PMDD

Understanding and living with depression

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Despite the multitude of resources and information available, as a person who has experienced depression in many forms and contexts, it is my experience that most people – even those who may have gone through a depressive period – don’t actually understand depression, it’s many forms, and how it manifests differently in different people.

The society I live in, and probably most modern societies, tends to pay lip service to acknowledging how debilitating and dangerous living with untreated depression can be while at the same time making receiving actual treatment of the type and duration needed virtually impossible to receive.

There’s an awareness and informational understanding that depression is physiological: hormonal and neurochemical, in nature. However, there is an impatience and stigma for those who are medicated to try to balance out the biochemistry. Those who find medications too difficult to stay on and slide back into symptoms after going off meds are looked down on and criticized, often treated as if they are responsible for their illness, “I don’t understand why she won’t stay on her meds. She just doesn’t care how she affects others. If she did, she’d stay on her meds. She’s just selfish and self-centered.”

Women experiencing postpartumn depression get judged and labeled as bad moms because they have fears and feelings, outside of their control, that society says no mom should ever have. When the truth is that, as human beings, we all have scary, negative thoughts that we don’t like to have, about even the ones we love the most. A woman experiencing postpartum depression just has less ability to filter, censor, and control those thoughts and feelings. She recognizes and understands on an instinctual level that those filters and control are fragile and absent and becomes even more anxious.

People in our society – I include my past (and sometimes present) self- have learned mental health terms, then use them as labels to criticize, demean, and judge others by. We stop seeing individual people and just try to assign the label so we can determine the appropriate amount and kind of time, attention, and care we should invest. We place unrealistic expectations on those experiencing depression, whether it is ourselves or others.

What follows is a list of various forms of depression that I or those I love and care about have gone through or are dealing with now. I have provided links and brief descriptions. It is my hope that the next time you or someone you know starts showing signs of depression, you will remember this and seek compassionate, empathetic responses, offering understanding and patience instead of platitudes, minimizing statements, and the attitude that they, or you should, “just get over it.”

Major Depressive Disorder, via the Mayo Clinic:

More than just a bout of the blues, depression isn’t a weakness, nor is it something that you can simply “snap out” of. Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure.

Dysthymia, via Medline Plus:

The main symptom of dysthymia is a low, dark, or sad mood on most days for at least 2 years. In children and adolescents, the mood can be irritable instead of depressed and lasts for at least 1 year.

In addition, two or more of the following symptoms will be present almost all of the time that a person has dysthymia:

• Feelings of hopelessness
• Too little or too much sleep
• Low energy or fatigue
• Low self-esteem
• Poor appetite or overeating
• Poor concentration

People with dysthymia will often take a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem more difficult to solve.

Bi-Polar Disorder, via MentalHelp.net:

a category of serious mood disorder that causes people to swing between extreme, severe and typically sustained mood states which deeply affect their energy levels, attitudes, behavior and general ability to function. Bipolar mood swings can damage relationships, impair job or school performance, and even result in suicide. Family and friends as well as affected people often become frustrated and upset over the severity of bipolar mood swings.

Cyclothymic Disorder, via PubMed Health:

Cyclothymic disorder is a mild form of bipolar disorder (manic depressive illness) in which a person has mood swings over a period of years that go from mild depression to emotional highs.

Think dysthymia with episodes of hypomania.

Postpartum Depression, via Web MD:

Postpartum depression is a serious illness that can occur in the first few months after childbirth. It also can happen after miscarriage and stillbirth.

Postpartum depression can make you feel very sad, hopeless, and worthless. You may have trouble caring for and bonding with your baby.

It is now recognized that “you can have postpartum depression any time in the first year postpartum.”


PMS/PMDD, via Psych Central:

For a woman to have premenstrual syndrome (PMS), the symptoms must be severe enough to interfere with her social or work life. Severe cases of PMS are diagnosed as premenstrual dysphoric disorder (PMDD). Symptoms of PMS and PMDD include those for depression as well as breast tenderness, headaches and joint and muscle pain.

Women who have a family or personal history of depression or postpartum depression are at higher risk for developing PMS or PMDD. PMDD affects five percent of menstruating women.

Seasonal Affective Disorder, via NAMI.org:

The symptoms of depression are very common. Some people experience these only at times of stress, while others may experience them regularly at certain times of the year. Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression, usually in late fall and winter, alternating with periods of normal or high mood the rest of the year.

Atypical Depression, via Discovery Fit & Health:

it’s a very specific subset of the mental health disorder, with careful criteria for diagnosis. All “atypical” means here is that some of its symptoms are the opposite of what doctors had come to expect with depression.

Melancholic depression is what most people mean when they talk about being depressed. You can’t sleep, you can’t eat. You can’t concentrate on anything. And nothing seems to bring you out of it. Things that used to make you smile leave you feeling empty.

With atypical depression, some of those symptoms are reversed. Patients oversleep (hypersomnia), overeat (hyperphagy) and exhibit mood reactivity — they’re able to brighten up in response to happy news; it just doesn’t last long. Because of that latter quality, they may not even know they’re depressed. They may think that their baseline of depression is just how everyone feels.

They do know, however, that feeling like your limbs are so incredibly heavy that you can’t move is not normal. This symptom, leaden paralysis, is different from a lack of energy — it’s more like being physically anchored to your bed. With actual metal anchors.

Atypical depression tends to set in fairly early, in the teens and young adulthood, and it’s more common in women.

Situational Depression, via BeForLiving.com:

Situational depression, also known as reactive depression: This type of reaction is thought to be universal and frequently seen in patients who have had to cope with events of personal injustice, humiliation, frustration, and helplessness (Linden et. al., 2007). A stressful life event (SLE) can be events that would seem insignificant to others, however, to you the event was perceived as an offense to you. A feeling as if there has been a small pinch to your inner self. Any situation that leaves you feeling deflated and helpless can be considered as a SLE. When this happens, it is imperative that you ask yourself some difficult and honest questions.

When did I start to feel this way?

What was said or done that served as a precursor to my ill feelings?

Do I feel ashamed?

Do I feel embarrassed?

Do I feel humiliated?

Do I feel exposed?

Do I feel powerless?

In my research, I found that three of these depressions can also be exhibited with signs of psychosis, where the people experiencing them can also suffer hallucinations and delusions that can be dangerous and frightening for them and for those around them: major, bi-polar, and postpartum depression.

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I was first told I was experiencing depression in my early teens by a school counselor. I later received a diagnosis of dysthymia. I have had a couple of major depressive episodes and experienced postpartum depression after each of my three children were born. I recently realized that I do have periods of hypomania, PMDD, and SAD.

It seems that every year or two situations occur which trigger a situational depression that often coincides with or leads into one of these other forms of depression.

Lack of consistent access to treatment, incomplete/inaccurate diagnoses, and the subsequent treatments which may include medication have led to additional problems or issues. My own poor and incomplete understanding has played into exacerbation of symptoms at times. I have been afraid of judgment, stigma and how the assumptions and misunderstanding of others, especially those in positions of power and authority over my life, could and have impacted my life.

I’m doing better than I’ve done in many years. At least I’m more in tune with the symptoms and triggers. I’m more cognizant of my own thought processes and choices that can help manage the symptoms or make them more difficult to manage. Sometimes it’s a moment by moment daily struggle. Some days I feel like I’m done with the depression, only to be frustrated when the signs start popping up again.

I’m still here and I’m still fighting.

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Hypomania Interrupted

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Yesterday felt like the beginnings of a hypomanic episode. These were some of the signs present:

• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

• More talkative than usual or pressure to keep talking

• Flight of ideas or subjective experience that thoughts are racing

• Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)

• Increase in psychomotor agitation

This is how these symptoms manifest for me:

• Insomnia kicks in and I wake up after one or two hours of sleep,

• Even if my body is still tired, my mind just jumps from one thought stream to another,

• I feel an insistent and urgent need to communicate – since no one is usually present for me to talk to, I feel a compulsion to write.

• If I can write, I wind up with five or more tabs open while I “rabbit trail” with the different streams of thought and trying to link to this idea/concept or find a new quote, then try to create an image to illustrate what is going on in my head and emotions, all while Facebooking.

• If I can’t write, my agitation and irritability increase and I will find myself wandering in and out of the various rooms in my apartment, picking things up and putting them down.

So, when I woke up around 1:30 in the morning yesterday and couldn’t get back to sleep, after an hour and a half, I risked waking my daughter up and got on the computer to write. I spent an hour writing then an hour editing and rabbit trailing while I got ready to hit the publish button on the post. By then it was around 4:15-4:30 and I still couldn’t sleep. So, another hour or so was spent on Facebook, until my body crashed again around 6 am. I slept for 2-2.5 hours then had to get up and get Luna ready to go to her respite care program. Once she got on the bus, I went to the pool and swam laps for an hour and a half. The perfect place to get out the psychomotor agitation and let the thoughts just flow.

Some other things were happening for me as well:

PMDD/PMS

• Sadness or hopelessness

• Anxiety or tension

• Extreme moodiness

• Marked irritability or anger

When I got home, I discovered I was locked out. The anxiety and panic tried to take over and I began feeling really frustrated with myself for not taking my key and with those who locked the door without realizing my keys were still hanging in the entryway.

I remembered that the kitchen window had recently been opened and figured it hadn’t gotten locked again. So, I removed the screen and was able to slide it open. The next task was to figure out how to haul my 266 lb body through it and avoid all the boxes and bags of stuff stacked in front of it without causing injury or creating a mess.

I did it! It was a huge accomplishment to get through all of that in the way I did. However, it was also a LOT of energy and effort, not just physically, but also mentally and emotionally, because all I wanted to do was throw a tantrum, go into panic, and be pissed off.

I soon got my wish. I went in the kitchen to cook myself some eggs only to discover that despite all the cleaning that others had done in there the previous night, the sink was full and the counters were covered, as was the stovetop, with an accumulation of unwashed dishes.

Then I discovered 2/3 of the myzithra cheese, which I had been saving for a special pasta dish I’ve been craving, was gone!

I. Was. LIVID!

Within 30 seconds, it seemed, the one responsible for me having been locked out, the likely culprit of the cheese theft and major contributor to the kitchen mess, returned my phone call.

Uh huh. What followed was less than pretty.

She laughed at my description of what I went through to get into the apartment then turned the cheese thing around on me, raising her voice in the process, deflected and told me I was yelling, talked over me, then hung up.

Over the past year and a half or so, I have worked hard to create a different response when this sort of thing happens. I usually just let the matter rest until everyone is calm again. Often, that means the apologies are said later and the issue just blows over.

This time, however, my mental and emotional state was so overwhelming and I was so agitated and righteously pissed, that I just kept hitting redial while she kept sending me to voicemail, until she answered the phone, talked at me and hung up again.

By that point I was in a fury and so frustrated, hurt, and angry that I started pacing around muttering and crying. I even slapped the wall at one point, which hurt, stinging my hand so bad it made me cry harder.

The feelings of not counting or being treated with the effort, courtesy, consideration, and acceptance were swirling and roiling like a tempest through my heart, mind, and body. The depression started trying to rise and all the fears and worries about our financial circumstances started. My throat constricted and all the energy just drained out of my body.

That’s when I remembered that there were a couple of friends I could call, whom I’ve been reconnecting with. I got voicemail with the first one, but the second one answered. We talked for probably an hour.

The conversation started with me stating that I hated the life I’ve created for myself. We talked through what had happened and the history and established patterns of my family relationships. She empathized with me, validated my feelings, and sought to understand what was really going on. I shared about the things I’m learning in my Circle of Security parenting group and the realizations I’ve been having about some key things about how I grew up and how those things had carried through into my parenting, especially with my adult children.

The best thing about the call though, was that I was able to not make it all about me and my stuff. We talked about her experiences in these matters and I asked about a health issue she’s been having. That may not seem like a big deal to many, but it is a huge indicator of how much I’ve grown and healed.

After that call, I was able to cope better and follow through on scheduled activities, which, even as recently as a week or two ago, I may have wound up canceling because of how crappy my day had been.

That evening I was able to talk through the issues that had happened earlier in the day with the one(s) who had contributed to my earlier distress. Eventually, Luna and I made it to bed.

Miracle of miracles, I slept . . . Through the night with minimal waking moments which I was able to return to sleep from.

I think that a few things were key in the disruption of what otherwise would have turned int a full-blown, four plus period of hypomania:

1) I’ve been exercising. Everyday during the month of May, I have walked a minimum of a mile or exercised at least 20 minutes. Whether I felt like it or not, regardless of what else was happening or who else was in distress, even when it was the very last thing I wanted to do, I exercised Every. Single. Day. Since Tuesday, May 21st, I swam three miles and today I walked over 4.5 miles.

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So, physically, my body needed the downtime of sleep to rest and repair, regardless of what the neurochemistry and hormones were doing to my brain and emotions. The exercise also satisfied the psychomotor agitation and allowed space for the thoughts to just flow through and not get stuck.

2) Community support. In addition to knowing I had three different people I could call and safely talk things through with, there are some online communities I’m consistently engaging with where, not only can I get encouragement and support, I am actively participating in the support and encouragement of others.

3) Practicing presence. As painful, frustrating and difficult as it was to go through yesterday’s experiences, I stayed in the moment and didn’t short circuit the process by numbing out on television and/or food.

I’m not out of the woods and there is still a long and winding path ahead. However, I finally can see and am realizing that I am growing and changing. I am now able to recognize that I am a new me and while things like PMDD, Cyclothymia, and Fibromyalgia may always be factors in my life, they no longer have to fully define and dictate the person I am.