Depression right before period

How to Deal with Premenstrual Depression

There’s no standard treatment for depression during PMS. But several lifestyle changes and a few medications may help relieve your emotional symptoms.

Track your symptoms

If you don’t already, start keeping track of your menstrual cycle and your emotions throughout its different stages. This will help you confirm that your depression symptoms are indeed linked to your cycle. Knowing that there’s a reason you’re feeling down can also help keep things in perspective and offer some validation.

Having a detailed log of your last few cycles is also handy if you want to bring up your symptoms with your doctor. There’s still some stigma around PMS, and having documentation of your symptoms might help you feel more confident about bringing them up. It can also help your doctor get a better idea of what’s going on.

You can track your cycle and symptoms using period-tracking app on your phone. Look for one that allows you to add your own symptoms.

You can also print out a chart or make your own. Across the top, write the day of the month (1 through 31). List your symptoms down the left side of the page. Put an X in the box next to the symptoms you experience each day. Note whether each symptom is mild, moderate, or severe.

To track depression, make sure to note when you experience any of these symptoms:

  • sadness
  • anxiety
  • crying spells
  • irritability
  • food cravings or appetite loss
  • poor sleep or too much sleep
  • trouble concentrating
  • lack of interest in your daily activities
  • tiredness, lack of energy

Hormonal birth control

Hormonal birth control methods, such as the pill or patch, can help with bloating, tender breasts, and other physical PMS symptoms. For some people, they can also help with emotional symptoms, including depression.

But for others, hormonal birth control can make depression symptoms worse. If you go this route, you might have to try out different types of birth control before you find a method that works for you. If you’re interested in the pill, opt for a continuous one that doesn’t have a week of placebo pills. Continuous birth control pills can eliminate your period, which sometimes helps eliminate PMS, too.

Natural remedies

A couple of vitamins may help relieve PMS-related symptoms of depression.

A clinical trial found that a calcium supplement helped with PMS-related depression, appetite changes, and tiredness.

Many foods are good sources of calcium, including:

  • milk
  • yogurt
  • cheese
  • leafy green vegetables
  • fortified orange juice and cereal

You can also take a daily supplement containing 1,200 milligrams of calcium, which you can find on Amazon.

Don’t be discouraged if you don’t see results right away. It can take about three menstrual cycles to see any symptom improvement while taking calcium.

Vitamin B-6 might also help with PMS symptoms.

You can find it in the following foods:

  • fish
  • chicken and turkey
  • fruit
  • fortified cereals

Vitamin B-6 also comes in supplement form, which you can find on Amazon. Just don’t take more than 100 milligrams a day.

Learn about other supplements that can help with PMS symptoms.

Lifestyle changes

Several lifestyle factors also seem to play a role in PMS symptoms:

  • Exercise. Try to be active for at least 30 minutes more days of the week than not. Even a daily walk through your neighborhood can improve symptoms of depression, fatigue, and trouble concentrating.
  • Nutrition. Try to resist the junk food cravings that can come with PMS. Large amounts of sugar, fat, and salt can all wreak havoc on your mood. You don’t have to cut them out completely, but try to balance out these foods with fruits, vegetables, and whole grains. This will help keep you full throughout the day.
  • Sleep. Not getting enough sleep can kill your mood if you’re weeks away from your period. Try to get at least seven to eight hours of sleep a night, especially in the week or two leading up to your period. See how not getting enough sleep affects your mind and body.
  • Stress. Unmanaged stress can worsen depression symptoms. Use deep breathing exercises, meditation, or yoga to calm both your mind and body, especially when you feel PMS symptoms coming on.

Medication

If other treatment options aren’t helping, taking an antidepressant may help. Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant used to treat PMS-related depression.

SSRIs block the absorption of serotonin, which increases the amount of serotonin in your brain. Examples of SSRIs include:

  • citalopram (Celexa)
  • fluoxetine (Prozac and Sarafem)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Other antidepressants that work on serotonin might also help treat PMS depression. These include:

  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)

Work with your doctor to come up with a dosage plan. They might suggest you only take an antidepressant during the two weeks before your symptoms tend to start. In other cases, they might recommend taking them every day.

Why Do I Feel Depressed When I Have My Period?

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When my period comes, I feel ill and depressed. I don’t want to do anything. My period is heavy and I don’t go to school because of the cramps. It rules my life and I can’t go out at all. Please help.
– Vicki*

It’s normal to have the blues or feel sick before and during a period. As hormone levels rise and fall during a girl’s menstrual cycle, it can affect the way she feels, both physically and emotionally. This is known as premenstrual syndrome (PMS) and it can make a girl feel like hiding in bed with the covers over her head.

Luckily, you can do a few things to ease PMS symptoms. Try eating a balanced diet with lots of fresh fruits and vegetables and cutting back on processed foods like chips and crackers. Reduce the amount of salt you eat and drink more water. Say no to caffeine and yes to foods with calcium and whole grains. And get plenty of sleep at night.

Occasionally, PMS symptoms might include feelings of extreme depression and hopelessness. If this is the case, speak with your doctor — it may be a sign something else is going on.

Heavy bleeding every so often, especially at the beginning of your period, is probably nothing to worry about. But if you soak through a pad or a tampon in an hour or less, call your health care provider, who can check you out to make sure everything’s OK.

Unfortunately, cramps are a fact of life for many girls. Over-the-counter pain relievers can be helpful. Try taking them as soon as you notice cramps starting instead of waiting for the pain to get bad. Regular exercise can make cramps less painful and help with PMS symptoms. Plus, exercise is a good mood lifter. Some girls find that heating pads or warm baths can also help with cramps. If your periods are still painful, talk to your doctor for other suggestions.

PMS, occasional heavy bleeding, and cramps can all be part of normal periods. But when your period keeps you home from school or prevents you from doing stuff with your friends, talk to your doctor. He or she can suggest ways to help you feel better.

*Names have been changed to protect user privacy.

Reviewed by: Larissa Hirsch, MD Date reviewed: September 2017

Premenstrual dysphoric disorder

A healthy lifestyle is the first step to managing PMDD.

  • Eat healthy foods with whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine.
  • Get regular aerobic exercise throughout the month to reduce the severity of PMS symptoms.
  • If you have problems sleeping, try changing your sleep habits before taking medicines for insomnia.

Keep a diary or calendar to record:

  • The type of symptoms you are having
  • How severe they are
  • How long they last

Antidepressants may be helpful.

The first option is most often an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts. You may also take it the whole month. Ask your provider.

Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.

Other treatments that may help include:

  • Birth control pills typically help reduce PMS symptoms. Continuous dosing types are most effective, especially those that contain a hormone called drospirenone. With continuous dosing, you may not get a monthly period.
  • Diuretics may be useful for women who have significant short-term weight gain from fluid retention.
  • Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation.
  • Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramps, and breast tenderness.

Most studies have shown that nutritional supplements, such as vitamin B6, calcium, and magnesium are not helpful in relieving symptoms.

Premenstrual Dysphoric Disorder (PMDD)

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.

What causes PMDD?

The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency. Serotonin is a substance found naturally in the brain and intestines that narrows blood vessels and can affect mood and cause physical symptoms.

What are the risk factors for PMDD?

While any woman can develop PMDD, the following may be at increased risk:

  • Women with a family history of PMS or PMDD
  • Women with a personal or family history of depression, postpartum depression, or other mood disorders

Other possible risk factors include lower education and cigarette smoking

Talk with your healthcare provider for more information.

What are the symptoms of PMDD?

Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts. These symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have trouble functioning at home, at work, and in relationships during this time. This is markedly different than other times during the month.

The following are the most common symptoms of PMDD:

Psychological symptoms

  • Irritability
  • Nervousness
  • Lack of control
  • Agitation
  • Anger
  • Insomnia
  • Difficulty in concentrating
  • Depression
  • Severe fatigue
  • Anxiety
  • Confusion
  • Forgetfulness
  • Poor self-image
  • Paranoia
  • Emotional sensitivity
  • Crying spells
  • Moodiness
  • Trouble sleeping

Fluid retention

  • Swelling of the ankles, hands, and feet
  • Periodic weight gain
  • Diminished urine output
  • Breast fullness and pain

Respiratory problems

  • Allergies
  • Infections

Eye complaints

  • Vision changes
  • Eye infection

Gastrointestinal symptoms

  • Abdominal cramps
  • Bloating
  • Constipation
  • Nausea
  • Vomiting
  • Pelvic heaviness or pressure
  • Backache

Skin problems

  • Acne
  • Skin inflammation with itching
  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache
  • Dizziness
  • Fainting
  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
  • Easy bruising
  • Heart palpitations
  • Muscle spasms

Other

  • Decreased coordination
  • Painful menstruation
  • Diminished sex drive
  • Appetite changes
  • Food cravings
  • Hot flashes

The symptoms of PMDD may look like other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always talk with a healthcare provider for a diagnosis.

How is PMDD diagnosed?

Aside from a complete medical history and physical and pelvic exam, there are very few diagnostic tests. Because there are mental health symptoms, your healthcare provider may want you to be evaluated for mental health concerns. In addition, your healthcare provider may ask that you keep a journal or diary of your symptoms for several months. In general, to diagnose PMDD the following symptoms must be present:

  • Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:
    • Depressed mood
    • Anger or irritability
    • Trouble concentrating
    • Lack of interest in activities once enjoyed
    • Moodiness
    • Increased appetite
    • Insomnia or the need for more sleep
    • Feeling overwhelmed or out of control
    • Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
  • Symptoms that disturb your ability to function in social, work, or other situations
  • Symptoms that are not related to, or exaggerated by, another medical condition

How is PMDD treated?

PMDD is a serious, chronic condition that does need treatment. Several of the following treatment approaches may help relieve or decrease the severity of PMDD symptoms:

  • Changes in diet to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol
  • Regular exercise
  • Stress management
  • Vitamin supplements (such as vitamin B6, calcium, and magnesium)
  • Anti-inflammatory medicines
  • Selective serotonin reuptake inhibitors (SSRI)
  • Birth control pills

For some women, the severity of symptoms increases over time and lasts until menopause. For this reason, a woman may need treatment for an extended time. Medicine dosage may change throughout the course of treatment.

Key points about PMDD

PMDD is a much more severe form of t premenstrual syndrome (PMS).

The exact cause of PMDD is not known.

  • The main symptoms that distinguish PMDD from other mood disorders or menstrual conditions is when symptoms start and how long they last.
  • Symptoms of PMDD are so severe that it affects your ability to function at home, work and in relationships.
  • Aside from a complete medical history and physical and pelvic exam, there are very few tests to diagnose the condition.
  • Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:
    • Depressed mood
    • Anger or irritability
    • Trouble concentrating
    • Lack of interest in activities once enjoyed
    • Moodiness
    • Increased appetite
    • Insomnia or feeling very sleepy
    • Feeling overwhelmed or out of control
  • PMDD is a serious, chronic condition that does need treatment that may include lifestyle changes and sometimes medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down the questions you want to be answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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