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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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Please help me, I have an 18 year daughter who apart from 1

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Please help me, I have an 18 year daughter who apart from 1 or 2 days a month when shes is menstrating has been a pleasure to be around. The last 3 or 4 months she has become a nightmare, her mood swings are unbearable, she is so angry all the time and really miserable she is making it very uncomfortable for the whole family. She has been in a relationship for 20 months with the same guy and they have been happy he is a good kid and tip toes around her most of the time. She does not appear to know what she is doing or saying and it is definately escalating. Im not sure if this is relevant but a year ago we put her on the BCP and pretty much immediately she had a bad reaction to it and got very depressed and angry and suicidal, i took her back to the GP and they made her come off of it !! Do you think she has some sort of chemical imbalance ? Any help you can give me would be really appreciated, she is alienating everyone and her friends are avoiding her now too
Hello. I believe I can be of help to you with this issue.

I don't want to disparage her GP, but this configuration of problems may exceed their general working knowledge. I would definitely get an opinion from an endocrinologist or gynecologist---a specialist. I have a couple of questions, the answers to which you would want to share with this specialist.

First, could you please summarize what her premenstrual behavior and mood state has been like since she first started her periods e.g., generally stable until the last year or so, last 3-4 months. Has she ever been treated for PMS per se?

Prior to the apparent, BCP-related depression you describe in your post, has your daughter ever experienced an episode of depression in which she was seriously sad, blue, depressed or unable to experience joy in any of her usual activities, for a period of two weeks or more? Was this her first use of birth control pills?

Does your daughter recognize she is 'not herself' the past few months? Is she open and willing to obtain help from any reasonable source, or is she resistant?
Customer: replied 6 years ago.
Thank you for replying...firstly she has always been moody when she is having her monthly but it is normally for a day or 2 before hand, then she is fine, she has never been treated for pms although we have spoken to the doctor about it, when they put her on the birth control pill they said it may help her with her moods and heavy blood loss, as i explained it really didnt it literally took 3 days and she totally changed was very emotional, we discontinued that and she got back to normal. Sometimes when she is willing to talk she accepts that there is something wrong and she says she doesnt know what it is and why she is like that, she doesnt seem to remember any of the hurtful things she says, she is very resistant to talking at the moment, but i think maybe we could get her to see someone if we knew who she should see
As you know, there are various BCP formulas and another one may be helpful, rather than harmful to her. The odds are that whatever is occurring is due to sex hormone cycling and as you put it, a biochemical imbalance. Blood tests assessed repeatedly before,during and after her periods, taken across several months, can help determine which hormone levels are abnormal.

The other issue of concern of course, is that your daughter is in the high risk period of life for developing a mood disorder that is independent of, or interacts with her menstrual issues. It might be that a mood stabilizer or antidepressant, taken throughout the month may help her a great deal.

Regardless of the physiological findings and outcome above, your daughter will no doubt, still have some mood regulation problems, as she has had for as long as you can remember. The clear message that you and her boyfriend can communicate to her is that: 1) it really does seem that your emotional roller-coaster and some of your unpredictable behavior are related to hormones and neurotransmitter imbalances; 2) since you are beset with these problems and we care about you, we want to help you fully understand how your emotional reactions and behavior affect the view that other people hold of you; and we would like to do what we can to learn to reduce the impact of your problems on your reputation, how you come across to people etc. This latter point of course, suggests that she will eventually benefit greatly from working with a clinical psychologist who specializes in an area called behavioral medicine or health psychology. These psychologists can be found in most large hospitals or medical centers, especially teaching hospitals affiliated with medical schools. The would be in departments of psychiatry, behavioral medicine, family medicine, women's health, etc.

If the visits to the endocrinologist or gynecologist doesn't seem to be pointing toward answers, the other issue as I said might be an emerging mood disorders and you daughter should eventually be assessed for such a problem e.g., bipolar disorder II, cyclothymic disorder. You can Google these topics: DSM Bipolar Disorder; DSM Cyclothymic Disorder and read about the diagnostic criteria; if either or both seem to "fit" you should draw attention to this fact when you talk to the medical specialists, or visit the clinical psychologist-behavioral medicine specialist directly.

I hope this information is helpful to you. Let me know if I have overlooked any aspect of your question.
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