Q:
I struggle with depression several days before and while I'm on my monthly cycle. I start crying for absolutely no reason and then start to have awful thoughts. I hate it because normally I feel that I have a great life and couldn't ask for anything more, yet when I feel this way, I have thoughts that say I don't (I'm trying to word this correctly because I'm not suicidal, I just have thoughts about not deserving life.).
This has been a problem for as long as I can remember, but since I went on Tri-Previfem, it has escalated and is interfering with my classes. I am wondering if there is any prescription medication that would solve this because it seems like I've tried everything else. (I'm trying Vitamin B supplements currently.) I've tried talking to doctors about it, but I don't think they realize how severe it is.
Also, I don't know if this is relevant, but I have struggled with depression my entire life, but have gotten it under control without medication. However, the depression that comes with my cycle hasn't gone away and that concerns me. One more thing, I don't want to be told to "come into the health center for an evaluation." I'd like to know here if I have options and what they might include. Thank you.
A:
I am going to thoroughly disappoint you as treating depression and cyclic mood changes is not something any provider can do effectively without evaluating a patient directly. It takes direct communication between provider and patient and your symptoms sound exceedingly distressing. The birth control pills can be an aggravating factor, no question about it, so you should be discussing them with the prescribing provider.
Counseling can be beneficial for cyclic depression, but medications are often necessary and indicated for relief of symptoms. The SSRI drug class has the best data supporting their benefit in premenstrual dysphoria, such as Prozac or Zoloft and I would highly recommend that you make an appointment to talk with one of us about it. There is no evidence that herbal remedies are beneficial for this kind of mood disorder.
~The Doc
