The question was submitted
04/01/2008
Subject: PMS
Hello,
My depression is diminishing gradually but before my menstrual period, everything starts again. I feel like I am not getting well, I become as bad as my worst days. As soon as my period starts, everything starts to get well and I start to think again that I am getting well. As a result, one third of my life, I suffer PMS. What can I do for this? Thank you
Answer from DepNet
Thank you for your question.
PMS (Pre-Menstrual Syndrome) is a common experience for many women, who regularly experience a variety of symptoms just before they menstruate. These include physical symptoms (eg abdominal bloating or cramps, breast tenderness, or changes in sleep and appetite). They also include psychological symptoms (eg feeling tense and irritable, mood fluctuations, changes in libido). This is extremely common: some estimates suggest that almost all women experience these in relation to their menstrual cycle at some time in their lives. For most women, these are not disabling symptoms.
But for a number of women, the symptoms are more severe and interfere with their lives, affecting work, relationships and their ability to function. When it is severe, it may be diagnosed as PMDD (Pre-Menstrual Dysphoric Disorder). While this has been a controversial diagnosis at times, most clinicians in Australia agree that while it is far less common than PMS, it is a genuine entity that can benefit from treatment.
So it is possible that what you are experiencing is a period-related exacerbation in your depression, or it could be PMS or PMDD, or there could be another explanation. Only your treating doctor is in the position of taking a full history, making a diagnosis and recommending an appropriate treatment approach.
Whatever the diagnosis, however, a number of approaches are available and could help you significantly. Some have solid evidence behind them and others do not, but as PMDD is an area still in the early days of research, you need to rely on the advice and follow up of an experienced clinician who knows you and your circumstances well. The best person to discuss it with would be the doctor treating your depression. If your depression is being treated by your local doctor, you may benefit from an assessment by a psychiatrist as well.
Approaches to treatment can include the following:
1. A variety of lifestyle strategies have been tried and many are reported to be helpful. There little data to support or reject them, as little research has been done with them, but many women report these to be of great benefit. They are also generally extremely safe, easy to try, and ‘healthy’ in a more general way. They include changes to patterns of diet, exercise and sleep.
2. Psychological strategies, including developing skills to anticipate, recognise and better manage stress, anxiety, anger, interpersonal conflict, relationship difficulties etc.
3. A number of anti-depressant medications of the SSRI class (selective serotonin reuptake inhibitors) have been shown to be of benefit, especially for prominent mood and anxiety symptoms, and especially for women who generally have significant mood or anxiety problems or have had them in the past.
4. Hormonal treatment, often using the oral contraceptive pill or hormones delivered by patch.
5. Other substances have been suggested and tried, but the research evidence is generally inconclusive or negative. These include supplemental vitamins, minerals and amino acids, anti-inflammatory medications and evening primrose oil.
The most important thing to do is to discuss your experiences and concerns with the doctor who has been treating your depression. I wish you all the best.
The answer was published on DepNet
07/01/2008