Q. I have heard from a couple of people that when they went through menopause they no longer needed to be on Lithium. Is there any truth in that? My mother has been manic in the past, but now that she is going through menopause she is very depressed. Is there anything I can do to help her?

A. I know of no evidence that a woman with bona fide bipolar disorder will no longer require lithium or another mood stabilizer, simply because she has entered menopause.

In fact--although the notion that menopause per se causes depression has been shown to be largely incorrect--there is some evidence that women with pre-existing bipolar disorder may actually worsen with onset of menopause (see Freeman et al, J Clin Psychiatry 2002 Apr;63(4):284-7).

This is not necessarily due to changes in female hormones, though some evidence indicates that bipolar women who were not using hormone replacement therapy (HRT) were significantly more likely than those who were using HRT to report worsening of symptoms during perimenopause/menopause (Freeman et al, 2002).

I think the best way to help your mother is, first, to let her know you are concerned about her and are available to just listen; and second, to encourage her to seek treatment with an expert in bipolar disorder, perhaps in consultation with a gynecologist, if she is not already doing so. There are certainly new and effective treatments for bipolar depression--including, but not limited to, lithium. One such agent is the anticonvulsant, lamotrigine.

For more severe depression, electroconvulsive therapy (ECT) may also be very effective. In some cases, HRT or treatment with thyroid hormone may be appropriate. You may also want to get your mother's permission to discuss these issues with her physician, if you feel she is not bringing them up herself.

It may also be useful to put your mother in touch with the National Depressive and Manic-Depressive Association (NDMDA), which may also be able to advise and support you during this difficult time. NDMDA is reachable at 800-826-3632.

Finally, you may find it useful to read the new book by Dr. E. Fuller Torrey, Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers. I do hope things work out with your mother.

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April 2003

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