Health

Here's What's Up With Getting Depressed Around Your Period

Because at a certain point, it's more than PMS.

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Welcome to BuzzFeed’s Mental Health Q&A, where we consult with experts to answer your biggest mental health questions. Have a question about mental or emotional health, happiness, relationships, stress, or anything else? Hit us up at MentalHealthQs@buzzfeed.com.

This week’s question: Why do I get more depressed before my period?

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Hi,

I was diagnosed with major depression a couple of years ago, and while I'm still working it out, I have it pretty much under control right now. Without fail, however, crushing sadness/apathy/emotional numbness or a combination of those greet me about three days before my period starts.

At what point does this cease to be normal PMS and become something that maybe can or should be treated? Who should I talk to about this?

Thanks!

—Anonymous

Hey Anonymous! So, full disclosure, right off the bat: You'll have to see a doctor to know for sure what's going on with you specifically.

In the meantime, we talked to Dr. Catherine Birndorf, clinical associate professor of psychiatry and obstetrics and gynecology at Weill Cornell Medical Center and Dr. Mary Jane Minkin, clinical professor of obstetrics and gynecology at Yale School of Medicine, about the relationship between your period and depression. Here's what they had to say:

Being sad, moody, or irritable is a pretty typical symptom of PMS — but when it affects your ability to function, it's probably something more.

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"Functional impairment" — meaning when something gets in the way of your day-to-day life — is where experts draw the line between typical negative emotions and an actual disorder. We'll get to what those disorders might be in a second, but there are a few questions you can ask to know if something more serious is going on than regular PMS.

"Have you missed work or school?" says Birndorf. "Do you stay home a day or two a month because you're so miserable with these symptoms? Is it, 'I'm sad and moody and don't want to leave the house' or is it, 'I'm so miserable or angry or depressed that I can't?'"

And if that sounds like you, that's when it's time to talk to a doctor. When you do, these are the things they'll probably go over with you:

It could be premenstrual dysphoric disorder (PMDD), a disorder that causes severe depression symptoms before your period.

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In the simplest terms, PMDD is really bad PMS. According to the DSM-5, to be diagnosed, you have to have five of the following symptoms (and at least one of the first four):

* Sudden mood swings

* Irritability, anger, or increased conflict with others

* Depressed mood or feelings of hopelessness

* Anxiety or tension

* Decreased interest in usual activities

* Difficulty staying focused in attention or thinking

* Fatigue

* Change in appetite, or food cravings

* Trouble sleeping or sleeping more than usual

* Feeling overwhelmed or out of control

* Physical symptoms, such as breast tenderness, joint or muscle pain, weight gain, or bloating

What's also important here is that your symptoms are cyclical, says Minkin — aka most of the month you're completely fine, then anywhere from a few days to two weeks before your period (everyone's different), the symptoms set in. And then once you start your period, they lessen and go away. Rinse and repeat.

But if you already have a mental illness, it's more likely that your period is just making it worse.

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This is known as "premenstrual exacerbation." While it's possible to have both major depression and PMDD, if you're already dealing with depression (or another disorder like anxiety), these are probably the same symptoms you deal with all month long, just worse — not new ones altogether.

Experts don't know exactly why this happens, but Birndorf says it has something to do with a sensitivity to the hormonal changes that happen around your period. "It’s not due to an abnormal level of estrogen, progesterone, and cortisol, which are the normal hormones that change during the menstrual cycle," she says. "It has to do with an abnormal response to those normal fluctuations."

Also, for anyone reading who hasn't been diagnosed with a mental disorder: Don't count this one out. A lot of the time, people tend to assume it's just a period thing because their symptoms are worse around then, says Birndorf, when actually you could be dealing with something all month long and just haven't realized.

Your doctor will probably have you track your moods for a few cycles to get a definitive diagnosis.

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Don't worry — your doctor will probably start to treat your symptoms before that since there's no reason for you to keep suffering. But to really figure out whether you're dealing with PMDD or an exacerbation of an underlying condition, they'll also probably have you keep a chart of how you feel every day, says Minkin. That way, you can spot a pattern and see whether you really are fine for most of the month, or if you're actually feeling some level of crappy most of the time.

Either way, the go-to treatment is taking antidepressants (particularly SSRIs).

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This might mean starting them for the first time or upping your normal dose around your period. What your treatment plan looks like will depend on what you’re dealing with, but either way, antidepressants can help with both the emotional and physical symptoms.

And btw, taking antidepressants for PMDD doesn't mean you have a diagnosis of depression. Fun fact: If you have PMDD, dosing the day before you usually start feeling your symptoms might be enough, says Birndorf, since PMDD is unique in that antidepressants can offer relief in 24 hours. “That’s why we think it’s a different bird than depression,” says Birndorf. “You can’t treat depression the same day. You take days or weeks for the medication to work.”

Birth control might help. (Though, for some, it might make things worse.)

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It all depends. Some people find birth control negatively affects their mood and other people feel improvement on it, says Minkin. So if you're feeling shitty around your period, some experimentation with your doctor might be in order.

Or your doctor might switch you to a different pill or another method altogether. That's something you can talk to your OB-GYN about and they'll work with you to find the perfect match.

For more information on how birth control actually affects your mood, check out this post.

Taking calcium supplements might also reduce symptoms of PMS and PMDD, but there's not a ton of research on it.

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Some studies suggest that taking 1,000 milligrams or so of calcium a day can help — and even if it's not definitive, Minkin thinks it's worth a shot.

"It's one of those things that's like, 'Why not?'" she says. "It's good for you anyway and if could help with PMDD, it's worthwhile to give it a try."

And all those things you would normally do to be good to your body, like exercising, sleeping, and eating well? Also helps here.

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In this case, eating well = decreasing caffeine, salt, and sugar intake around your period, according to Minkin. Basically, most things that you wind up craving when you're PMSing will likely wind up actually making you feel worse, she says.

Bottom line: This isn't something you should have to deal with and you have treatment options!

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You can probably start with whatever doctor you already have a relationship with, whether that's a mental health specialist like a psychiatrist or therapist, an OB-GYN, or a general practitioner. They'll be able to help you figure out next steps, which might involve seeing someone else. No matter what, don't feel like you have to suck it up and deal. Good luck!