Recognizing 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?
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.
Important Safety Information
Cymbalta® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.
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.
You should also know that:
- Suicide is a known risk of depression and some other psychiatric disorders.
- Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
- All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
- Cymbalta® is not approved for use in patients under age 18.
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 (an eye disease)
- You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:
- about all of your medical conditions, including kidney problems, glaucoma, or 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, tell 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. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta
If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
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
WebMD's Symptom Finder:
Physical Symptoms of Depression
The Truth About Depression
Back Pain, Muscle Aches, Fatigue
Depression Myths vs. Facts


