PMDD Threat Advisory: Code Orange

 

My body is talking to me: A few days ago I began the luteal phase of my menstrual cycle. Two new cysts have appeared on my neck, and they tell me I’m headed to The Danger Zone. The sex hormones (progesterone and allopregnenolone, also called neurosteroids) that synthesize and collect in my brain are doing a weird and poorly-understood little dance with my GABA receptors. Within days my serotonin level will tank and my stress levels will spike. A generalized social anxiety will chase me indoors. The anxiety will slowly progress to panic attacks and obsessive-compulsive behaviors. If it’s a really bad month it will turn into a clinical depression, complete with incapacitating crying jags and suicidal thoughts.

That is . . . unless the Zoloft will keep me afloat this time. Will the pills work? Is the dosage sufficient? Will I feel bad? Normal? Will I notice a difference?

I’m a little bit surprised at how anxious I am over the upcoming trial of my new drug regimen. Is the anxiety from my PMDD, or is it due to an understandable concern for my personal safety given last month’s suicidal impulses? I do not know.

In the mean time, my research has unearthed the following facts:

• 10% of PMDD sufferers experience suicidal thoughts. Also, the incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.
• An estimated 2/3 of women who suffer from PMDD don’t get the treatment they need. Women who suffer from PMDD fear that they are “crazy,” because PMDD is labeled as a psychiatric disorder. It is only when they are about to commit suicide or experience feelings of anger that turn into violent outbursts that they finally decide to seek safe and effective treatments.
• The Alpha (brain) waves of women suffering from PMDD are messed up.
• Women with Seasonal Affective Disorder often also have PMDD.
• Selective serotonin reuptake inhibitors (SSRIs) are very effective in treating PMDD, up to 70% effective, although it may take some time to achieve the proper dosage. When SSRIs don’t work it might be the sign of a different (underlying) psychiatric disorder. Birth control pills and synthetic progesterone are NOT effective treatments for PMDD.
• PMDD in women can be misdiagnosed as Bipolar disorder or schizophrenia. PMDD may also coexist with and exacerbate other illnesses, so sometimes a proper diagnosis may be difficult to come by.
• Caffeine can make PMDD symptoms worse.
• A compound called L-theanine, found in tea, improves Alpha-wave functioning and may be helpful for women suffering from PMS/PMDD.
• The Tegretol (Carbamazepine) I took for epilepsy for fourteen years is an anticonvulsant. However it is also an analgesic and a mood enhancer, used to treat folks with bipolar disorders, and – fancy that! – during those years I had no PMDD symptoms. I was treating my PMDD without even knowing I had it! My PMDD started when I weaned myself from the Tegretol, and it also explains why I spent most of my adult life being a total lightweight when it comes to alcohol.

So, it looks as though I have a 70% chance of being helped by Zoloft, pretty good odds all things considered. I might still feel a little blue, but it should be manageable. One thing that worries me, however, is that sometimes SSRIs make suicidal impulses even worse. I heard on NPR that researchers don’t know why this is the case, but they’ve theorized that sometimes an antidepressant can give a suicidal person the energy s/he needs to go through with his/her plans. Nowadays every antidepressant comes with a warning:

People on antidepressants and their families should watch for worsening depression symptoms, unusual changes in behavior, and thoughts of suicide. Patients should call their doctor if they have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant at the beginning of treatment or whenever there is a change in dose.

I suppose the only thing to do is to be constantly vigilant, without letting myself get too anxious about my situation (if that is possible). I’ll do my best to reason with myself since I know what’s happening to me, but sometimes reasoning is hard to do when it’s my brain that is betraying me in the first place! As of tonight I’m feeling great, so . . . so far, so good.

Also, I have friends, family members and a neighbor who’ve agreed to call or visit every few days or so to make sure I feel all right and that I’m not about to do something foolish or stupid. I love you gals/guys!