We had a great case in one of our graduate mentoring sessions the other day (thanks Kate 😉 ) , about a 40 something mum of 3 who reported to have cyclical mood and depression. Further investigation of the case, however, revealed that some of the key characteristics of the mood disorder were actually anger, aggression, irritability, hyperactivity, vivid nightmares etc. This particularly came to light with her responses to a mood survey that the practitioner had asked her to complete. I think validated tools like this (esp. DASS), when used appropriately, can give us enormous insight – often revealing things we might not have thought to ask about or that the client might not have voluntarily offered up, particularly if they are not socially accepted or attractive qualities.
If you practice anything like me, then Vitex is an absolute reflex response (think the very funny reflex paper ad – that’s me in my clinic!) & godsend for most cyclical mood issues. However, apart from the fact that this woman’s key period of mood aggravation, although clearly related to her menstrual cycle, was day 5-14 rather than during the late luteal phase, there was another stand out reason for me why I definitely wouldn’t use Vitex.
It’s important to remember that one of the established mechanisms of Vitex is dopaminergic, engaging with D2 receptors via a range of its constituents. It’s also important to remember that dopamine is a stimulant amongst neurotransmitters, part of the catecholamine family and while we’re often on the lookout for patients with too little of this neurotransmitter (poor stress tolerance, anhedonia, low libido etc.) some of our patients will also be in the camp of having too much of this whole class, as typified by the anger, aggression, vivid dreaming etc.) and even if we might feel they need some progesterone support, Vitex would make the wrong choice in these scenarios! Interestingly enough, this woman prior to see the practitioner, had self-prescribed Vitex amongst several other supplements and when the practitioner suggested she stop taking the Vitex the patient reported feeling less anxious.
I’ve actually seen this before in clinic, women who feel markedly worse on Vitex…whose premenstrual anger turns into whole cycle anger or even, in one case, a depersonalisation experience! I love what Vitex can do for so many patients but I guess this is just a reminder that it has its contraindications and cautions as well 🙂