Are You Depressed Or Do You Just Have PMS?

Photographed by Alexandra Gavillet.
Despite the fact that PMS comes every month, it can still be surprising and frustrating to have your emotions hijacked by your hormones. Some months, it doesn't hit you that you're experiencing the wrath of PMS symptoms until after you've lashed out at your partner for some trivial mistake or cried about a low-key passive-aggressive text from your roommate. Yet, PMS is very common in the U.S. (up to 75% of women who menstruate experience it to some extent). And it's not just cramps and bloating: Psychological symptoms can also fall under the umbrella of PMS, and everyone's symptoms are slightly different, says Elizabeth Albertini, MD, assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai, who specializes in women's health.
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It's normal for some people who menstruate to experience mood swings or feel more irritable, angry, or emotionally sensitive as part of their PMS, Dr. Albertini says. They might also feel more bloated, hungry, or fatigued on top of that. "It's all a spectrum," she says, meaning that some people get a whole bunch of severe symptoms while others only have to deal with a few.
But, if you feel severely hopeless, sad, or otherwise bummed out every single time you get your period to the point where it impacts how you live your life, Dr. Albertini says those feelings could be a sign of something more serious than run-of-the-mill PMS. Specifically, you might have premenstrual dysphoric disorder (PMDD), a very severe form of PMS.
"The difference between PMS and PMDD is the impact it has on your life," she says. Although normal PMS can make you more on-edge, for example, someone with PMDD might be so testy that they lash out at loved ones or coworkers during this time. "It might be so hard the week before your period that you go home and cry every night, or you're not seeing your friends, or just not involved in your life normally," Dr. Albertini says. But, the weird thing about PMDD is that everything usually goes back to normal once you actually get your period.

75% of women who menstruate experience PMS symptoms to some degree.

Unlike PMS, PMDD is not that common, and only 5% of people who menstruate regularly report such severe symptoms, Dr. Albertini says. And many people don't realize they have PMDD until their 20s, she says. That could be because PMS symptoms tend to get worse as you age, or it might just be harder for young women to recognize that their PMS symptoms are abnormal until they reach their 20s.
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To get diagnosed, you have to retroactively look at how your period has impacted your life over the course of about a year. So Dr. Albertini usually tells patients to keep a log (on an app or just in a journal) of all their symptoms, when they feel them, and when they go away. If someone has these depressive symptoms for two consecutive months, that's usually enough to diagnose PMDD, she says.
In some cases, people realize that they're feeling down all month, every month, and not just the week before their period, Dr. Albertini says. That could be a sign that person has an underlying depressive or anxiety disorder, and many people who have PMDD have a previous history of depression. In other cases, patients are "having these symptoms all month long, and it's just more pronounced before their period," which could also be a sign of an underlying mental health issue, she says.
Why do some people end up getting PMDD, and other people just have PMS? It's not totally clear, but Dr. Albertini says there's definitely a hormonal component to developing PMDD. And a recent study in Molecular Psychiatry found that PMDD might be partly genetic.
If you already have a mental health provider, it's a good idea to mention your cyclical symptoms to them so they can get you going on a treatment plan. Switching to hormonal birth control or switching birth control methods can sometimes help treat PMDD, Dr. Albertini says. "Certain people respond to birth control in different ways," she says. "Birth control can regulate symptoms or make them worse — it works both ways."
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Depending on the severity of your symptoms, your doctor might prescribe medication to take the week right before the period, she explains. For some people, taking an antidepressant definitely helps PMDD, but it can be tricky to figure out exactly when to start and stop taking those medications. "For every month, you take it a few days before you know your period starts, then take it through the week-long period, then taper down," she says. "Logistically, it's not always an easy thing to do," so taking that into account is part of figuring out if that method is going to work for you. For others, especially those who have an underlying mental health issue, it might make more sense to take an antidepressant all month long, but it totally depends on the person.
But medical treatment isn't always necessary for PMDD. In some cases, going to therapy and adopting a mindfulness practice (such as yoga or meditation) can be enough to control your monthly symptoms, Dr. Albertini says. Doctors might also suggest that you change your diet, avoid caffeine and alcohol, and start exercising.
Whether or not you actually have PMDD, it's important to talk to your doctor about how you're feeling before, during, and after your period, because mental health is a huge part of your big picture health. If you think your PMS symptoms are even slightly messing with your life, it's worth saying something. Just because PMS happens every month, doesn't mean you should have to deal with it alone.
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