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Understanding the Link between Depression and the Menstrual Cycle
Sarah Graham
The relationship between depression and the menstrual cycle is complex and may affect different people in different ways. And while both depression and its treatments can affect your monthly cycle, there are also ways to mitigate these effects.
The effects of both depression and menstruation have a significant bearing on your daily life, so it's natural to have questions. You might wonder, can depression delay my period? Will antidepressants affect my menstrual cycle? To answer these and more, here's a look at the evidence.
Breaking Down the Menstrual Cycle
Firstly, how does a
"normal" menstrual cycle work? Roughly once a month (every
24 to 38 days), the ovaries release an egg, and the uterus thickens its lining (endometrium) in preparation for pregnancy. If the egg is not fertilized, the endometrium sheds as a period—a mixture of blood, mucus, and tissue. Remember: your cycle is more than just your period, and everyone's experience may differ.
Can Depression Delay My Period?
Yes, it can. There is research that shows that people with anxiety typically have shorter periods, and people with depression are more likely to have irregular cycles. One of the most common causes of delayed or missed periods is functional hypothalamic amenorrhea, or stress-induced anovulation. This is essentially a survival mechanism: your body decides it isn't a good time to be worrying about reproduction and presses pause on ovulation. Not ovulating disrupts the cycle; your periods may stop, or they may become more irregular. This can be triggered simply by the emotional stress of depression or by changes to your appetite and diet if you undereat when you feel depressed.
Can Antidepressants Affect My Menstrual Cycle?
Besides the link between depression and the menstrual cycle, there's also evidence that antidepressant medication can affect your periods. For some people, this may mean an increase in symptoms, such as painful, heavy, or irregular periods. Research found that women who were taking antidepressants had "significantly higher" rates of menstrual disorders than those who weren't. Researchers concluded that these symptoms "appear to be associated with antidepressant use at least in some women."
Antidepressants affect the chemical serotonin, a neurotransmitter associated with depression and anxiety. However, serotonin also
plays a role in blood clotting. This could explain why antidepressants seem to increase the risk of heavy bleeding. Some antidepressants have also been linked to
high levels of the hormone prolactin, which can prevent ovulation. This may result in disruption to your cycle, such as missing or irregular periods or changes to your menstrual flow.
Can Periods Make Depression Worse?
It's also worth noting that the connection between depression and the menstrual cycle works both ways. A study published in 2005 found that 64 percent of women with depression experience "premenstrual exacerbation." In other words, the depression symptoms get worse for most women during the five to 10 days before their periods. For women with premenstrual dysphoric disorder, premenstrual symptoms of depression can be particularly severe and may even lead to suicidal thoughts.
How Can I Mitigate the Effects of Depression on My Period?
If depression or antidepressants are disrupting your menstrual cycle, talk with your doctor. There's no one-size-fits-all solution, but lifestyle changes may help you lessen the stress-induced effects. As much as possible, try to make sure that you're eating enough to fuel your body, sleeping enough to rest, and exercising moderately. Gentle movement, such as walking and yoga, can help ease stress, as can breathing or mindfulness exercises and journaling.
If antidepressant medication seems to make your symptoms worse, speak to your doctor about non-pharmaceutical treatments for depression. These could include talking therapies, such as counseling or cognitive behavioral therapy, or transcranial magnetic stimulation therapy.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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