New research from a group of American scientists indicates that women with bipolar disorder experience notable menstrual cycle-related mood alterations, even when they receive effective treatment for their condition. Doctors can treat bipolar disorder with several types of medications, including mood stabilizers, atypical antipsychotics and antidepressants. However, even after receiving generally effective treatment, any given individual may still feel significant symptoms of his or her condition. In a study published in May 2015 in the Journal of Affective Disorders, researchers from the Stanford University School of Medicine examined the impact of menstrual cycle-related mood changes in women receiving treatment for bipolar disorder. These researchers also specifically explored the usefulness of a mood stabilizer called lamotrigine in reducing menstrual-cycle related mood fluctuations.
Bipolar Disorder and the Menstrual Cycle
All forms of bipolar disorder (including bipolar I disorder, bipolar II disorder and cyclothymia) involve episodic changes in mood that produce periods of mild-to-severe mania symptoms and mild-to-severe depression symptoms. The most severe form of the illness, bipolar I disorder, typically produces distinct episodes of full-blown mania, as well as episodes of depression that separately meet the criteria used to diagnose major depressive disorder. Other bipolar illnesses produce episodes of a less extreme type of mania called hypomania and/or episodes of less serious depression symptoms. Some people with bipolar disorder experience episodes of combined mania and depression, while others cycle between manic and depressed episodes with unusual rapidity. The monthly menstrual cycle triggers hormone-based mood fluctuations in women. Significant numbers of women develop the notably disruptive but relatively minor mood alterations associated with premenstrual syndrome (PMS). A much smaller number of women develop a more serious form of menstrual cycle-related mood alteration called premenstrual dysphoric disorder (classified as a diagnosable depressive illness). Women with bipolar illness apparently develop PMS symptoms at least twice as often as women unaffected by bipolar illness. Hormonal changes associated with the menstrual cycle can also reduce the effectiveness of some of the medications used to treat the various forms of bipolar disorder. In addition, the presence of bipolar disorder may alter the menstrual cycle in unpredictable ways.
Lamotrigine and Bipolar Treatment
Lamotrigine (Lamictal) is classified as a mood stabilizing medication. It also has dual status as an anticonvulsant and plays an important role in the treatment of epilepsy and other seizure disorders. In the context of bipolar disorder, lamotrigine helps increase the time between manic episodes and depressive episodes. It also helps individuals avoid unwanted mood changes not strictly classifiable as mania or depression. However, lamotrigine does not provide any treatment benefit during active episodes of mania and may or may not provide any benefit during active episodes of depression. For this reason, doctors commonly combine the medication with other treatment options.
Menstrual Influence on Treatment
In the study published in the Journal of Affective Disorders, researchers used a project involving 85 women to gauge the impact that menstrual cycle-related mood changes have on the course of bipolar disorder treatment. Forty-two of these women followed a treatment plan that included lamotrigine, while another 30 women followed a treatment plan that did not include the medication. The remaining 13 participants formed a comparison group of women unaffected by bipolar illness. Over the course of four menstrual cycles, the women in all three groups made daily assessments of their baseline moods and their sleeping patterns. They also reported any symptoms of insomnia. The researchers concluded that, compared to the group of women unaffected by bipolar illness, all of the women receiving treatment for their bipolar symptoms experienced larger variations in their day-to-day mood and their nightly sleeping patterns as they moved through the monthly menstrual cycle. The women being treated for bipolar disorder also had generally less satisfactory moods and slept for longer amounts of time on the average night. The researchers concluded that the addition of lamotrigine to a bipolar disorder treatment plan reduces the mood alterations associated with the menstrual cycle and brings bipolar disorder-affected women’s moods and sleeping patterns closer to the norm found in women without bipolar symptoms. The study’s authors also looked at the impact of contraceptive use on women with bipolar disorder. They tentatively concluded that the combined use of contraceptives and medications like lamotrigine may limit menstrual cycle-related mood changes even further. However, they point toward a need for additional research on this topic.