When PMS-Induced-Depression Overwhelms You: Three Coping Strategies

Note: Like all my posts, what I write here does not constitute medical advice. 

I love the Oscars.

I used to host an annual Oscar party that served up fancy hors d’oeuvres, ballots, and silly prizes. My much more subdued Oscar plan this past February was to watch the show at my sister’s apartment. Sunday morning, I woke up feeling as good as I ever feel. I made the bed, took my morning medication, and I even made it to a 9:30 a.m. yoga class. That afternoon, I saw my closest friend and visited with her baby.

Later, back at home, while I was reading the paper, emotions unrelated to anything I was doing or thought I was feeling–sadness, jealousy, anger, and desperation–overwhelmed me. In what felt like an instant, I couldn’t imagine getting up from my sofa. I couldn’t  even imagine caring about the Oscars.

“I’m not feeling well,” I texted my sister. “I think I have a cold.”

“Oh no!” she responded. “Take Vitamin C and feel better!”

And then I went to bed, around nine o’clock, without watching any of the awards show I’ve loved so much over the years.

On Monday, I woke up with that heavy weight of depression still on top of me. I couldn’t get out of bed. I called in sick to work. (I am grateful to have a job where it’s OK to call in sick.) Of course, I didn’t tell anyone what was really wrong. How can you properly explain: “So sorry, but I just feel a sense of existential dread so deeply rooted in me that I can’t move.”

I spent my morning in and out of sleep. By noon, I did manage to shower and to get out of bed. I realized that my sadness is almost definitely induced by PMS. But this knowledge didn’t make it much easier.

Right now, I write this because I am still feeling very down. I’m not clinically depressed. I  have what I’d label PMS-induced-depression, which colors my whole world grey. I did manage to get through my day, and I wanted to offer some of my coping mechanisms.

Accept that Your Best is Ever-Changing.
I learned this from one of my favorite books, The Four Agreements. The fourth agreement is to ‘always do your best,’ but Ruiz notes that our ‘best’ changes from moment to moment. Yesterday, the best I could do was to get out of bed. And I accepted that this was OK. Getting out of bed can be an achievement on some days.

Try to Gain Perspective
It’s not so easy to attain when you’re feeling depressed. But it is possible to zoom out and at least think about the suffering you’re not enduring. My mind wanders to images of war-torn countries, to parents who have lost children, to homeless people out in the cold. I don’t do this as a means of schadenfreude, as I’m not gaining pleasure thinking of those less fortunate than I am. Instead, I’m opening myself up to a world of suffering far greater than my own. These reminders really do help me step outside my own pain.

Be Kind to Yourself
I took a bath with green tea bath salts yesterday. I rested. I let myself cry. There’s a time when all of this would have made me feel guilty–made me felt like I was inferior to other people in the world who get up and go to work every day.  But I have to remind myself that I DO get up and go to work almost every day. My body and mind sometimes needs a ‘Time Out,’ so that’s what I gave it. At work today, I still felt troubled, but I made it through.

The good news is that I believe the PMS will be lifting soon. The good news is that I’m feeling well enough to write this blog post. For all of you who are suffering from PMS-induced-depression or just plain old depression, I know that this advice is not going to fix things, but I hope it helps to know someone else is out there, feeling the way you do, telling you that it’s going to be OK.







When Bipolar Disorder Meets PMS

cryingfromflickrYesterday, I cried on the platform of Metro North a few minutes before the train arrived to pick up me and my boyfriend and bring us to meet my parents and sisters for dinner. There wasn’t anything terribly wrong, except I’d bought my sisters presents and he had forgotten to bring the shopping bag with him.

“I’m so sorry,” he said. “I’m such a dummy.”

“It’s fine,” I told him.

But then I looked away, and I just started to well up with sadness. I’m not normally one to get mad about something as insignificant as a shopping bag left at the apartment, but all of a sudden, there on the platform yesterday, his forgetting of the gift was in my mind indicative of a larger problem in our relationship. I was irrationally angry at him. And even though I knew the anger was irrational, I felt it as deeply as any anger I’ve ever felt. I also felt a clawing sadness inside my chest because everything felt wrong. I didn’t want to go to dinner. I hated my job. My co-workers, for the most part, were completely incompetent. Let’s face it: my whole life was a disaster.

One thing I did know, and I knew this yesterday–in the back of my mind– when I wrote a post about moods and bipolar disorder (though I wasn’t really admitting it), was that I was about to get my period.

Back when I was too young to understand what a period really was, I remember my mother standing in front of the sink washing dishes in a state of sadness, telling me that she was going to feel fine “the minute she got her period.” I think I was around ten years old at the time, and I sort of knew what a period was, but not really. It had something to do with going to the bathroom and blood. But I couldn’t fathom what it had to do with making her feel better. Years later, after my late-bloomer body decided to finally deliver my period to me months after I earned my driver’s license, I still didn’t understand what she meant.

It wasn’t until I was out of college that I began to suffer from PMS and experience the strange feeling of overwhelming relief, as if the heavens had opened up and delivered me into this hallowed hall of happiness, where my pulse quickened with creative energy and the cobwebs in my mind cleared away, that I understood what she meant. Life sucked, and then I got my period and it was better again. My other bipolar mood swings felt unpredictable, but this was one I could count on.

By the time I was in my early 20s, I was managing as best I could with medication. With the help of a patient boyfriend, I got enough sleep to not let my flights into hypomania get so out of hand that I lost my job or did something really stupid. But we had very loud, overblown fights in the first year of that relationship. At one point, as I flew into a rage about something insignificant, he said, “Have you noticed we almost break up every month, right before you get your period?”

What he said hit me right in the gut because I’d never considered breaking up. But he was clearly suffering as much as I was.

With the help of a good gynecologist, I went on a birth control pill that worked for a number of years to calm down my previously stormy PMS. And with the help of my psychiatrist, extra Wellbutrin in the morning the week before my period helped boost my mood and keep the PMS at bay. That worked for a while. But since then I’ve switched birth control.

About a year ago, I tried the NuvaRing. It worked like a charm for a while, and then it didn’t. I found myself sobbing for no reason, wanting to pick fights with everyone, right before it was time to take the ring out at the end of my cycle.

The funny thing about living with bipolar disorder and PMS is that, like cousins raised in separate countries, the two disorders, syndromes–whatever you want to call them– are related, yet so different. When I’m in a depression, I slow down and feel a kind of existential pain that makes it hard to understand how anyone even makes it from one day to the next because life is so dark and meaningless. When I have PMS, it’s like depression, spiked with mania. I’m angry and sad. And it’s a different kind of sadness, a sadness that’s so close to the surface, it bubbles up at a moment’s notice.

The smallest incident–a shopping bag left at home–leads to sobbing.

And so last month I switched from NuvaRing to a birth control pill called Loestrin. This is only my first month on the new pill. The specialist doctor I saw who prescribed this told me the end of the month might be rough like this, and that if it proved to be this way for a couple months, we could start a routine where I just skip the placebos all together so I don’t have any hormone dip at all.

For now, here I am, this morning, able to write this with a feeling of relief. Because as it turns out–and I know this is too much information, but I think it’s relevant– I got my period this morning.