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PMS, PMDD & Depression: Way More Than Just the Blues
by Dr. Daniel J. Heller
When Melanie, a 32-year old single professional woman, came in to talk to us about her moods (especially moods before her period), she told a story we'd heard many times before, and that we think is familiar to many women. She began by describing what it's like for her for a week or more out of most months: "It literally feels like I'm in a brain cloud or fog—it's hard to think clearly or to concentrate. I feel a lot of sadness and can cry at the drop of a hat. I don't want to deal with anyone, and I'm really on edge and anxious."
She went on to describe how her PMS depression takes a toll on her life. "I don't want to get out of bed in the morning, and I just don't have motivation, even for things that usually interest me. It's all I can do to get up, go to work, and make it through the day—I just have no energy. All my relationships suffer, including romantic ones. Then a day or two after I get my period, I feel like myself again: I'm happy, energetic, I'm calling friends, getting things done. I wish I could crawl into a hole for those days and just surface when the real me comes back."
PMS and PMDD depression symptoms can also include feeling on edge and anxious; angry and irritable; and having trouble with focus and concentration (many patients report: "I'm in a brain cloud"). Sleeping too little or too much, change in sex drive, and social withdrawal—avoiding friends, family, partners, coworkers, or all social contact—are additional signs of PMS and PMDD depression.
Even in moderate intensity PMS, these symptoms can have a real impact on your ability to function and your quality of life. In severe PMS and PMDD, depression symptoms can bring your life to a standstill.
The main difference between PMS or PMDD depression as compared to other types of depression is the premenstrual pattern: PMS and PMDD symptoms occur before the period, and get much better once the menstrual flow begins. PMS and PMDD symptoms are intimately tied to your hormonal cycle.
It's Important to Seek Help
Because medical conditions such as major depressive disorder, bipolar disease, and personality disorders can cause depression symptoms that are aggravated premenstrually, it's important that you seek help if your symptoms are severe or interfere with your life, work, and relationships.
However, there is still so much overlap between the symptoms of depression, and the symptoms of PMS and PMDD, that it can be hard to tell them apart unless you keep a daily symptom log or journal. Over several months, this can help clarify whether your moods before your period follow your menstrual cycle. Almost every symptom of depression is part of the spectrum of PMS and PMDD as well.
Another helpful tool is our PMS Comfort Self-Assessment Quiz, a free online tool that allows you to rate the severity of your own PMS symptoms and which can help you better understand yourself and your symptoms. We also recommend you read about the range of PMS symptoms and PMDD symptoms. These and other articles on our site can help you put your own premenstrual symptoms in perspective.
Below is a list of the most common symptoms of depression. It is persistent, rather than occasional symptoms that identify true depression.
Nearly every woman will experience one or more of these symptoms, to some degree, at some point in her life. Depression symptoms, by themselves, are not the same as depression. These symptoms can also be caused by other conditions. For instance, attention deficit disorder can cause difficulty concentrating, and anemia can cause fatigue.
Depression can be exogenous and endogenous, which simply means it can be caused by external or internal factors. For instance, losing a job, change in relationship status, loss of a loved one, or troubles at work or school can be highly distressing and can lead to depression. Exogenous depression usually gets better when circumstances change or with the passage of time. Endogenous depression, on the other hand, is caused by internal factors, so that it occurs even when things are going well.
Over the years, many theories of endogenous depression have been proposed, and there is no single cause or correct theory that explains all types of depression. The best explanations for depression include chemical and genetic factors, but also take into account social and psychological elements.
Fifty years ago, most doctors thought depression was caused by forgotten childhood memories, and required psychoanalysis, an intensive form for counseling. Over the past 20 years, with the advent of more effective medications for depression, brain-based theories of depression have carried the day, usually focusing on mood-regulating brain chemicals such as serotonin and dopamine. In their drive to promote antidepressant medication, pharmaceutical companies and concerned organizations have helped de-stigmatize depression. Where depression used to be seen as a character flaw, it is now more often correctly viewed as a complex condition with multiple causes.
There is more than one approach that can bring relief from depression. While psychoanalysis has largely fallen out of favor, various forms of counseling clearly help depression. While drugs often work wonders for depression, the initial enthusiasm for the SSRI drugs has been tempered by experience and ongoing research, so that it is looking more and more like those drugs are not a cure-all after all. Of course, many people prefer to avoid medications because of concerns about side effects and other problems.
Natural remedies can truly help PMDD depression—and PMS depression too. Diet, exercise, nutritional and herbal supplements, counseling, and lifestyle changes can all help lift the cloud of depression—they are more powerful than people often suspect. In fact, a combination of natural therapies, as part of a holistic program, often works better than any one treatment alone. In the next section of this article, we'll discuss some specific ways you can naturally relieve depression.