Friday Q&A: Hormonal mood swings; tapering antidepressants; HRT and breast cancer; & long COVID
A collection of your queries! 🥳
ICYMI 👉
The first question (on hormonal mood swings) is free for all subscribers. Questions 2-4 (on tapering antidepressants; HRT and breast cancer; & long COVID) are for paid subscribers only. If you would like a paid subscription but it’s not in your budget, please message me directly.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
QUESTION #1: HORMONAL MOOD SWINGS
Thanks for your post about antidepressants. I have been tracking symptoms and, almost like clockwork, somewhere between days 22 and 26 of my menstrual cycle I am depressed for 1-3 days. I feel hopeless, teary, and totally unmotivated/disinterested in things I enjoy. Then, it's like a switch flips and I feel better and/or start my period. I'm approaching 40, am not on hormonal birth control, and have regular cycles. My doctor ran a hormone test and nothing appeared concerning, and mentioned antidepressants. It feels like overkill for something that is 1-3 days a month, but I'd be lying if I said I didn't suffer during those days. How would you counsel someone on a decision like this? Thank you!
-T
Dear T,
It sounds like you are experiencing premenstrual dysphoria. So sorry to hear! This is a common phenomenon whose symptoms can range from significant moodiness to milder fatigue and malaise. When the symptoms are clearly tied to a woman’s hormonal cycle and when they significantly impact her daily life (even if only a few days a month), we call it Premenstrual Dysphoric Disorder (PMDD).
Here is the general advice I give my patients for managing PMDD:
Keep a record of your menstrual cycle and symptoms. This can help you identify patterns and better plan for and manage your symptoms.
Get Regular Exercise. I advise patients to aim for at least 30 minutes of moderate exercise most days of the week to improve mood and reduce stress.
Eat a Nutritious Diet. A well-balanced diet with a focus on whole foods, fruits, vegetables, and whole grains—and limited caffeine and alcohol intake—can help round out the edges of PMDD symptoms.
Adequate Sleep. Ensure you get enough quality sleep, as sleep can significantly affect mood and overall well-being.
Hormonal Treatments. Birth control pills for menstruating women may help regulate hormonal fluctuations and reduce PMDD symptoms. Specifically I often recommend taking the birth control continuously for three months at at time.
Selective Serotonin Reuptake Inhibitors (SSRIs). Antidepressant medications like fluoxetine, sertraline, and others have been shown to be effective in alleviating PMDD symptoms. They are typically taken only during the luteal phase of the menstrual cycle. I often prescribe fluoxetine 20 mg to be taken 7 days of the month.
Psychotherapy and Stress Reduction Techniques. Cognitive-behavioral therapy (CBT) and other forms of psychotherapy—plus practices such as mindfulness meditation, deep breathing exercises, and yoga—can help manage stress and improve overall mental well-being.
You are not alone! PMDD is real and potentially debilitating. As always, it's crucial to work with your own doctor to develop an individualized treatment plan that addresses your specific symptoms and needs. I hope this helps.
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QUESTION #2: TAPERING ANTIDEPRESSANTS
Can you please talk about how you get off an anti-depressant successfully? I've read and seen many stories by people that wish they never started them because of how difficult or impossible it was to come off them. Bc of this, I don't really see antidepressants as an option although I really like that you said you were then able to use psychotherapy to retrain your brain...that sounds amazing.
-Cassandra
Dear Cassandra,
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