That I have a mood disorder goes unquestioned; the true nature and biological aspects of cause are up in the air. Besides the usual childhood traumas and genetic influences, it looks like hormones are in part to blame. Don’t start any hating about stigmatizing women’s normal, natural cycle, because I’m not talking about a normal experience.
I’m talking about a set of oversensitive physiological responses to and/or chronic imbalances of basic hormones like adrenaline, cortisol, estrogen, progesterone, and testosterone. The kind of sensitivity to adrenaline, for example, that means I can’t have medications containing epinephrine (aka adrenaline, often found in injectable local anesthetics, to reduce bleeding) because it immediately sends me into shock. It took awhile to figure that out, during which time I became thoroughly conditioned to have panic attacks at the dentist’s and oral surgeon’s offices as a matter of course. My body’s over-reaction to epinephrine presents as a classic panic attack, complete with cold sweats, elevated heart rate, and vasovagal syncope – all completely involuntary responses – and a sure sense of apocalypse.
Evidence suggests that some of my hormones are out of whack, but lab tests don’t find much that really falls outside of a normal range, aside from my cortisol levels (which are much too high. Sigh.) Way to be invalidating, modern medicine! The problem is, the testing isn’t done in a way that actually could identify a hormonal pattern underlying the cyclic aspects of bipolar-type symptoms that I experience, independent of whether there’s any empirical foundation to my suspicions in terms of abnormalities of hormone levels, rates of change, or sensitivity.
Somehow a “hormone imbalance” sounds different and less stigmatized than a “neurotransmitter imbalance”, especially because simply referring to “hormones” implies the cyclical sex hormones, which are both familiar to all and clearly not under my control. I found myself wondering, if I have a mood disorder (yes, yes, I do) that is at least in part caused by hormones, is that really mental illness?
Well, duh. Yes, it is. The manifestation of extreme mood symptoms was what earned my PMDD diagnosis, regardless of the suspected hormonal basis and accompanying physical complaints (like aching ovarian pain and limp-inducing grinding joints).
Every month, there’s a depressive dip, on the short side but usually just as sharp, ranging from a little blue to suicidal ideation. Surrounding that nugget of negativity is a longer period of general dysphoria, irritability, hyper-reactivity, and reduced cognitive capacity. It’s brutal, but because I know approximately how long each phase of my cycle lasts, I also know when an episode is more than “just” hormones – the depression simply lasts too long. Long enough to just barely count as major depression, when at least a couple of times a year, four to seven days of dysfunction turns into two to four weeks, and things get pretty dark and scary.
I also know how soon to expect improvement, however temporary. I’m starting to adjust the way I work to better accommodate the more predictable and generally brief losses of cognitive and emotional functioning. But I also know how soon to expect things to decline again, which currently makes me very hesitant to take on new projects or make commitments that span more than a few weeks’ time. I can predict that I’ll be out of action for a couple of days at certain times, but I can’t predict how much longer the malingering lows may linger.
Still, having identified hormonal imbalances as a chief suspect in the great mystery of my mental dysfunction, there is much more hope for effective treatment to stabilize the mood rollercoaster. Where antidepressants have failed to contain my melancholy tendencies, a little progesterone might make all the difference. There’s also that much more room for disappointment, of course, but I can’t help but hope for better outcomes.
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