Women's Health

Seasonal Mood and Hormonal Changes

Treating PMDD

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.  

Antidepressants
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."