You’re crying and you can’t stop. Your significant other asks if you’re about to start your period soon. What do you do? For many women, this might provoke a good slap (and with good reason), but for me, it’s a fair enough question. Am I about to start my period soon? Because for the few days leading up to it, I get full-on, dramatically depressed.
Pre-menstrual depression has dogged me for years. The first doctor who ever prescribed me antidepressants was a gynecologist—a shiny, pink package of Pristiq, which is essentially Effexor (venlafaxine) marketed exclusively at the ovary-having set. I only took it for a month or two; it seemed silly to me to take antidepressants every day of the month to combat a condition that lasted just a few days.
That still seems silly to me, which is why I’m currently not doing anything pharmaceutical to treat the PMS depression. I’m actually coming off a year or so of antidepressants: Prozac and mostly Wellbutrin, which were life-saving circa January 2012. I have no qualm about continuous antidepressant use, but I don’t have health insurance, so I try to ween myself off when reasonable. And right now, it’s reasonable. I am in a really good mental place—except for these pesky two or three days a month.
Knowing that this depression is period-related (and temporal) does help in dealing with it, but it’s trickier than you might think. For one, my periods are pretty irregular, so there’s no set time of the month I can be expecting this awful mood onslaught.
For another—well, it works about the same way as a regular serious depressive spell, albeit much shorter, meaning it’s hard to see around it. I’m naturally nihilistic and pathologically ambivalent on my best days, so when everything suddenly starts to seem cyclical and hopeless and just not worth it, my meta-brain starts out like, yeah, okay, that’s reasonable.
It often takes talking to someone who knows me well, writing in my journal or crying to the point where I’m half-heartedly contemplating walking into traffic before I realize, jeeeeeeeeezus, Liz, you’re about to start your period. If you hang on for another day or so, the whole world will go back to normal. Things will have points. All is not loneliness. Etcetera.
If there are there are three things I’d like people to know about premenstrual depression, they’re that a) it is real, b) it does not affect most women* and c) it’s nothing like most people portray it or think. At least not for me; perhaps there should be a fourth takeaway: It’s individualized.
Some women experience absolutely no PMS symptoms; some only experience physical duress; some do get irritable, ill-tempered and chocolate-craving. And some—like me—go batshit bonkers with depression for a few days.
It’s never the angry, “bitchy” weeping-at-phone-commercials kind of PMS for me, though; it’s more mild existential despair, more like the kind of clinical depression I’ve suffered in larger chunks from time to time previously. And as with other depressive episodes, the PMS depression doesn’t render me incapable of meaning what I’m saying or distinguishing reality; I don’t invent problems in the midst of these spells that aren’t present other days of the month; there’s still a cohesive self directing the ship.
If you know someone who deals with premenstrual depression, please don’t assume they shouldn’t be taken seriously. That might (and should) earn you that slap. It’s a delicate balance, but the best way to help them is to both take their concerns, moods and emotions seriously but also gently remind them that the depression might be clouding their perspective and they should give it a few days before making any decisions or reaching any conclusions. And if you are someone suffering from premenstrual depression, I think the best thing you can do is learn not to get mad or upset when someone you trust tells you that.
* An estimated 3% to 8% of women have what’s known as premenstrual dysphoric disorder, or PMDD, a severe form of PMS that includes premenstrual depression as well as other potential mood disturbances and symptoms.