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.
There are several options for treating PMDD, from cognitive behavioral therapy and light box therapy to medications such as antidepressants, anxiety medicine, birth control pills, or other hormone treatments.
Some women are given antidepressants called SSRIs (selective serotonin reuptake inhibitors) to take just before they start menstruating. Typically treatment is started on cycle day 14 and stopped when menstrual bleeding starts. Generally, it takes several weeks for these antidepressants to have an effect, but for women suffering depression linked to menstrual cycles, the medicine seems to work more quickly.
Cognitive Behavioral Therapy
Cognitive behavioral therapy can help you develop skills to manage depression and mood changes linked to your menstrual cycle, says Catherine Monk, Herbert Irving Assistant Professor of Clinical Psychology in the departments of psychiatry and obstetrics at Columbia University College of Physicians and Surgeons.
"You can learn to have resources in place for when you go into your vulnerable period," she explains. That may mean knowing not to schedule tough work deadlines during those days, or making sure to plan for a massage or not to miss your yoga class.
"Ahead of time, you should write a list of things that you really enjoy and that allow you to move outside yourself," says Monk. "This may include books and DVDs that keep you from ruminating, or activities that energize you, like running or painting. Make the list ahead of time, because if you don't, you won't have the energy to do it when you're feeling down. Then commit yourself to trying them even if you don't want to."
Light Box Therapy
Studies have also found that light box therapy -- a specific treatment that mimics outdoor light and causes biochemical changes in the brain that improve your mood -- may be effective for women with PMDD. It may be that light therapy improves melatonin levels, which have been found to be abnormal in women with PMDD.
Whatever treatment may work for you, it's important not to dismiss your symptoms as "just PMS."
"If we're in a situation where we're fortunate, we tend to think we couldn't possibly be depressed and have no right to be," says Stotland. "Or if our circumstances are lousy, we say, 'No wonder I feel bad.' But if you're out in the cold and you get frostbite, you don't say, 'No wonder I have frostbite' -- you treat it. If you're depressed, it's important to do the same thing."