PMS symptoms might be depression

If you’re a woman, this probably sounds familiar. One week out of every month, you find yourself crying more than usual. You have to refrain from snapping at your co-workers. You constantly crave chocolate.

Experts tell women these are just side effects of premenstrual syndrome, or PMS. But if you find yourself in a serious emotional funk that goes so far as to disrupt your work and relationships, you may have PMS’s debilitating cousin, premenstrual dysphoric disorder (PMDD). And if the blues continue even after your period, they could be a sign of depression or bipolar disorder.

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What is PMDD?

PMDD wreaks the same emotional havoc of PMS, but more so. The disorder strikes women the week before their period and subsides when their period starts, just like PMS. Experts associate PMDD with higher incidences of suicidal thoughts in women.

While about 75% of women have at least mild premenstrual symptoms, only about 5% have symptoms severe enough to quality for PMDD, says M. Beatriz Currier, MD, an associate professor of clinical psychiatry at the University of Miami Miller School of Medicine. No one knows exactly what causes either PMS or PMDD, but figuring out whether you have PMDD can help you ease its effects. Most women with PMDD have found relief through diet, exercise, and rest.

If these six symptoms describe how you’re feeling, you may have more than PMS.

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Your symptoms are all emotional

PMS includes a whole host of physical symptoms—like breast tenderness, bloating—along with emotional symptoms like mood swings. "When it crosses over to where the symptoms are mostly emotional and are really interfering with your life, that could be PMDD," says Patricia J. Sulak, MD, a professor of obstetrics and gynecology at the Texas A&M Health Science Center College of Medicine and the director of the adolescent sex education program at Scott & White Clinic and Memorial Hospital, in Temple.

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You experience debilitating depression

If you’re a little down the week before your period but feel fine the rest of the month, chances are you’re experiencing PMS. But if your pre-period depression really interferes with your work and your relationships, PMDD is likely to blame. And if you can’t climb out of the rut all month long, you may have depression or another underlying illness.

"Some women will say they’re really, really impossible the week before their period, but when you start probing into their energy, appetite, and sleep conditions, they tell you they never really get back to their old self," explains Dr. Currier. "That could mean patients have a baseline depression that gets worse during their premenstrual time."

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You're extremely irritable, anxious, and cry easily

Even if you don’t have depression, you could still be a victim of PMDD if you are irritable, anxious, and cry easily. But how do you know if your irritability level is normal or not? Who hasn’t had a day where her nerves are wound a tad tighter and everyone is annoying?

If your annoyance level rises to the point where you’re lashing out at your family or co-workers, you may have moved beyond PMS. And while you may be weepier than usual before your period, you shouldn’t be concerned unless you are regularly crying over nothing.

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You feel easily overwhelmed and out of control

When you’re juggling family matters, work obligations, and more, who wouldn’t be overwhelmed? But when that feeling threatens to engulf you, take note—it may be PMDD. "My patients tell me they’re easily discombobulated when they need to get the kids off to school," says Dr. Currier. "They feel overwhelmed with their typical day-to-day schedule."

"I’ve even had a couple of patients tell me in tears that the week before their period was when they were most apt to scream at—or even think about hurting—their children," Dr. Sulak adds. "They get to the point where they feel completely out of control."

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You have problems concentrating

Memory or concentration lapses—like misplacing your keys or blanking on a name—are no cause for alarm right before your period. But when these issues start seriously interfering with your life, you should see your doctor. “It’s really common for women with PMDD to say, 'I just can’t get through my work,'" says Dr. Currier. "They’ll tell you they’re just not productive during this time."

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The duration of your symptoms

Whatever your combination of symptoms, they should disappear within a day or two of getting your period—if you have PMS. If the symptoms are life-disrupting but they still go away at the start of your period, you should talk to your doctor about the possibility it may be PMDD. In either case, says Dr. Currier, "the symptoms typically become a problem the week before you get your period and abruptly subside on Day 2 of menses."

But if the symptoms aren't necessarily in sync with your period, generalized anxiety disorder or depression may be to blame. "If the bad stuff is going on all month long," says Dr. Sulak, "there’s something other than PMS going on."

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