At the recommendation of my mother a little while ago, I picked up a copy of The Female Brain neuropsychiatrist Louann Brizendine’s 2006 exploration of just that: the lifecycle of the female brain, from infancy and girlhood, adolescence and young adulthood, onward to middle age, menopause, and beyond. Less than 50 pages in, I put the book down and cried uncontrollably – I had read what I thought was a hauntingly accurate description of my very self. Brizendine was discussing her experience diagnosing patients with a condition called premenstrual dysphoric disorder, or PMDD: “Those women with the least estrogen and progesterone are more sensitive to stress and have fewer serotonin brain cells. For these most stress-sensitive individuals, the final days before their periods start can be hell on earth. Hostility, hopeless feelings of depression, plans for suicide, panic attacks, fear, and uncontrollable bouts of crying and rage can plague them. Hormone and serotonin changes can result in a malfunction in the brain’s seat of judgment (the prefrontal cortex), and dramatic, uncontrolled emotions can push through more easily from the primitive parts of the brain.”
So imagine PMS – crankiness, short fuse, crying at mediocre Lifetime movies – and then give it claws and rows upon rows of shark teeth and the overwhelming power of The Hulk.
After I read what Brizendine had to say about PMDD, I sat down with a few sheets of paper and wrote out the depressive breakdowns I had in recent memory. Not just “low points” or “bad days,” but terrifying moments or days of frozen panic, depression so deep and heavy I could not take my head off of my pillow. One summer, a few weeks after my 21st birthday, where I stayed awake for 48 hours straight mostly just staring out the window of a muggy London apartment in a fit of immobilizing panic; when my depression began to manifest into my physical body to the point of a back injury so severe my boyfriend had to put on my socks and tie up the laces of my Converse for me; a summer so lonely and hot that I would come from home work, swallow two codeine pills, and wait for the days to pass slowly, unmoving; and finally the worst one, at twenty-four, printing and filling out a Personal Firearms Eligibility Check application to begin the process of purchasing a handgun, considering where I might courteously end my life – Tahoe, perhaps, or somewhere in the dry trails of Lake Berryessa, where I wouldn’t get in anyone’s way. Apologetic as always, even my suicide was planned in such a way that was entirely convenient for anyone who might have stumbled upon my corpse. In the woods, I thought, where I could fold in on myself, into the grass or the dirt, decomposing politely, without ruining anyone’s hike.
As I recollected these experiences and other ones, I considered the days that followed them. I considered when in the month they occurred: “a few weeks after my 21st birthday” would have put those specific 48 hours in mid-August; the day in London in mid-December, crying that I couldn’t put on my own socks and shoes on such a cold winter day, when I needed to walk to the library to study for finals; mid-July in California, so hot and dull and depressing; the night I planned how I might end my life, after an annual work event that occurs in the middle of every October. The light bulb went off, bright and blinding: my period comes around the 20-25th of every month. All of these deepest bouts of paranoia, depression, and panic had occurred in the middle of the month. When I was PMSing.
So I made some changes. I swapped my hormonal birth control pills for a Paragard – the hormone-free, copper IUD – and felt the tiniest bit like I had come back into myself. I started therapy. I did research. I began a new routine of texting my mother when I feel it happening — the paranoia, the self-loathing, the blackness of depression creeping up on me. I have a collection of timed and dated text messages to roll back on, to know I’ve been here before, will be here again. To know that it’s cyclical. The simple act of being aware that it’s happening has made it that much more manageable.
What separates PMDD from other mood disorders – and yes, it’s a mood disorder and not a woman being “crazy” or a “raging hormonal bitch” – is the immediate release of the symptoms. On top of major depressive disorder – which grows in enough branches of my family tree to leave me basically a big red target for it – I wondered if maybe I was bipolar. After all, the symptoms would be so severe one day and completely, 100% gone the next, with the start of my period. It felt very much like living in someone else’s head for a few days before waking up, fresh-faced with blood-soaked underwear, wondering about the horrible mental hellscape from which I’d just escaped.
The Massachusetts General Hospital Center for Women’s Mental Health says that “PMDD affects 3-8% of women in their reproductive years symptoms usually emerging during a woman’s 20’s” — ding ding ding! – “[It] can be distinguished from other mood disorders primarily by the cyclical nature of the mood disturbance. PMDD mood symptoms are only present for a specific period of time, while other mood disorders are variable or constant over time. With PMDD, mood symptoms are present only during the luteal phase (the last two weeks) of the menstrual cycle. The best way to distinguish PMDD from an underlying mood disorder is by using daily charting of symptoms.”
But many aren’t convinced it’s even a “real” thing – and some argue that it can be dangerous for women and our pursuit for equality and accessibility in professional and social platforms. In the American Psychological Association journal, an article entitled “Is PMDD Real?” explores these issues, with one author arguing that it’s “really appalling that using PMDD for women who want recognition for discomfort is a very clear message that goes something like: ‘OK, OK, we’ll believe you are feeling bad if we get to call you mentally ill for feeling bad.’ Can you imagine if we did that to men? Women are supposed to be cheerleaders. When a woman is anything but that, she and her family are quick to think something is wrong.”
It’s an understandable argument. Women have fought for decades to be taken seriously, to rid everyone of the notion that, for example, our “periods attract bears.”
Scientific evidence that we’re naturally “crazy” could be potentially very damaging for women as a whole.
But not for me. I draw the line at planning at my own suicide. Finally, at 25, I called bullshit. I reread Brizendine’s section on PMDD, and how she handled it in her patients: “For some girls I add an antidepressant—a so-called SSRI (selective serotonin reuptake inhibitor)—which can further stabilize and improve the brain’s serotonin level, in other words, improve one’s mood and sense of well-being.” After one last PMDD-induced breakdown in a small Brooklyn bedroom this last October, I called my doctor and my gynecologist. I called my mom. If it were migraines or sinus infections debilitating my life at this level, I would have started taking medication years ago. So, I finally started my daily 10mg dose of fluoxetine – otherwise known as Prozac.
Three days ago, I started my period. I had a short fuse and cried during an episode of Friends and suffered some gnarly chin acne – other than that, I had no idea my period was coming. There was no recurring playlist telling me to hurt myself, no recoiling at every glimpse of my own reflection, no 60-minute paranoid showers or late nights crying so hard I couldn’t sleep.
Prozac is my jam. I am my seeing my best self and feeling it, too. I’m a thousand times less self-obsessed. I sleep better. I still like sex. I’m still creative. I get more work done. And when I consulted with a well-known Michigan psychiatrist about all this, I let her words resonate: “The meds won’t hurt you, but anxiety and depression are like a scrub brush in the brain…don’t want that shit in there too long.” Sure don’t! I’ll take a healthy brain and body over outlandish stigma any day of the week – rain, blood, or shine.
Photos Via Anne Taintor, Giphy. Illustration by Shawheen Khorshidian from KHOR Designs.
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