PMS and Its Impact on Mental Health: A Personal Journey

I suspect it might be premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)?

Hello Dr.
Ding,
I'm not sure if it's due to the excessive stress from my previous job, but over the past two and a half years, my emotional fluctuations have become increasingly pronounced.
Sometimes, it even affects my work and interpersonal relationships.
Even though I resigned nearly two months ago, there hasn't been much improvement.
Out of concern, I started recording my premenstrual symptoms over the past couple of years, which usually include irritability, tearfulness, depression, anxiety (I have a compulsive habit of picking at my nails, and I've lost two nails completely while the others are fine; I've been trying to control this since childhood), feeling down, being on the verge of losing control, insomnia, chest tightness, abdominal pain, and edema.
At times, I have even resorted to self-harm by cutting the back of my hand (which has happened multiple times).
I also find it difficult to talk to strangers and fear crowded places.
Sometimes, I can't even tell if it's depression or something else.
However, I try to maintain a normal facade in front of my family and friends.
I don't have much trouble eating, but occasionally I lose control and binge eat, which leaves them confused about my emotional state.
My family is probably quite worried, especially since they have noticed my self-harm but don't know how to help.
They just tell me to talk about my feelings.
I know I shouldn't harm myself, but whenever I feel pressure or can't express my anger, I end up doing such things.
Since I stopped working, I've been actively looking for a job, but there haven't been any leads.
Sometimes my family pressures me, which makes me irritable again and causes my self-confidence to plummet.
Recently, I've also started experiencing insomnia; I lie awake for a long time before I can fall asleep, and I wake up feeling exhausted every day, unable to get enough rest (I've always had sleep issues, but they've worsened recently).
I find myself wanting to turn my days and nights upside down, reluctant to see the sun, and I force myself not to sleep past 2 PM, just drifting through the day.
Although I've been exercising regularly for the past four months, it doesn't seem to help much, and I don't feel much joy.
Interacting with unfamiliar people causes me stress again; I prefer to stay at home.
If I have someone to accompany me when I go out, it's fine, but being alone outside makes me uncomfortable and unhappy.
I thought I had returned to my happy self recently, but it seems that feeling has faded again.
Last year, I visited the psychiatric department at Shih-Pai Veterans Hospital once, and the doctor mentioned that I have depressive tendencies.
He prescribed medication and advised me to force myself to go out and walk the dog.
Honestly, I find it hard to do, so I didn't go back for a second visit.

Thank you for taking the time to read this, and I appreciate your patience.
Wishing you all the best.

Banbi, 20~29 year old female. Ask Date: 2016/03/15

Dr. Ding Shuyan reply Psychiatry

Hello, the symptoms of premenstrual syndrome (PMS) typically appear a few days before menstruation and improve after the onset of menstruation.
Based on your description, it seems that this condition has not been specifically mentioned, making it difficult to determine if it applies.
Generally speaking, depression is treatable and can improve.
Of course, individual values can influence how people choose to cope with depression; some may prefer to try to improve on their own first, while others (especially those who have experienced depression and have recovered) may choose to see a doctor directly.
The suffering from depression can significantly impact work, interpersonal relationships, and the quality of daily life, comparable to that of a serious physical illness.
Moreover, it can be worse because others may not understand, as they might say we appear to be physically fine.
Concern from family can indeed add to our distress.
Since you have decided to see a doctor, I think it would be beneficial to continue treatment and complete a full course.
In my experience, the improvement from medication can be quite rapid.
Psychological therapy or self-adjustment can also be pursued simultaneously without conflict! Not having a job is challenging, as finding work is not something that happens overnight.
I recommend continuing to exercise and get outside, as this greatly aids in recovery from depression.
Additionally, using this time to learn something new can help distract you and develop your interests or skills.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2016/03/15

More Info

Dear friend,
Thank you for sharing your personal journey and the challenges you are facing. It’s clear that you are experiencing a complex interplay of emotions and symptoms that can be overwhelming. Your description of premenstrual syndrome (PMS) and its impact on your mental health highlights a significant issue that many individuals encounter, and it’s important to address it with care and understanding.

Premenstrual syndrome (PMS) is a condition that affects many women, characterized by a range of emotional and physical symptoms that occur in the luteal phase of the menstrual cycle, typically one to two weeks before menstruation. Symptoms can include irritability, mood swings, anxiety, depression, fatigue, and physical discomfort such as bloating and breast tenderness. For some, these symptoms can be severe enough to interfere with daily life, work, and relationships, leading to what is often referred to as premenstrual dysphoric disorder (PMDD), a more severe form of PMS.

From your account, it seems that your emotional fluctuations, including irritability, anxiety, and depressive symptoms, have been exacerbated by stress from your previous job and the transition to being unemployed. The fact that you have been keeping track of your symptoms is a positive step, as it can help you identify patterns and triggers, which is crucial for managing PMS and its mental health implications.

Self-harm, as you mentioned, is a serious concern and often indicates a need for immediate support. It’s important to recognize that while these behaviors may provide temporary relief from emotional pain, they can lead to further distress and complications. Seeking help from a mental health professional is vital, especially since you have already been diagnosed with depressive tendencies. A therapist or psychiatrist can provide you with coping strategies, therapeutic interventions, and, if necessary, medication to help manage your symptoms more effectively.

You mentioned that you have been reluctant to return to the psychiatrist after your initial visit. It’s understandable to feel apprehensive about seeking help, especially if you feel that the recommendations were difficult to implement. However, it’s crucial to remember that mental health treatment is not one-size-fits-all. A different provider may offer new perspectives or treatment options that could resonate better with you. Additionally, therapy can provide a safe space to explore your feelings and develop healthier coping mechanisms.

In the meantime, here are some strategies that may help you manage your symptoms:
1. Routine and Structure: Establishing a daily routine can provide a sense of stability. Try to set regular sleep, meal, and exercise times to help regulate your body’s internal clock.

2. Physical Activity: While you mentioned that exercise hasn’t improved your mood significantly, it’s still beneficial for mental health. Consider finding activities you enjoy, as this can make it easier to stay active.

3. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or yoga can help reduce anxiety and improve emotional regulation. These techniques can be particularly helpful during the luteal phase when PMS symptoms may intensify.

4. Social Support: While you may feel more comfortable at home, try to maintain connections with friends or family, even if it’s just through phone calls or messages. Social support is crucial for mental well-being.

5. Journaling: Writing down your thoughts and feelings can be a therapeutic outlet. It allows you to process emotions and reflect on your experiences without judgment.

6. Nutrition: A balanced diet can impact mood and energy levels. Consider consulting with a nutritionist to explore dietary changes that may alleviate some PMS symptoms.

7. Professional Help: As mentioned earlier, don’t hesitate to reach out to a mental health professional. They can provide tailored support and may suggest therapy options such as cognitive-behavioral therapy (CBT), which has been effective for many individuals dealing with anxiety and depression.

Remember, it’s okay to ask for help, and taking that step can be a sign of strength. You deserve support and understanding as you navigate this challenging time. Please take care of yourself, and I wish you the best on your journey toward healing and well-being.

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