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When PMS and Depression Hit Together —and Some Skills to Help Cope

Managing Depression

April 18, 2023

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Photography by Adene Sanchez/Getty Images

Photography by Adene Sanchez/Getty Images

by Elizabeth Drucker

•••••

Medically Reviewed by:

Joslyn Jelinek, LCSW

•••••

by Elizabeth Drucker

•••••

Medically Reviewed by:

Joslyn Jelinek, LCSW

•••••

Managing the emotions of premenstrual syndrome (PMS) can be a challenge, especially when you’re already dealing with depression. Here are some ways I separate the two and gain control over my symptoms.

Every month, around the same time, something very predictable happens to me: I feel like I lose my mind. I kid you not. It feels like absolute madness. In addition to depression, I also feel anxious, agitated, hopeless, and absolutely terrified about what is going to come next. For me, this cycle lasts about 10 days and ends around the second day of the actual bleeding that comes with my period.

I have been diagnosed with premenstrual dysphoric disorder (PMDD), which is an extreme form of PMS. It’s really an exacerbation of my bipolar disorder, with the usual symptoms getting worse during this time. I can usually pinpoint it to the day, especially with the physical symptoms that accompany these extreme mood shifts. Acne erupts in the cleft of my chin, and I feel bloated and crampy.

I have spent many sessions with psychiatrists and gynecologists, looking for a solution to ease some of these symptoms. But having a mood disorder complicates the picture.

Doctors usually prescribe selective serotonin reuptake inhibitor antidepressants and birth control pills for women who live with PMDD. Unfortunately, both of these classes of medication make my bipolar disorder even worse.

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How my PMS differs from my depression

For me, depression feels a bit different from the mood instability I experience with my periods. The depression with my period, or PMDD, comes with more anxiety and agitation. During any other time of the month, my depression feels more listless. I feel so paralyzed that I can’t move, let alone leave my bed.

PMDD has me pacing around my apartment, wringing my hands and wanting to peel the skin off my body. This agitation often leads to suicidal thoughts, while my depression at other times makes me feel more hopeless and that I will never get out of this state of despair.

After living with PMDD, I have developed some skills that I would like to share with you.

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5 tips for battling PMS and depression

1. Get to know your symptoms

The first step in taking charge of your PMS is to learn what to expect. That way, you know why you feel so awful and that the same thing happens every month.

For example, I know that when I get acne surrounding my mouth and chin, I am due for my period very soon. It’s just a cue that my body is sending me so I can predict what’s to come.

Additionally, I feel extremely anxious and obsessive. I also have obsessive-compulsive disorder that gets worse around this same time every month. Feeling crampy and bloaty is another signal that something is changing in my body.

2. Self-talk

Self-talk is a coping skill that really helps me. I might say, “My body is telling me that I’m about to get my period. This will only last for a certain period of time, and then I will feel better.”

Self-talk helps give you control back over your symptoms instead of them dictating how you feel. If you can learn to talk yourself down, you will be able to better deal with the anxiety that may come with your period. Anxiety is one of the harder symptoms associated with PMS, but in my experience, it really responds well to self-talk.

3. Relaxation techniques

Over the years, various therapists have taught me different ways to relax. They definitely work with PMS too. For example, I feel better when I darken the lights in my bedroom and listen to calming music.

There are also many apps you can download on your phone that provide guided meditation techniques. I also like to self-soothe, like doing something to distract myself. For example, I might watch a favorite TV show or movie, take myself out to dinner, or read a book.

It will definitely be worth your while to learn relaxation techniques that you can put into play when PMS makes everything worse.

4. Consult an expert

I can’t take antidepressants or hormonal medications (like birth control pills), but that doesn’t mean that you can’t. You don’t need to just accept that your PMS makes you more depressed and anxious. I would recommend that you consult both a psychiatrist and OB-GYN to work together to find the optimal treatment for you.

As far as medications go, there are many options, so don’t give up after the first one. It might also be helpful to look for a psychiatrist who specializes in women’s mental health. I recently had a consultation with such an expert, and while acknowledging the complexity of my case, he said that there were some options available.

5. Keep track of your symptoms

When it comes to dealing with PMS-exacerbated depression, it’s helpful to record every symptom that happens to you and when. You will also want to know when your periods occur and how long they last. Are they heavy?

Pretty soon, you will be able to predict when you are getting your period — a very empowering advantage. Again for me, when I get super anxious, I know that I will be bleeding soon.

The bottom line

Never give up. PMS certainly makes life more complicated when you’re dealing with depression too. Again, you shouldn’t take the stance that this PMS-enhanced depression is incurable.

You can come up with your own “period plan” to get through the tough days when PMS worsens your depression. Periods are no picnic, and we know that depression does not mix well.

Take care of your mind and body to fight back against your periods. Make sure that your body is healthy, too, including exercise (another great coping skill for dealing with depression!).

Medically reviewed on April 18, 2023

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