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Print ArticleRecognizing the Symptoms of Depression
Seasonal Mood and Hormonal Changes
Many women report mood changes linked to their monthly menstrual cycles. Between 3% and 9% of women of reproductive age experience premenstrual dysphoric disorder (PMDD), often with severe depression symptoms.
How are these monthly mood changes -- mild or severe -- affected by seasonal weather and activities? When should you talk to a doctor and seek treatment for depression?
Understand the symptoms of depression, from sadness to hopelessness to headache.
Seasonal Mood Cycles
"When we screen women to get into our studies of PMDD, many of them mention that they generally feel somewhat better in the summer, and worse in the winter," says Jean Endicott, PhD, professor of clinical psychology in psychiatry at Columbia University College of Physicians and Surgeons. "We'll sometimes get phone calls in the summer from women saying 'It's not so bad now, but will you be taking new patients in November?'"
Endicott doesn't know of any scientific studies that specifically link severity of cycle-related mood changes to the seasons, but says it makes sense.
"In addition to the effect that light has on mood and depression, there's the fact that women could be outdoors and exercising more during the summer months, and exercise can help with depressive symptoms linked to the hormonal cycle," she says.
The link also makes biologic sense, adds Dorothy Sit, MD, assistant professor of psychiatry at the University of Pittsburgh Medical Center. "People who have changes in mood related to season may experience this partially due to changes in circadian rhythm," she explains. "Estrogen and progesterone fluctuations have also been shown to advance and delay circadian rhythms."
Whether these cyclic changes are enough to bring on or worsen mood changes
or PMDD symptoms probably depends on the individual woman, and how sensitive
she is to estrogen and progesterone.
Is It PMDD or Depression?
Before you conclude that your mood changes or depression are definitely linked to your menstrual cycle, try keeping a diary for three months, suggests Nada Stotland, MD, MPH, professor of psychiatry and obstetrics and gynecology at Rush Medical College in Chicago.
"Many women who think they have PMS [actually] have symptoms that have nothing to do with their cycles at all," she says. "We tend to blame everything on that."
Buy a calendar and chart your daily moods -- up, down, happy, sad, tired, euphoric, angry, irritable, or fatigued. But make sure it's a page-a-day calendar, not a monthly one.
"If you're looking at a monthly calendar, you anticipate your period and are thinking, 'That's when I'm going to feel bad,'" Stotland says. "In order not to prejudice yourself, find a way to keep track of your moods day by day and not pay attention to where you are in your cycle. You can put that together later."
Do You Need Treatment?
If your diary does indeed reveal that your ups and downs are linked to your cycle, how do you know if you should seek treatment? Consider some of these questions:
- Are you not just irritable at these times, but having the worst fights ever with your partner or children?
- Do you find yourself unable to enjoy work or family life at these times?
- Do you experience major disruptions in your ability to function, your eating habits, or your sleep patterns?
- Do you have extreme levels of anxiety and self-criticism?
- Do you have morbid thoughts about death, dying, or wanting to die?
If you answer yes to several of these questions (especially the last one), call your doctor. "If your cyclic symptoms really start to impair your work or personal life significantly, it's time to seek professional help," says Sit.
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Important Safety Information About Cymbalta
Antidepressants can increase suicidal thoughts and behaviors in children, teens, and young adults. Suicide is a known risk of depression and some other psychiatric disorders. Call your doctor right away if you have new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Approved only for adults 18 and over.
What should I talk about with my healthcare provider?
Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
Who should NOT take Cymbalta?
You should not take Cymbalta if:
- You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
- You have uncontrolled narrow-angle glaucoma (increased eye pressure)
- You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, talk with your healthcare provider:
- about all of your medical conditions, including kidney or liver problems, glaucoma, diabetes, seizures, or if you have bipolar disorder. Cymbalta may worsen a type of glaucoma or the control of blood sugar in some patients with diabetes
- about your alcohol use
- if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life-threatening condition
- if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
- if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant
While taking Cymbalta, talk with your healthcare provider:
- if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
- if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
- before stopping Cymbalta or changing your dose
- if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose.
- about your blood pressure. Cymbalta can increase your blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
- if you experience headache, weakness, confusion, problems concentrating, memory problems, or feel unsteady while taking Cymbalta which may be signs of low sodium levels
- if you develop problems with urine flow
If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
In clinical studies of depression, the most common side effect of Cymbalta was nausea. Other common side effects included dry mouth, constipation, decreased appetite, fatigue, sleepiness, and increased sweating. This is not a complete list of side effects.
Other safety information about Cymbalta:
Cymbalta may cause sleepiness and dizziness. Until you know how Cymbalta affects you, you should not drive a car or operate hazardous machinery.
See Prescribing Information for additional Important Safety Information, including Boxed Warning.
Depression Glossary
- Antidepressant: Drugs to be used to treat depression...
- Dysphoria: An emotional state marked by anxiety, depression, and restlessness ...
- Dysthymia: Chronic depression that is less severe than major depression ...
- Major Depression: Depression that lasts for at least two weeks and interferes with daily life ...
- Psychotherapy: Treatment by talking about emotional problems ...
- View All Terms
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