or maybe you could try another SSRI such as Prozac?) Paxil *should* be controlling anxiety & panic symptoms. I would also emphasize (to whatever doctor you see) that you have tracked the pattern, that it is a distinct hormone-related trigger. Are you in your 40s?

I've struggled with this for years. My depression has become mostly manageable except the week of PMS, it can be a real sh*tshow. I have tried everything also. I'll tell you one thing, GPs are pretty useless (they'll often just shrug, say you are "stressed", give you the pill, or antidepressant). Ideally, try to find a good Obgyn AND Psychiatrist that are knowledgeable about hormones, you are dealing with 2 inter-related issues. Or even an endocrinologist... Many doctors do not consider PMDD an official diagnosis, but loads of women struggle with it. Treatment gets complicated when you have BOTH a hormone disorder & mood disorder!

Everyone wants to pin it on a psychological issue or stress. I suggest you keep a detailed symptom log with the dates and all of your symptoms (several months worth or more) to show the distinct pattern. Good to get a general check-up for thyroid disorders (thyroid disease can exacerbate mood symptoms)

Hormones also made me feel 100% worse (particularly Progesterone) so hormones or the pill are not always the answer.  There is a certain protocol for PMDD, usually, you start with diet (make sure you are getting plenty of vitamin D, Calcium, Magnesium, B6, B12. Omega3's are most helpful as well as Tryptophan, 5-HTP,  Evening primrose oil. Avoiding alcohol & caffeine that week...Some women (peri-menopause age) recommend Agnus Castus.

Next step, they will try the pill usually...If that doesn't help, it's often trying low dose Prozac or Zoloft (only in the Luteal phase, 2 weeks before period). Some lucky ppl can get away with not taking it everyday.

Some don't do well with SSRIs, you can also try a mood stabilizer (Lamictal) has been great for me, because I have no side effects and you won't have dependency (like with xanax). Helps smooth things out. I have had (relative) success with doing all of these things (daily vitamins/supplements + Lamictal + low-dose Prozac) Xanax only for emergency.

This site has been one of the most helpful: https://iapmd.org/steps-to-diagnosis

and this one: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.14260

Edited by Blahblah
added links
  • Like 1

Share this post


Link to post
Share on other sites

So I found a psych using Psychology Today. We talked on the phone (free consultation) and I guess she does not think I have PMDD because I have symptoms all month, it's just worse during PMS. So maybe I have premenstrual exacerbation of my mental health issues. She was willing to see me for an intake but I told her I'm not ready for that yet. I'm just not ready to start over again with a new provider yet. So I will tell my PCP my symptoms at my next appt and maybe she can help. If she tells me she can't, and i have to see a gyn or psych, then I definitely will. 

Share this post


Link to post
Share on other sites

Well done!! So glad you called her; at least you have a little more info and more potential options at your disposal. I understand your reluctance to start with someone new, I think it's something most folks wrestle with (at least I do). You might warm to the idea in time, and at least you know she'll be there. Cycling can absolutely wreak havoc both physically and emotionally; I still remember telling my gyno about my "homicidal rage" that went on 1 week a month for years. Anyway, best wishes for your next PCP appt- I have my fingers crossed for you!

Share this post


Link to post
Share on other sites

I had my dr appt. It was kind of weird. I was 100 percent honest about my symptoms. She didn't seem that concerned. Asked if i wanted to stay on the paxil. I said yes. Asked if i ever heard voices when no one was around. Because i told her i sometimes think i hear voices and then i realize its the neighbors. Asked if i get chest pain. I said yes. Then the appt was over and i got the same paxil prescription. The dr was nice but nothing really changed. I think she just wanted to make sure i wasn't a danger to myself or others. Now I'm having pms again, extreme anxiety and im confused and not sure what to do.

 

Share this post


Link to post
Share on other sites

I have had experiences like that and felt confused and frustrated. For me, going back and saying maybe I wasn’t clear—this is a big problem and this med isn’t working, I need something more or different, but something beyond this, please I need help. You wouldn’t think you’d need to spell it out like that but I’ve had to and sounds like you may need to. I have a problem downplaying my symptoms apparently or maybe they just don’t understand what I’m asking for or expecting. But I think you need to call, email or however it’s set up, and say you need something additional. Whatever dose of Paxil you’re on isn’t working, so does she think more, a different med, 2nd med, whatever, but she’s the highly trained professional, she should form a more effective plan. That’s my take on it, you’re paying her to actually help with the problem you came in for. If she feels unable, she can opt to consult a colleague and get back to you. It’s not easy to be persistent though, I know. 

Share this post


Link to post
Share on other sites

So basically things got worse, I finally "bit the bullet" and starting seeing a psych, he prescribed Remeron. Tonight I will try my first dose and hopefully it helps.

Share this post


Link to post
Share on other sites
12 hours ago, BostonGirl123 said:

So basically things got worse, I finally "bit the bullet" and starting seeing a psych, he prescribed Remeron. Tonight I will try my first dose and hopefully it helps.

Keep us posted on how it goes & hope it helps!!

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...