my pmdd story

finding a diagnosis and treatment after more than a decade of intermittent depression and anxiety

a couple of disclaimers: i am not a medical professional. this is just my experience, not medical advice, and before you make any changes you should consult your doctor. also, a trigger warning – this post discusses depression, suicidal ideation, and mental health challenges.

once upon a time

it started in my late teens. intense, seemingly random bouts of depression, anxiety, hopelessness, overwhelm, anger.

i would cry so hard i burst blood vessels under my eyes.
i would be unable to get out of bed for days.
i would be sure i could not go on, that life was completely hopeless, that i could never escape the despair.

i remember sitting with my mom in her living room on winter break from college, deep in one of my moods. the concern swept across her face as she knitted her brows and remarked, “you feel things so deeply.”

i couldn’t find a way out of these (what felt like) irregular spells of intensity, so i absorbed them into my identity. “oh, it’s just my scorpio nature.” “i’m just a highly sensitive person.” “i wouldn’t be an artist without my moods.”

when i started to put the pieces together

throughout the years i would occasionally track my months – diet, exercise, alcohol consumption, work, etc. – trying to find a pattern for what would spur these psychological breakdowns. i wondered if i was bipolar because much of the time i felt my usual positive, goofy self. but then, one day, out of the blue, i would get hit with a wall of depression and anxiety.

in march of 2021, i was on a trip to santa fe just before getting my period. i’d been eager to travel after a year of staying close to home because of the pandemic. i rented a little airbnb in downtown santa fe and had plans to see lots of art, eat delicious new mexican food, and spend days wandering through juniper trees in the sunny desert. but once i arrived, i was bed-bound and weepy. i didn’t want to leave the house. i couldn’t stop crying and catastrophizing. i hardly had any energy and felt utterly depressed. i sobbed while driving home across empty highways and through mountain passes. i thought how much easier it would be to just die. i imagined jumping out of the moving car. i thought about how horrible of a person i must be to those around me.

i often play with contrast in my work, which represents the “two parts” — one light, one dark— of myself that i’ve experienced much of my life. [this is “alice,” from my latest series wise women, available on my website]

i got my period the next day. like magic, the cloud lifted. i snapped back into my “normal” self so abruptly that i had to do some research. i googled “depression before period.” that’s when i learned about pmdd.

“premenstrual dysphoric disorder is a much more severe form of premenstrual syndrome (pms). it may affect women of childbearing age. it’s a severe and chronic medical condition that needs attention and treatment. lifestyle changes and sometimes medicines can help manage symptoms.” source: hopkins medicine

a lightbulb went off. i couldn’t remember exactly when all of my previous stints of depression hit, especially because my cycle used to be long and irregular (i would get my period every 45 days-ish, and sometimes skipped periods, which since has shortened and become more regular). i thought this could possibly explain why some days i felt wildly depressed and others totally normal.

i specifically remember finding the instagram account @pmddmemes, which i scrolled through obsessively, laughing out loud, suddenly feeling slightly hopeful and much less alone.

credit: @pmddmemes

natural approaches that have helped

the cause of pmdd is not known. it may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. the hormone changes can cause a serotonin deficiency.

there’s a lot of information about natural ways to treat it. over the next year and a half, i did it all. i dove into supplements, teas, herbs, exercise, and lifestyle changes. i also started following dr. alisa vitti’s teachings (which i still love and reference regularly), specifically in her book in the flo: unlock your hormonal advantage and revolutionize your life.

for me, i saw the most benefit from:

• regular cardio exercise (i hate running, but it helps)

• a calcium supplement during the luteal phase only

• not drinking (i quit for more than a year)

• meditation/actively trying to manage stress

most everything helped. the mindfulness, the better diet, the sobriety – it all made me feel better overall and even reduced how often i might experience severe pmdd symptoms, but i still would regularly have debilitating emotional symptoms that would take 1-2 weeks away from me living life. it wasn’t just that i would get a little sad or irritable. i continued having meltdowns around that time of the month and occasionally severe instances of suicidal ideation or extreme hopelessness.

much of my art stems from emotional experiences, and treating my pmdd has only benefited my practice [pictured here: “sophie” available on my website]

the tipping point + my first experience with ssris

i started dating someone this past summer and shortly after had one of the worst episodes i’d experienced in a long time. my period was late (which is not uncommon and often correlates with a more severe round of pmdd for me). it was just a couple of months into our relationship, and one night when i was at his apartment i had a panic attack. i woke up and went into the spare bedroom, curled into a ball, and started hyperventilating. he woke up and found me there. so soon into our relationship, i didn’t know how he would react to seeing me like that. thankfully, he was incredibly kind and comforting and didn’t shy away from this thing i’ve been dealing with for more than half of my life. it was the next morning that i knew i needed to try something different. i didn’t want this to be my normal anymore.

i’d heard about the research behind ssris (selective serotonin reuptake inhibitors, commonly referred to as anti-depressants) for pmdd, but i’d always been incredibly resistant to medication. up until the last year, i didn’t understand why the depression/anxiety happened so irregularly. a good portion of the time i felt like myself, so it was hard for me to rationalize taking medication.

there’s actually some good research that shows intermittent ssri use is extremely effective in treating pmdd. that means i only take the medication for about half of the month, starting in the luteal phase (approximately 14 days before my period), otherwise known as “luteal-phase dosing.”

i made an appointment with my doctor, an amazing md who focuses on functional medicine, and she signed off on the idea, also citing research for intermittent ssri treatment. she wrote a prescription for 25 mg of sertraline (the generic form of zoloft) and told me to take it when i felt pmdd symptoms coming on. “i hope the next time we talk, it’s like all of the windows have been opened and you have a new lease on life,” she said as i left her office.

what it’s been like since starting ssris

it’s like all of the windows have been opened and i have a new lease on life.

i am not exaggerating; this treatment has changed my life. i always worried taking medication would dull my sense of wonder… my ability to feel deeply, which is what inspires so much of my art. i convinced myself that if i didn’t have the low lows, i wouldn’t have the high highs.

many titles for my pieces come from moments or phases in my life that have been emotionally difficult, like this one, “the beauty of survival” [available here]

i’ve been doing luteal-phase dosing for four months, and i still feel very much like myself. i still tap into emotional depths for my work. i get sad. i cry. i still feel my emotions. the difference is that now i don’t lose half of my days to insomnia from anxiety or being bedridden from depression. i might experience some mild pms (what i’m guessing most other people typically feel) but i am able to continue on with my day and my life.

it feels like a miracle.

phew, this was a long one. i’ve wanted to write about this for a while, so thank you for reading. please keep in my mind, this is just one experience. although there is science behind this approach, always discuss with your doctor before trying anything new. we all have to find our own way. but i hope that sharing my experience might give someone who’s struggling some insight into the options we have to cope. or maybe you’ve experienced depression off and on throughout your life but have never heard of pmdd.

whatever the case, you are not alone. i’m happy to answer any questions or point to resources. please feel free to share/ask in the comments.

love,
amanda