I am 41 and started continuous birth control in the spring to help with mood swings and other late-reproductive-stage symptoms. Many symptoms have improved with the birth control, like breast tenderness and headaches, but my mood swings still seem present and I am considering an SSRI. Can you speak about when an SSRI makes sense to help manage these mood issues?
—Moody Mom
I am glad some of your symptoms have improved, but it sounds like there is still room to get you feeling better. Mood changes with our menstrual cycles are very common and become more common as we age. Depression, anxiety, and irritability can all be exacerbated by the more extreme hormone shifts women experience during their menstrual cycles in their 40s.
There is excellent data supporting the role for SSRIs in treating menstrual-cycle-related mood disorders. In their review of 113 published papers, the authors found multiple randomized controlled trials of SSRIs for premenstrual dysphoric disorder. The most common SSRIs, including sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and fluoxetine (Prozac), have been shown to be effective.
Interestingly, two different regimens appear to be effective: taking an SSRI continuously or taking an SSRI just in the week or two leading up to your period. I choose between the two regimens based on patient preference, how regular my patient’s cycle is — I want to be sure they will know when to start taking the SSRI — and whether my patient has symptoms of anxiety and depression at other times during their menstrual cycle.
Anytime I am considering adding a medication for menstrual cycle symptoms, I think there are two factors at play. First, what other treatments have been tried and for how long. In your case, you started a birth control pill. Unless the mood symptoms are severe, ideally I like to reassess symptoms about three months after starting a birth control pill. This allows us to really see how much benefit you will get from the first treatment before adding a second one.
Secondly, I consider how severe the mood symptoms are. Any symptoms that are impacting your functioning should be addressed promptly. If mood symptoms are impacting my patients’ relationships at home or at work, or are preventing them from functioning in their daily lives, adding a medication or making a medication change is warranted.
The takeaway: SSRIs are effective in managing cyclic mood changes. You should discuss adding one to your medication regimen with your doctor if changes in your mood are impacting your relationships or functioning.
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