Managing Severe Monthly Depression Problems
Every woman knows what it feels like to suffer from the monthly blues. But for some women, suffering depression whilst having a period can turn into a debilitating part of the month. Every month.
If this is you may have premenstrual dysphoric disorder or PMDD.
PMDD can produce symptoms that are so severe that they can be disabling.
The main symptoms of PMDD are:
And, noticeably, depression.
These symptoms typically happen in the week before a woman’s period. Once the bleeding begins, the symptoms ease off.
Only 5-8% percent of women suffer from PMDD but for those women life can seem so unbearable that for one or two weeks a month they find it difficult to work, maintain healthy relationships or socialise. It can also lead to experiencing suicidal thoughts.
The symptoms of PMDD have been compared to the severity of symptoms for people who suffer from major depressive disorder. Major depressive disorder can have a marked negative effect on how the sufferer functions. Women who suffer from PMDD appear to experience similar symptoms.
How Do You Know If You Have PMDD? Or If You’re Just Suffering Some Depression With Your Period?
In diagnosing PMDD your doctor will refer to the Diagnostic and Statistical Manual of Mental Disorders, better known as DSM, which is the standard classification manual of mental disorders.
The DSM’s diagnosis of PMDD is clear-cut:
During the symptomatic phase (during the week or two before the menstrual period and remit soon after the onset of the menstrual period), there must be at least 5 or more of these 11 specific symptoms present most of the time during each symptomatic phase:
Decreased interest in usual activities
Lack of energy
Marked change in appetite
Insomnia or hypersomnia
Physical symptoms such as bloating and breast tenderness
The symptoms must include at least one of: depressed mood, tension, mood swings, or irritability.
The indicated symptoms must be prevalent through all the menstrual cycles in one year and prevent the sufferer from engaging in everyday activities or relationships.
The sufferer must also confirm that all of the above symptoms appear during at least two consecutive menstrual cycles. It must also be clear that the symptoms are not as a result of any other disorder.
“When PMDD strikes, which was every month for me, it was soul destroying. I felt despair anxiety, misery, isolation and in the darkest moments, thought about suicide. I suffered for 10 years before I was diagnosed with PMDD and before that I just thought there was something very seriously wrong with me. It robbed me of anything that made me feel happy. I just scraped through each day. But the worst bit was knowing that I have to go through it all again next month. I begged my doctor for help but it took years for them to decide I had PMDD not least because it’s not very talked about. Once I was diagnosed and got some treatment, I stopped thinking I was going crazy.” Kristy.
Diagnoses is difficult because when you suffer from PMDD, that’s not what you present to the doctor; what you actually say is ‘look, I can barely function each month, I’m going crazy, what’s wrong with me?’
What If I’m Struggling To Get A Diagnosis?
It’s not uncommon to find that’s getting a diagnosis of PMDD is a lot more difficult than you’d think. This may be because it takes a long time to realise that there is a cyclical nature of your symptoms. Because PMDD is, relatively speaking, a more recently identified mood disorder, even doctors might overlook what you’re telling them.
There are some things that you can do to help yourself to get the right diagnosis. These include:
1. Keeping a record of your symptoms over three months – but the longer the better. You could use a mood chart or a diary but make sure that you note down all your symptoms with plenty of details. The key is that the symptoms are cyclical i.e. they are recurring, they happen at regular intervals and they repeat every month.
2. You could also help your Doctor by being clear on what the treatment guidelines are for PMDD. These can be found at National Association for Premenstrual Syndrome (NAPS). Do be aware that sometimes the term ‘severe PMS’ means the same as PMDD.
3. If your doctor can’t guide you, you could ask to be referred to a gynaecologist to get some more specialist help. If you feel nervous about asking for this or other types of help, it may be worth taking in a trusted friend or family member and ask them to sit in on the consultation and help you to put your questions across to medics.
Where does it come from? Is it simply a depression with period? No, it’s suspected to be genetic.
The exact source of PMDD is not known. It may be an abnormal response to normal hormone fluctuations that happen with each menstrual cycle.
However, the experts tend to side with the theory that women with a family history of PMDD or severe PMS are more at risk of contracting the disorder. And while any woman could develop PMDD, you’re more at risk if you have a family history of depression.
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What Are The Treatments For PMDD? There’s A Three-Line Approach
First Line Treatment
Antidepressants appear to be the go to first line treatment for PM DD. because can help people who suffer with depression, irritability and anxiety.
The types of antidepressants that could include are SSRI antidepressants like fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).
It is acknowledged, however, that more research is needed to compare the efficacy of a continuous dose of SSRI’s to the dosing of them just for the luteal phase. The luteal occurs after ovulation and before your period starts when the lining of the uterus normally gets thicker to prepare for a possible pregnancy.
Second Line Treatment
Other antidepressants or anxiety drugs.
Other antidepressants may help symptoms of PMDD as well as certain anti-anxiety drugs may help with specific symptoms.
For example, the anti-anxiety drug alprazolam used in the luteal phase may help PMDD sufferers but it’s widely regarded that more robust research is needed to confirm these as a viable treatment option.
Third Line Treatment
For some women with PMDD an option could be anovulatory treatments. These are treatments that decrease hormones that promote egg production, inducing a state of medical menopause.
These could include oral contraceptives or gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex).
These treatments may not be readily available because of the side effects and high cost.
Are There Any Self Help Treatments For Depression With Period Problems? Nothing Is Medically Claimed But These May Help
According to the Mayo Clinic[i] there are some known complementary remedies that are used to soothe the symptoms of severe premenstrual syndrome:
Calcium: 1,200 milligrams (mg) in your diet may reduce the physical and psychological symptoms of PMDD.
Magnesium: take 360 mg of supplemental magnesium
Vitamin E: Take 400 international units daily
Herbal remedies: Some herbs, such as ginkgo, ginger, chasteberry, evening primrose oil and St. John's wort may help.
The Mayo Clinic also states that there isn’t the regulation or research to back up these claims and you must talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you're taking.
There is some research[ii] to suggest that mindfulness meditation can reduce anxiety, depression and pain. The study’s author stated:
“But in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants.”
There are many brilliant apps that show you how to build a meditation practice.
One study showed that acupuncture[iii] might help improve PMDD symptoms.
Acupuncture is used in Chinese medicine when the needles are inserted into acupuncture points on the skin. They have been shown to relieve pain and stress in people with bad backs and anxiety.
Studies show that acupuncture significantly improved symptoms when compared with sham acupuncture.
Of course much more research is needed and further rigorous trials undertaken, but it couldn’t do any harm to try it out. It certainly helped me feel better.
What About Changing My Diet? Yes, You May Want To Try That And These Additional Things.
The information relating to diet is confusing because doctors will tell you to eat well but there is no research to confirm how conducive this is for PMDD symptoms.
Still, eating healthily generally minimizes discomfort and increases well-being. It’s recommended to try these tips for two monthly cycles to see if there is any improvement:
Eat plenty of fruit and vegetables
Eat small but frequent meals to combat bloating
Eat whole meal bread, brown rice and complex carbohydrates rather than white flour foods
Avoid caffeine, salty snacks and alcohol
In order to increase tryptophan levels, eat high protein foods
Exercise is generally a good way to you help with severe PMS symptoms. Both aerobic and gentle exercise works well.
Please remember that I am not a doctor and this information not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.
Further reading from MIND: