What Is PMDD & How Does It Impact Mental Health?

Have you heard of PMDD?

A majority of women experience at least some of the symptoms of premenstrual syndrome (PMS).

But for millions of women, the symptoms don’t stop there. It’s estimated that between 3 and 8% of women of childbearing age— millions worldwide— experience a range of mood and mental health symptoms related to their periods that may be signs of premenstrual dysphoric disorder (PMDD).

Because PMDD is a mental health condition, and because not recognizing the signs or symptoms and seeking treatment can have a dramatic impact on your life, we wanted to take a moment and explore this complex and disruptive condition.

What Is PMDD?

PMDD is a premenstrual condition that combines the physical symptoms of PMS with emotional symptoms that can be severe. According to the Mayo Clinic, “Both PMDD and PMS may cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioral symptoms stands out:

• Sadness or hopelessness
• Anxiety or tension
• Extreme moodiness
• Marked irritability or anger

Per DSM-V-TR, in addition, one or more of the following must also be present for a diagnosis of PMDD:

1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings. 5. Hypersomnia or insomnia.
5. A sense of being overwhelmed or out of control.
6. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

It is believed that PMDD is caused by changes in the serotonin and hormonal levels in a person’s body at the time leading to menstruation. As the Cleveland Clinic explains:

“Decreasing levels of estrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. Serotonin, a brain chemical that regulates mood, hunger, and sleep, may also play a role. Serotonin levels, like hormone levels, change throughout your menstrual cycle.”

Researchers at the National Institutes of Health found evidence that PMDD may be genetic. Girls whose mothers have a history of severe premenstrual symptoms are more likely to have PMDD.

As we explained above, PMDD can be incredibly disruptive, and identifying the signs and symptoms is key.

If you think you may be experiencing PMDD learn about how Brightside Health can help.

Want to speak 1:1 with an expert about your anxiety & depression?

Start with a free assessment

Symptoms of PMDD

PMS and PMDD share a number of symptoms. This can make it a little tricky to determine if you are experiencing PMS vs PMDD. To help make the distinction, let’s review the common symptoms of both.

PMS symptoms include:

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating
• Cramping
• Headache or muscle aches
• Clumsiness
• Lower tolerance for noise or light
• Irritability
• Feeling tired
• Sleeping problems
• Appetite changes
• Trouble with concentration or memory
• Tension or anxiety
• Depression, feelings of sadness, or crying spells
• Mood swings
• Reduced interest in sex

PMDD may also include severe feelings of anxiety which might involve:

• Anger or irritability
• Feelings of sadness or despair, or thoughts of suicide
• Panic attacks
• Loss of interest in usual activities and relationships
• Feeling out of control

PMDD symptoms include the symptoms mentioned above, and may also include:

• Difficulty in controlling the feelings of worry, often without control in shifting from one topic to another
• General restlessness
• Fatigue or the feeling of being easily tired
• Difficulty concentrating
• Insomnia
• Irritability
• Muscle aches or soreness
• Feelings of panic, dread, or ‘impending doom’

As the Mayo Clinic puts it, “In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days of your period.” The key difference between PMS and PMDD is the presence of the specific emotional symptoms listed above.

PMDD is treatable

The good news is that PMDD is treatable. PMDD treatment will often involve both therapy and medication (such as an SSRI antidepressant that can help balance the serotonin levels in your body).

That said, therapy isn’t going to make PMDD or its symptoms go away. Instead, therapy would focus on how to manage symptoms to reduce functional impairment and impact. For example, therapy might help individuals use urge surfing or mindfulness techniques when irritability or mood swings are notably activated.

Therapy can also be helpful for tracking purposes. As you gain more knowledge of the rhythm of your cycles over time, you gain a better understanding of the initial symptoms that are the cues to greater symptom presentation/elevation in the coming days. That can be helpful for organizing daily decision-making opportunities.

Perhaps you can plan around when you feel most capable of managing symptoms. You may be able to work with close people in your life, like a partner, to get extra support with tasks or other household duties, because it may be more challenging to do them yourself during that time.

Therapy may also be helpful for having those discussions with your partner or close others in your life so that they know that it is a time for extra interpersonal empathy and sensitivity relative to the rest of the month.

Mental health impact of PMDD

While not every woman will experience PMDD, You may be more prone to PMDD if you have:

• Anxiety
• Depression
• Family history of PMDD, or mood disorders

And, like any disruptive mood disorder, PMDD has the potential to make existing depression or anxiety worse. Depending on the severity and duration of symptoms, those with PMDD may experience suicidal thoughts.

If you do experience symptoms, it’s very important to get treatment. Untreated PMDD can lead to depression and affect your life, relationships, and career.

Brightside is able to help you manage your PMDD. With a range of treatment options that include therapy right in your own home. If your symptoms are impacting your daily life, Brightside’s providers may recommend medication to treat your PMDD.

Want to speak 1:1 with an expert about your anxiety & depression?

Start with a free assessment

The post What is PMDD? appeared first on Brightside.

For us at Brightside Health, the prevention of suicide isn’t a monthly conversation or tied to a specific day. It’s something that we work on every day. And it’s a mission we take very seriously. So before we dig too much deeper, here’s a quick but vital reminder:

Brightside Health can help treat severe mental health symptoms, including suicidal ideation (general thoughts about ending your life). If you have a plan, intend to harm yourself, or are in crisis, please call 988.

If you are not in immediate crisis but would like to see how we can help, start with a free assessment.

There is a good reason that we feel strongly about the relationship between suicide and mental health. Here are a few key statistics from the National Alliance on Mental Health:

• Suicide is the 2nd leading cause of death among people aged 10-34.
• ​Suicide is the 12th leading cause of death overall in the U.S.
• 46% of people who die by suicide had a diagnosed mental health condition.
• 90% of people who die by suicide may have experienced symptoms of a mental health condition, according to interviews with family, friends and medical professionals.

In other words, suicide is a major problem, and it’s tightly linked to overall mental health. Most importantly, there is often something that can be done to help people who are experiencing suicidal thoughts. It starts by talking about it. Here are 5 facts to get us started:

Talking about suicide does not cause suicide

It might seem as though avoiding talking about suicide is a good idea: What if we put the idea of suicide into someone’s head? The thing is, many studies show that that’s not how it works. 

According to a study at the University of Nevada, “asking someone if they are having thoughts of killing themselves is actually more likely to save a life. In addition, most people who are thinking about suicide are at least somewhat ambivalent about it, and research also shows that almost all deaths by suicide are preceded by warning signs of some sort.” This indicates that it’s something we should talk about a lot more frequently.

When someone is having suicidal thoughts, it can feel very isolating. It may even feel as though they are all alone. This means that it’s a good time to remind them that they are not.

Suicidal thoughts can affect anyone

Speaking of not being alone, anyone can have suicidal thoughts. They can be scary and unsettling, but they are not uncommon. In fact, the National Alliance on Mental Health suggests that: 

• About 5% of all adults 
• Over 11% of those between 18-25
• Nearly 20% of high school students
• 45% of LGBTQI youth

 have serious thoughts of suicide each year.

When you consider why most people experience suicidal thoughts, those numbers come into focus. Many people who consider suicide want to escape some sort of pain or problem they have experienced. 

This might be physical, emotional, social, or another type of pain. In many cases, the individual doesn’t want to end their LIFE, they only wish to end the pain they are in. This sometimes becomes the root of a suicidal crisis because they may not see a way out of problems they are facing.

It can be easy to forget that there are other ways to manage intense pain when you are hurting. Know that there are other ways to handle that pain and continue to live. Many suicide prevention programs center on finding and beginning to address the source of pain. This starts with reaching out for help at 988. 

There are signs to look out for

For friends and family members, there are signs to watch for that suggest that someone is at risk of a suicidal crisis and in need of urgent help. These include:

• Talking about wanting to die or wanting to take one’s own life
• Giving away treasured possessions
• Writing goodbye letters
• Talking about feelings of despair and hopelessness
• Preparing for death in some way, like by giving away or selling personal items 
• Self-isolation from family, friends, and other loved ones
• Mood swings
• Difficulty concentrating
• Loss of interest in daily activities or things one used to enjoy
• Changes in appetite and eating patterns
• Over or undersleeping
• Changes in appearance such as not brushing one’s hair, teeth, etc.
• Increased or new usage of alcohol and drugs
• Becoming more impulsive
• Talking about feeling trapped or in pain
• Self-harm
• The creation of a suicide plan

If you or a loved one is experiencing any of signs of suicidal ideation, it is time to have an honest talk about suicide and seek professional help.   

Treatment is available, and it works

In the midst of a crisis, anyone in the U.S. can call or text 988 (the Suicide & Crisis Lifeline). This can mobilize emergency responders to help quickly. There is substantial evidence that therapy and other mental health treatment is very successful in helping those that are experiencing suicidal thoughts; in helping to relieve the pain that underlies the thoughts themselves.

Additionally, creating a safe and supportive environment is important. Professionals can help with this. Creating a safe, supportive environment allows you time and space between a suicidal thought and the ability to act on that urge or thought in a dangerous way. Safety planning is a strategy that can help keep people safe in the moment and includes a number of strategies and resources for individuals to use. You can start to create a safety plan and share it with yourself or others here. 

There are a lot of stories of hope and recovery 

We think the most important thing to know about suicide is that there are many stories of recovery and unlimited reasons for hope. In fact, one study from Harvard found that 90% of those who survive a suicide attempt at some point in their lives do NOT ultimately die by suicide. In fact, in this study, over 70% never made another attempt.

For those looking for hope, there are dozens of incredible stories posted on the Suicide & Crisis Lifeline’s website. These survivors share their inspiring stories and many have a common theme: talking about suicide can help. 

Brightside Health can help treat severe mental health symptoms, including suicidal ideation (general thoughts about ending your life). If you have a plan, intend to harm yourself, or are in crisis, please call 988.

If you are not in an immediate crisis and would like to see how we can help, start with a free assessment.

The post Suicide Prevention & Mental Health: 5 Key Facts appeared first on Brightside.

A common worry from many new parents is that there is something wrong with them or they are not good enough. This is a struggle that many parents encounter and it can be challenged with reframing strategies—a skill a licensed therapist can help you with. 

Whether you’re concerned you’re not good enough (odds are that if you’re invested enough to be worried about being a good enough parent, you probably are one!), you’re feeling really stressed or anxious, or you’re wondering if you’re experiencing a postpartum mental illness, you’re in the right place. Support is available.  

Postpartum mental illness: What to look out for

Many new parents may experience hormonal changes that lead to mood swings before and after childbirth. According to the Anxiety & Depression Association of America (ADAA), 80% of new parents are affected by these “baby blues.” Usually, symptoms resolve within a couple of weeks. If not, you may be experiencing a postpartum mental health condition like postpartum depression.

Postpartum mental health conditions

Here are some postpartum mental conditions to be aware of:

• Postpartum depression 
• Postpartum obsessive-compulsive disorder
• Postpartum anxiety
• Postpartum post-traumatic stress disorder 
• Postpartum bipolar disorder

Ways to get postpartum mental health care

Consider these four ways to get postpartum mental health support. 

Therapy

Whether you’re experiencing a condition like postpartum anxiety or depression, or you’re simply feeling overwhelmed and need help, therapy is a good place to start. 

During therapy sessions, your therapist will listen to your concerns and work with you one-on-one to develop a treatment plan that will help you reach your goals. Over time, you can learn evidence-based skills and strategies that help you reframe thoughts, manage symptoms, and pursue more valued alternative behaviors. You can also put your skills into practice in your daily life and discuss any challenges you’re facing in weekly sessions and unlimited messaging. You’ll have support by your side every step of the way.

Psychiatry

If your symptoms are impacting your day-to-day life, you might also consider meeting with a psychiatric provider. Your psychiatric provider can work with you on a treatment plan, which may include medication, to help you feel better. At Brightside Health, our psychiatric providers use our PrecisionRx tool to analyze data and over 1,000 medication combinations to recommend the right medication for your needs—so you can start feeling like you again.

Psychiatric providers also monitor your treatment over time and can manage medication, refills, and dosage adjustments, if needed.

Self-care

Another key aspect to postpartum mental health care is self-care. When you become a parent, you may feel overwhelmed or think a lot about what your baby needs. However, it’s important to not forget about what you need. Practicing self-care daily—actions or habits that are for your wellness alone—can help you improve and protect your mental health. 

Whether it’s eating nutritious foods, taking a walk outside, enjoying a hobby, or prioritizing sleep, taking actions for your health can help you replenish your energy before you give to others. If you are co-parenting with a partner, you might consider working together to align schedules so you can both prioritize something for yourselves each day. You can learn more about self-care here.

Support network

Having people around you who support you is important throughout life and is especially crucial when you become a new parent. If there are friends, family members, or other people in your life offering to help you, lean on your support network and take them up on the offer. 

Whether it’s a listening ear, help with laundry, or assistance with grocery shopping, try to ask for what you need and name one helpful action others can do to support you when they offer help. If you’re looking for community support, you might consider joining a group for new parents or taking a class. You can view state-by-state resources here. 

Get started with the right treatment for you

No matter how you’re feeling, remember that you’re not alone. If you notice differences in your mental health postpartum, the best thing you can do is reach out for support. Mental health practitioners can work with you to find the combination of postpartum mental health care for your needs.

Get started today with a free assessment. 

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Postpartum depression is a form of depression that affects new or expecting mothers. It’s relatively common, that one in seven mothers experiences postpartum depression. 

Postpartum depression symptoms include:

• Feeling hopeless, overwhelmed, guilty, or angry
• Crying a lot 
• Feeling empty or numb
• Feeling disconnected from your baby—not wanting to be around them or worried you will hurt them
• Having an unexplained physical illness like stomachaches, headaches, or nausea 
• Lacking energy or having trouble concentrating
• Having sleeping difficulties
• Isolating yourself or being unable to enjoy social situations or activities you once loved

If you think you may have postpartum depression, or think a loved one may be experiencing these signs, it’s important to talk to a mental health professional. Postpartum depression is treatable with therapy and/or medication. It’s also a good idea to talk to your partner or family member about how you’re feeling so they can support you. 

What causes postpartum depression?

According to womenshealth.gov, “Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression.”

After childbirth, many women have mood swings, feel sad or anxious, lose their appetite, or experience trouble sleeping. These symptoms usually go away 3 to 5 days after they start. Postpartum depression is different—the symptoms last longer and are more severe. Typically, postpartum depression begins within the month after giving birth, but it can also start during pregnancy or up to a year after birth.

6 ways to take care of yourself with postpartum depression

If you’ve been diagnosed with postpartum depression (part of a larger category called peripartum depression), here are a few ways to take care of yourself. 

Stay on track with your treatment

Whether your care includes therapy and/or medication, it’s important to keep up with your appointments and treatment plan so you can feel better. At Brightside Health, our expert providers can support you every step of the way with video visits and unlimited messaging. You can also track how you’re feeling, view lessons, and practice reflections. 

Lean on others when they offer to help

Having a supportive group of people around you can be really helpful when you’re experiencing postpartum depression. If you feel comfortable, it’s a good idea to tell people you trust about what you’re going through. Try to accept others’ offers to help even if your first inclination is to politely decline or verbally agree to accept the help, only to not act on it later.  When someone offers to help, tell them, “Yes, I’d appreciate your help… taking care of the baby, picking up groceries, or helping with cleaning around the house.”

Practice self-care

As a mother, you’re often taking care of others’ needs. Try to remember to do things you enjoy for yourself too. Whether it’s taking a walk outside, keeping a journal, reading a book, or practicing some mindfulness exercises, see if you can do something for yourself every day. Remember, this also includes rest—allow the other parent, friends, or family to help care for the baby outside of your earshot so you can get some uninterrupted rest. 

Rework negative self-talk

When you’re experiencing postpartum depression, you might feel guilty or ashamed. You might even think difficult thoughts such as, “I’m bad at this” or “I’m not a good mother.” Know that just because you’re thinking those thoughts doesn’t mean they’re true. Our minds can be skilled at tricking us. If you catch yourself thinking negative thoughts about yourself, there are a few ways you can rework them:

• Write down what you’re thinking and try to challenge it. Consider the evidence that’s for or against your thought. Sometimes, seeing thoughts on paper can help you look at them with a fresh perspective.
• Talk to a mental health provider or to a loved one. Tell them about what you’re thinking or feeling and they can help you think about the roots of the negative thought. 
• Consider adding to your thought. You could say “I’m feeling like I’m bad at this, but I’m actually trying my best” or “I’m feeling like I’m not a good mother, but I actually took great care of my baby yesterday and the pediatrician said they’re healthy.” 

A therapist can spend time working with you weekly on skills like challenging negative thoughts to help you overcome postpartum depression.

Spend time with your baby

Postpartum depression can make you feel disconnected from your baby. Try to spend time bonding with your baby by trying skin-on-skin contact or doing one of your preferred activities with them safely tucked away in a sling on your chest. If you feel overwhelmed, let a partner or loved one follow through on the help they may have already offered but was previously politely declined. 

Make small goals

When you’re experiencing postpartum depression, things that were once small tasks for you can feel large and insurmountable. Know that you won’t always feel this way. If you can, try to make a small goal for yourself like taking a shower or emptying the dishwasher. Your therapist can also help with goal-setting. Small goals lead to small wins which can help inspire the motivation needed to take on larger tasks that previously felt impossible.

Takeaways about postpartum depression & self-care

Being a new mother involves a lot of changes. Be kind to yourself during this process and remind yourself that things will get better. Don’t hesitate to ask for help or talk about how you’re feeling—your health matters and you’re doing a good job.

Most importantly, know that postpartum depression is treatable with mental health care. At Brightside, 86% of members experience significant improvement and 71% achieve remission from their symptoms altogether in 12 weeks. Start getting quality care for postpartum depression today with a free assessment. 

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Trauma falls into the latter category and can impact families across generations. This type of impact is known as generational trauma (you may also hear intergenerational trauma or transgenerational trauma). 

What exactly is generational trauma?

Generational trauma is trauma, or the effects of trauma, that are passed on and experienced by more than one person. It can be nuanced, complex, and indirectly addressed. People experiencing generational trauma describe picking up on these implied lessons as they observe their family members struggling to overcome systemic barriers in their lives.

Dr. Steven Lucero, associate director of therapy at Brightside Health, emphasizes this. “It’s important to know that generational trauma is a systemic issue, not an individual one,” he says. “Generational trauma isn’t an explicit lesson taught by a parent to a child. It’s interwoven more subtly into how families interact with one another and with the outside world.” 

For example, a parent that was in a car accident that led to the loss of their sibling may act emotionally distant as they observed negative reactions from their family whenever they brought up the pain associated with that loss. If they never healed or dealt with the trauma, their children may deal with their emotions in a similar way as the family reinforces avoidance of such an emotionally fraught topic. When a traumatic experience does occur again in the future, they may try to cope with denying or minimizing the situation.

Researchers have been studying the effects of generational trauma and how to treat it for decades. Here are some examples of intergenerational trauma: 

• In one 1988 study, published in The Canadian Journal of Psychiatry, grandchildren of Holocaust survivors were found to be 300% overrepresented in psychiatric care referrals. 
• Research in Neuropsychopharmacology found that the effects of parental stress can be directly transmitted to offspring during pregnancy or during early postnatal care of newborns.
• A study published in the Canadian Journal of Occupational Therapy in 2020 found that the occupational lives of second-generation Ilankai Tamil and Vietnamese refugees were heavily influenced by generational trauma: Sociohistorical, cultural, and familial contexts influenced the way second-generation refugees view what they can and should do.

Who is susceptible to generational trauma?

All of us are susceptible to generational trauma but there are certain groups that are more at risk. This includes families who have experienced:

• Systematic exploitation 
• Racism 
• Oppression
• Poverty
• Abuse
• Violence

Marginalized groups such as BIPOC and those with lower socioeconomic status may experience more prominent generational trauma, because of the consistent and ongoing problems their families have had to face over time.

In some cases, generational trauma is due to a collective historical trauma—such as refugees and Holocaust survivors—and other times, it is not—such as a family dealing with domestic violence or abuse.

Understanding the symptoms of generational trauma

Many times, people experiencing generational trauma may not explicitly be aware it’s happening or even talk about it. That’s why it’s important to know the symptoms and how generational trauma presents. 

Remember, generational trauma is a systemic issue. This means that the person who experienced the trauma coped with their emotions in a specific way and developed a trauma response that helped them manage their lives while they were going through that trauma. They may not have had the help they needed to cope in a healthy way with oppression, violence, or abuse, because the coping strategies that help us survive a situation are often not the same skills that will help us cope over the long-term.

As a result, behavior, adaptive to the initial trauma, is passed down across generations. Sometimes, this is referred to as survival mode. The American Psychological Association explains this further:

Trauma psychologist Elena Cherepanov, PhD, of Cambridge College in Boston, has been examining how survivors’ initial reactions to an event may affect future generations—a topic outlined in her upcoming book, tentatively titled “Understanding the Transgenerational Legacy of Totalitarian Regimes: Paradoxes of Survivorship.” Living under such difficult, oppressive circumstances, she surmises, can lead parents to formulate fear-based “survival messages” that they pass on to their children and grandchildren—ideas like “Don’t ask for help—it’s dangerous.” While the messages may have initially helped people stay alive, in the present they are often irrelevant and may even increase people’s interpersonal vulnerability. Fear of personal disclosure and not trusting mental health care providers, for example, “is exactly why it is so hard for trauma survivors to seek and accept support,” says Cherepanov, who is comparing these messages in Russian and American samples.

So, what are some of the signs of generational trauma? They can include:

• Anxiety 
• Depression 
• Insomnia 
• Panic attacks 
• Hypervigilance (excessive attention to the possibility of danger)
• Mood dysregulation (trouble managing emotional responses)

Healthline also mentions these symptoms:

• A sense of a shortened future
• A sensitive fight-or-flight response
• Issues with self-esteem and self-confidence 

You may be experiencing signs of generational trauma that aren’t listed here, such as behavior patterns or reactions that do not fit the demands of the situation that prompted them. Talking about them with a therapist can help you process them and start treatment.

Treatment for generational trauma: Take care of yourself

Whether you’re experiencing personal trauma or intergenerational trauma, there are treatments available that can help you heal. You don’t have to go through it alone.

At Brightside Health, we offer evidence-based therapy and precision psychiatry virtually—from the comfort of home. 

Get started with a free assessment 

While generational trauma isn’t formally encoded in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it is widely known among mental health professionals that trauma influences our daily lives. There are many strategies and coping skills that can help you process and heal. 

Given the subtlety of intergenerational trauma, treatment can often be more nuanced or longer-lasting than with other presenting concerns. Stay on track with your treatment plan with Brightside’s tools, check-ins, and reminders.

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As the shape of our working environments and day-to-day lives begin to change, depression is becoming more prevalent among many people. To seek therapy and medication treatment, it’s important that you can recognize symptoms in yourself and others. 

Let’s take a look at how depression in women and men differs, and explore why that is.  

Depression by gender

Before we get too far, we first need to acknowledge that gender is nothing more than a social construct, formed by:

• Lived experiences
• Societal norms
• Socialization
• Other identifiers
  

We also want to separate gender from biological sex, as these are not the same thing. 

That’s not to say that different gender groups (the social constructs of “man” vs “woman”) experience depression in the same way. 

Science suggests that there are differences in depression in men vs women. These group differences are primarily a result of socialization by society or other influences, not by biology.

Let’s take a look at depression in women and men and explore where they diverge.

Do men and women have different symptoms of depression?

Different people experience depression in different ways, regardless of gender or biological sex.

Ultimately, the core symptoms of depression are the same for women and for men. 

These symptoms might include:

• Having little interest or pleasure in doing things
• Feeling down, depressed, or hopeless
• Feeling tired or having little energy
• Poor appetite or overeating
• Feeling bad about yourself, or feeling like a failure
• Trouble concentrating on things
• Thoughts of self-harm or suicide

For both men and women, depression may feel like profound sadness. Others feel worthless, and some feel nothing at all.

Some of the key types of depression affect everyone. All genders and biological sexes might experience either:

1. Major depressive disorder
2. Persistent depressive disorder
3. Seasonal affective disorder

Even though men and women both experience depression, research suggests that women are more likely to report experiencing symptoms of depression and to seek help.

This may explain why, as the Mayo Clinic explains, “Women are nearly twice as likely as men to be diagnosed with depression.”

When do gender differences in depression occur?

There are some forms of depression that women (biologically) experience that men do not. This divergence tends to occur post-puberty. Some are tied to the menstrual cycle, and others are from social conditions that occur as women age. 

1. Premenstrual dysphoric disorder: In some women, premenstrual syndrome (PMS) might morph into premenstrual dysphoric disorder (PMDD). This is a health condition that results in severe irritability, depression, or anxiety within a week or two before menstruation. Symptoms usually disappear within a few days after the start of your period.
2. Pregnancy: Similarly, pregnancy can contribute to depression symptoms, especially around postpartum. Postpartum depression is a serious condition that may cause serious mood swings, feelings of detachment, anger, resentment, and even thoughts of harming the baby or self.
3. Menopause: This too, can contribute to an increased risk of depression that is unique to biologically female people. 

Depression can also stem from societal or social conditions that are unique to women in the United States and many other cultures. 

• Women tend to lack power in our society and are expected to contribute in unique ways at home. 
• Women are often in undervalued work roles that contribute to burnout and self-blame.

An example of these differences is that women often take on planning or other tasks that men tend not to take on and are often systematically overlooked for promotion and leadership opportunities, which leaves them feeling overloaded.

Do males and females respond in similar ways to depression?

One of the biggest differences between men and women when it comes to depression is in the ways that gender groups tend to respond to the symptoms when they occur. 

Over 30% of men experience a period of depression in their lifetime. Men are frequently socialized to not process emotional reactions. Gender stereotypes related to toxic masculinity often lead to the false belief that men don’t cry, and that showing emotional vulnerability is somehow not manly or masculine can negatively affect many men. Often this leads men to seek logistical ways of coping with depression symptoms that can be harmful. 

As a result, men with depression tend to self-distract from their internal emotional experiences and may turn to substance abuse more frequently than women. This can lead to tragic outcomes. According to the Centers for Disease Control and Prevention, men are more than four times as likely to die by suicide than women. 

Women are often socialized to engage in more social support and tend to cope with depressive symptoms more effectively than men. Women are statistically more likely to report their symptoms and to seek help than men.

For women, depression is also prevalent. “Approximately 12 million women in the United States experience clinical depression each year,” according to Mental Health America, and “one in eight women can expect to develop clinical depression in their lifetime.” 

Depression in women can also contribute to other health problems and mood disorders. Depression is closely tied to the prevalence of eating disorders, anxiety disorders, and other diagnoses. 

What to do if you are experiencing symptoms of depression

Depression can be debilitating for women and for men, but it is also highly treatable. If you are concerned about depression, talk with a mental health professional. Treatment possibilities for depression include therapy, medication, or both. At Brightside Health, you can access treatment from home and meet 1:1 with a dedicated provider. 

If you are experiencing emotional distress or thoughts of suicide, please seek help immediately:

• Text HOME to 741-741 to chat with a crisis counselor urgently.
• Call 800.273.8255 to speak with a crisis counselor.
• Call 911 if you are experiencing an emergency.

If you are experiencing symptoms of depression, Brightside Health can help. Our mental health professionals are ready to help you get back to being you. 

Start with a free assessment

The post Depression in women vs. men appeared first on Brightside.

This Mental Health Awareness Month, we’ve been thinking a lot about mental health in youth. In the United States, the state of mental health in children and young adults has reached a level that some researchers believe to be a crisis. 

Harvard’s Claire McCarthy, MD writes:

In the fall of 2021, the American Academy of Pediatrics, along with the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, declared a national emergency in child and adolescent mental health. 

They called for increased funding for mental health resources, as well as other actions, including more integration of mental health care into schools and primary care, more community-based systems to connect people to mental health programs, strategies to increase the number of mental health providers, and ensuring that there is insurance coverage of mental health care.

Because mental health among youth is such an urgent topic, we would like to look at why mental health awareness is so important for young people. 

What does mental health awareness mean?

Before we go too much further, let’s define “mental health awareness.” To us, mental health awareness involves fostering an understanding of:

• What it means to have good mental health
• The stigmas that exist about mental illness
• How many people experience mental health challenges
• The potential dangers of not treating mental health conditions
• The barriers to treatment that many individuals face

Every May, we join other mental healthcare organizations and providers to renew our commitment to promote awareness. And, as we have explained in our blog, to advocate for those who need us and to provide support to all who live with mental health conditions.

Why is mental health awareness in youth so important? 

Simply put, there is not enough attention being paid to mental health in children and adolescents. According to the National Alliance on Mental Illness in 2020:

• Statistically, only “50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment.”
• Among adolescents (12–17 years), “1 in 6 experienced a major depressive episode (MDE).”
• “3 million had serious thoughts of suicide.”

Statistically speaking, as a society, we are not talking enough about mental health in youth; we are not listening enough when there’s a problem, and we are not helping enough youth get the treatment they need. 

One of the best ways that we can begin to address these deficiencies is to promote awareness. Here are a few ways you can do this today.

Talk to youth about mental illness

If you were ever a child, you may recall that often the most frightening thing was the unknown. It can be terrifying when you feel bad but don’t understand why. Mental illness, and mental health in general, needs to be discussed in order to make it less scary for those who experience it.

The National Institute of Mental Health says that “An estimated 31.9% of adolescents had an anxiety disorder.” That’s roughly a third of the population. If these children simply understood that others experience anxiety as well, they may understand that they are not the only ones experiencing anxiety. If the other two-thirds of children also knew that their friends sometimes experience anxiety, then they are better suited to offer help.

Help them identify the signs of a problem

Talking more about mental health will also teach children, teens, and young adults the warning signs that often occur when someone may be on the verge of experiencing a crisis. Learning about these warning signs gives youth the chance to recognize these signs and take action if a friend exhibits them or if they themselves start to display them.

Of course, reviewing warning signs and symptoms will also help parents, teachers, and others. 

There is ample evidence that suicide prevention often starts with someone paying attention.  Claire McCarthy, MD says, “So pay attention, and take what you see seriously. If your child is showing signs of anxiety or depression, call your doctor. Don’t put it off.”

Help young people understand and overcome stigmas about mental health

It is common for youth (and adults) to be embarrassed by mental health challenges. Much of this embarrassment is caused by the stigma that mental health is somehow less important than physical health. Findings published in the academic journal BMC Psychiatry show that:

• “Young people, including adolescents and young adults aged 10–24 years, are at a critical period in the prevention and treatment of mental health disorders.”
• “Public stigma universally prevents people who experience mental health problems (i.e. symptoms that are not sufficient to warrant a diagnosis of a mental disorder) and those with mental disorders from seeking counseling and treatment.”
• “Educational interventions to reduce the stigma associated with mental health may improve help-seeking behaviors by avoiding the use of psychiatric labels that are not commonly understood…”

In other words, reducing stigma and normalizing mental health challenges increases the willingness to seek treatment in the future.

Help young people get the treatment they need

Perhaps the best way to promote youth mental health awareness is to help kids in need access mental health services. Children’s mental health, according to Youth.Gov, can change over time.

With the developmental changes and challenges that youth face normally, especially in adolescence, many experience transitional phases of mood and behavioral changes. Youth and their families can successfully navigate the challenges that come from experiencing a mental health disorder. Those with more persistent mental health challenges usually do very well with treatment, peer and professional support and services, and a family and social support network.

You can help Brightside Health promote awareness of youth mental health this month and every month. If you are experiencing mental health concerns, we want to help. Brightside Health treats people ages 18 and over and you get started with a free assessment. You can also:

• Text HOME to 741-741 to connect with a Crisis Text Line counselor.
• Call The 988 Suicide & Crisis Lifeline at 1.800.273.8255.
• Visit the National Alliance on Mental Illness website for additional resources. 

You can use the lifeline services mentioned above for yourself, or talk to someone for advice if you are concerned for a loved one. You are not alone.

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When it comes to treating depression, psychiatric providers have several medication options to choose from. The most popular medications, and generally considered the first option for most people with moderate to severe symptoms, are selective serotonin reuptake inhibitors (SSRI). But if these aren’t effective for the individual, or if SSRIs aren’t the best choice for other reasons such as side effects, doctors will examine alternatives to SSRIs to treat depression. One of the SSRI alternatives they may explore for depression is a class of medicines called serotonin and norepinephrine reuptake inhibitors, also known as SNRIs.

It can be difficult to determine whether SNRIs or SSRIs will be best for depression within an individual, so let’s take a look at how each class of medication works, and what may cause a provider to encourage one over the other.

How does an SSRI work?

As we said above, selective serotonin reuptake inhibitors (SSRIs) are often the first choice in treating depression. The Mayo Clinic says that SSRIs “are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe, and typically cause fewer side effects than other types of antidepressants do.”

Our psychiatric providers use SSRIs to help balance the serotonin levels in your brain—increasing those levels can improve your mood. Serotonin is one of the major chemical messengers (neurotransmitters) used to carry a signal from one brain cell to another.

SSRIs make more serotonin available in the brain. This may help your brain grow new cells and form stronger connections between neurons. SSRIs do this by blocking the reuptake of serotonin, which means more serotonin is available to help transmit messages between neurons.

SSRIs may also help generate cells in an important part of your brain that regulates mood and anxiety. This region is called the dorsolateral prefrontal cortex (DLPFC). When cells in this region are activated, they can help regulate mood, memories, anxiety, anger, and fear.

There are several SSRI options on the market, including name brands like Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), and Lexapro (escitalopram). Your psychiatric provider will determine which of these SSRIs are best for depression and at what dose, as efficacy depends on several factors and interactions.

How does an SNRI work?

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of medicines that work just a bit differently than SSRIs. It’s this difference that may help a provider determine whether an SSRI or an SNRI will better treat your unique depression symptoms. 

The key distinction lies in the inhibition of the reabsorption of norepinephrine. As implied in their name, SNRIs prevent the brain from reabsorbing both serotonin (like SSRIs) and the neurotransmitter norepinephrine. As a result, SNRIs can boost levels of serotonin and norepinephrine—neurotransmitters, or chemical messengers, in your brain that affect your mood.

Serotonin creates feelings of well-being, and norepinephrine promotes alertness and energy. SNRIs work by increasing available amounts of these neurotransmitters in the brain, making you feel better and improving symptoms of depression and anxiety.

Some of the most common brand names for SNRIs include Cymbalta (duloxetine) and Effexor (venlafaxine). 

SNRI vs SSRI for depression: How do you choose the right one for you?

If SNRIs work on norepinephrine as well as serotonin, then doesn’t that make them a better alternative than SSRIs for depression? Not necessarily. 

Both SSRIs and SNRIs have side effects that impact each individual differently. SNRIs are typically second-line agents when an SSRI has failed because in general SSRIs have fewer side effects, but sometimes SNRIs are used to treat specific conditions such as chronic pain. The Mayo Clinic says:

All SNRIs work in a similar way and generally can cause similar side effects, though some people may not experience any side effects. Side effects are usually mild and go away after the first few weeks of treatment.

Some of the common side effects for SNRIs, The Mayo Clinic continues, include headaches, nausea, dizziness, and changes in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction). It’s worth noting that the side effects list is very similar to the one they list for SSRIs. 

In deciding whether to prescribe SSRIs or SNRIs for depression, a provider will take all of these side effects into account, and will also evaluate any interactions the medicines may have with anything you are currently taking. All of these factors will also help your provider determine which particular SNRI or SSRI is best for your depression. As we explain on our blog, “If you try one SSRI and find that your body does not tolerate it well, you may still be able to tolerate a different SSRI. If you are experiencing unwanted side effects, your provider will work with you to adjust your medication or recommend another SSRI that may be a better fit for your needs.” And if they can’t meet that need with an SSRI, then they may try an SNRI.  

Generally speaking, a provider will work to find a medication for which the benefits far outweigh any side effects. Typically, that may take a bit of trial and error—however, at Brightside, our providers have access to our clinical decision-making tool, PrecisionRx, which supports them in personalizing treatment to you and finding the right SSRI, SNRI, or other medication to get on top of depression.

Are SNRIs or SSRIs better for depression?

The truth is, it’s impossible to know for sure or even to tell which SNRI or SSRI is best for depression, without knowing a lot of specifics about an individual, their specific depression symptoms or presentation, their comorbidities, and more. On our blog we explain, “Experiences with depression may vary as individuals respond to medications in different ways. This is why matching you with the right medication for your individual needs is essential.” 

What we can tell you is that, if you are experiencing depression, you and your Brightside provider can find the best SSRI or SNRI for you, if medication is the right choice. Your provider will want to know about your needs and family medical history, and they may try more than one medication before they find the right fit. Using our precision psychiatry technology, Brightside analyzes a variety of data about a member, including preferences and present symptoms, to recommend the medication that is likely to be most tolerable and effective for you. In a representative study of over 6K Brightside members, conventional prescribing practices only covered 13% of the unique treatment plans we prescribed.

Your provider may also recommend alternatives to SSRIs to treat your depression —an MAOI for example, or treatment that includes therapy. Treating depression often takes a combination of medication and therapy. 

Brightside is here to help with all of this. Get started by taking our free assessment today.

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What is PMDD?

Premenstrual dysphoric disorder is similar to PMS but is a more serious condition that’s considered to be a mood disorder within the fields of medicine and mental health. While 70-90% of women in child-bearing age report experiencing PMS symptoms, about 3-8% of women experience symptoms that would qualify them for a diagnosis of PMDD. This is about 6 million women worldwide. 

What causes premenstrual dysphoric disorder?

Research suggests that changes in hormonal and serotonin levels may play a role in the development of PMDD symptoms. As the Cleveland Clinic explains:

Decreasing levels of estrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. Serotonin, a brain chemical that regulates mood, hunger and sleep, may also play a role. Serotonin levels, like hormone levels, change throughout your menstrual cycle.

PMDD vs. PMS symptoms

Symptoms of PMDD and PMS usually occur in the days leading up to a women’s period and resolve a few days after menstruation begins.

PMS symptoms include:

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating
• Cramping
• Headache or muscle aches
• Clumsiness
• Lower tolerance for noise or light
• Irritability 
• Feeling tired
• Sleeping problems
• Appetite changes 
• Trouble with concentration or memory
• Tension or anxiety
• Depression, feelings of sadness, or crying spells
• Mood swings
• Less interest in sex

PMDD symptoms include the symptoms mentioned above, and may also include:

• Anger or irritability
• Feelings of sadness or despair, or thoughts of suicide
• Severe feelings of anxiety
• Panic attacks
• Loss of interest in usual activities and relationships
• Feeling out of control

Though more people are gaining awareness of PMDD, many women may not know to speak to a mental health professional or doctor about their symptoms. If you are experiencing severe symptoms like the ones above, talk to a provider as treatment is available.

If you’re in emotional distress, text HOME to 741-741 to connect with a Crisis Text Line counselor immediately. If you are experiencing an emergency, call 911. 

How is PMDD diagnosed?

Your provider will ask you questions about your medical history and your symptoms. They’ll also listen to your concerns and answer any questions that you have. 

As part of a diagnosis, you may be asked to track your symptoms over time. Because PMDD symptoms appear and subside on a monthly basis, this is important for a diagnosis. Your provider will then evaluate your symptoms and consider whether you may be experiencing PMDD or another anxiety or depression-related condition.

Treatment for PMDD

PMDD is treatable, so talk to a healthcare provider so you can start feeling like yourself again and enjoy life more fully. Here are a few treatment options that can be adhered to alone, or in combination for a better chance of symptom relief.

• Therapy 

Your therapist can support you every step of the way. They can work with you on adaptive skills to help you cope and manage PMDD symptoms. This can include goal-setting, stress management, and techniques to lessen anxiety and depression. Taking part in an evidence-based therapy program is a good idea as it follows proven principles to help you feel better. 

At Brightside Health, our therapists follow the evidence-based Unified Protocol, a modern enhancement of cognitive-behavioral therapy (CBT). Through therapy, you can better understand how your thoughts, feelings, and behaviors relate to your mental health concerns so you can approach them more effectively. 

• Medication 

Your psychiatric provider can find the right medication to treat your unique PMDD symptoms. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) affect serotonin levels in the brain, which can help treat your symptoms. With Brightside, you can get medication delivered to your door monthly. The Food and Drug Administration (FDA) has approved three medications to treat PMDD: 

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Paroxetine HCI (Paxil)

Like treatment for PMS, over-the-counter pain relievers such as ibuprofen and aspirin, and birth control may also help relieve symptoms. 

• Lifestyle changes

Depending on your current lifestyle, some changes may also help improve your symptoms of PMDD. Eating nutritious food, practicing self-care, and getting exercise can help reduce the negative impact of your symptoms. However, PMDD is a serious condition so it’s important to talk to a provider to discuss additional treatment options. 

In summary

Premenstrual dysphoric disorder is a condition that involves heightened PMS symptoms as well as more severe symptoms including depression and anxiety in the days and weeks leading up to one’s period. The symptoms usually subside in the days after menstruation.

If you have experienced any of the symptoms above, reach out for support. As Robert L. Reid, MD FRCS states in one text in the National Library of Medicine, “All too often their [women’s] concerns have been dismissed as “a normal part of being a woman” and therapy has been denied.” Fortunately, more people are aware of the seriousness of PMDD and many treatment options exist today. 

PMDD is treatable with a combination of medication, therapy, and lifestyle changes. At Brightside, therapists and psychiatric providers treat PMDD online so you can get care from the comfort of home. Within 12 weeks, 86% of Brightside members experience significant improvement and 71% achieve remission of their symptoms altogether. 

To get started, take a free assessment today. 

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Moving homes, reading the news, giving a presentation, starting a new job, or having a baby are just a few examples of times when you’re likely to experience stress. Sometimes, stress can be beneficial as it helps you prepare for big changes or motivates you to meet a deadline. There is an optimal level of stress according to the Yerkes-Dodson law—too little and we aren’t motivated enough to prepare, too much and anxiety can affect our performance.

When stress does get out of hand, it can negatively impact our physical and mental health. It may affect our sleep or lead to burnout, acute stress disorder, anxiety, and/or depression. According to the American Psychological Association, “Chronic stress, or a constant stress experienced over a prolonged period of time, can contribute to long-term problems for heart and blood vessels. The consistent and ongoing increase in heart rate, and the elevated levels of stress hormones and of blood pressure, can take a toll on the body. This long-term ongoing stress can increase the risk for hypertension, heart attack, or stroke.”

So, while it’s safe to say stress is a part of life, there are things you can do to help manage your stress levels for better health. One important element of this involves self-awareness.  As Stress Resilient Mind explains:

Self-awareness is a prerequisite for choice and control. If your thoughts and feelings are operating outside of awareness, then they control you. If you want to control them, the first thing is to open up a window of awareness that is an opportunity to pause and consider, before choosing, deciding, and acting.

What is self-awareness?

Self-awareness is being aware of who you are—of your thoughts, feelings, and actions. Having self-awareness doesn’t mean you have to thoroughly understand every single emotion you have or justify every thought. Instead, being self-aware simply means you observe your internal and external experiences. 

Hogan explains three main components of self-awareness:

• Understanding our own strengths and opportunities for change and growth
• Understanding how our strengths and challenges relate to those of others
• Understanding how to adapt our behavior to increase our effectiveness

Why is self-awareness so important when we’re talking about stress? Because stress is a physical or mental response, it’s vital that we recognize what we’re experiencing and why. If you’re self-aware, you might realize that you’re not eating as healthy as you used to, you’re feeling anxious, or that your work has become more challenging and cut into your free time.

In this way, self-awareness can help reduce stress—if you first start to recognize the causes, you can then more effectively manage the stressor or response. 

Tips for building self-awareness

If you’re looking to boost your sense of self-awareness, you can:

• Keep an open mind. Try not to judge your thoughts or feelings.
• Note your strengths and weaknesses. If you’re having trouble, you could ask a trusted loved one for help.
• Practice being mindful. You can write down what you’re experiencing or try breathing exercises.
• Take time to reflect. Think about your actions and reflect on why you may have behaved in a certain way.

When you’re thinking about building self-awareness, it may be helpful to consider these buckets: thinking, feeling, doing, wanting, and sensing. 

Self-awareness is also important for emotional intelligence, which is the ability to identify and manage one’s own emotions as well as the emotions of others. As Psychology Today says, “The emotionally intelligent are highly conscious of their own emotional states, even negative ones—from frustration or sadness to something more subtle. They are able to identify and understand what they are feeling, and being able to name an emotion helps manage that emotion.”

Stress management is key to better health

Now that you have a better understanding of self-awareness, and emotional intelligence, let’s consider how that can help reduce stress. By being self-aware, you can start to notice your thoughts, emotions, and behaviors as signals or clues to your overall health. 

If you catch yourself feeling run down, exhausted, or irritable, you can pause and consider what may be the stressor and take action to resolve or manage it. Maybe you realized that reading the news so much is causing you stress and worry. As a result, you can consider actions to take that may give you more control over your life or help you enact your values: You might donate to a cause, limit yourself to watching the news once a day, or talk to a loved one about it but then do an activity you enjoy.

This is known as stress management. Therapists at Brightside Health can help you improve how you manage stress with various skills. 

Here are some stress management techniques to try yourself:

• Try to exercise, eat nutritious foods, and get enough sleep. What’s good for your physical health is also good for your mental health. 
• Avoid drinking a lot of caffeinated or alcoholic drinks. They can affect your mood and sleep.
• Practice relaxing techniques like visualization or meditation like yoga. You can start with just 5 minutes a day.
• Take a walk in nature. Getting outside can help you gain a fresh perspective. 
• Start a gratitude journal. Focusing on positive aspects of your life can help boost your mood if you’re feeling stressed or down.
• Pursue an activity you enjoy. Pick up a hobby you once loved as a child or try a new activity you’ve always wanted to learn.

Over time, you may learn to stress and worry less about things that are completely outside of your control. As far as the things within your control, you can take steps to manage the stressor with the techniques above. 

As our blog about stress and depression says, “Stress isn’t something that can be fixed overnight, but by taking small, consistent steps and sticking with it over time you can see impactful changes.”

Stress, anxiety, and depression

If you’re having trouble dealing with stress, it’s a good idea to talk to a mental health professional. Even if you’re self-aware and practicing management techniques, sometimes stress may be constant. In this case, you may be experiencing anxiety, depression, or another mental health condition. 

At Brightside, you can access care online with support every step of the way. Our therapists and psychiatric providers can develop a personalized treatment plan for you that includes therapy, medication, or both. 

Start a free assessment today

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