‘I was told I was mentally ill for 20 years – but it was extreme PMS’
Thousands of women are being misdiagnosed with psychological disorders and mental illnesses every year because of an extreme form of PMS, and sadly Hannah Christmas was one of them. Nilufer Atik investigates...
For most of her life, Hannah Christmas had been labelled mentally ill by GPs, psychiatrists and just about any one she asked for help. Dogged by crippling depression, memory lapses, and at times unable to read or write properly because it felt like her brain ‘was slowing down’, doctors told her she had a severe mood disorder and clinical depression.
Since first going to see her GP at 18, the 35-year-old British solicitor had been given countless drugs to ‘cure’ her, from anti-depressants and sedatives to the mood stabiliser lithium. But none of the pills worked. She tried numerous holistic treatments such as St John’s wort, B vitamins, mineral supplements, dietary changes such as cutting out caffeine and sugar (which helped a little), aromatherapy, acupuncture, and meditation, and several forms of therapy such as cognitive behavioural and psychotherapy, all in a desperate attempt to rid herself of the ‘unbearable fog’ dominating her life.
It ruined her relationships and she was forced to take long periods off work, unable to drag herself out of bed. Eventually, in 2012, desperate after losing her job, a psychiatrist suggested she try electroconvulsive therapy – an extreme and controversial treatment that involves inducing seizures in the brain using electricity. It is usually the last line of intervention for illnesses such as schizophrenia and catatonia.
“The thought terrified me,” Hannah recalls. “It literally meant having my brain electrocuted. I really didn’t want to do that, but I had reached the end of the road in terms of treatment. I just wanted to get better so I could live a normal life.”
‘I would feel paranoid, and some days I would just lie sobbing in bed. I’d have panic attacks too’
Her dark moods ruined any chance of a relationship for a long time because boyfriends simply couldn’t cope with her mood swings. “I remember staying at my boyfriend’s family’s house one Christmas and it was Boxing Day. Everyone was happy and celebrating but I was in floods of tears for no reason,” she says. “He tried to comfort me but couldn’t understand why I was so upset – there was no reason. I just felt awful and overwhelmed by sadness.”
Hannah was in a long-term relationship for seven years in her late twenties, but they broke up. “He just suddenly ended it one day and it was a shock,” she says. “It wasn’t because of my health problems but I worried that someone new wouldn’t want to put up with my crippling depression every month.”
Hannah couldn’t even try to mask her low days. “I would feel paranoid thinking things like, ‘nobody likes me’ and have really negative thoughts about myself,” she says. “I would feel so low I didn’t even want to talk to anyone for up to two weeks. Some days I would just lie sobbing in bed. I’d have panic attacks too.”
Other times it was so bad that she couldn’t remember people’s names and would sleep for 15 hours at a time.
“It was so difficult and affected every part of my life,” Hannah says. “My cognitive function was so badly impaired. My memory was rubbish and it felt like everything in my head had slowed down.”
It took a long time but Hannah eventually began to notice a pattern. “When my period started, I would be back to normal again. It was like a big cloud had lifted from me. I’d feel energetic, relaxed, and happy. I’d socialise with people and just be Hannah again. It was so bizarre. Then two weeks later it would all start again. I would wake up feeling a little down and teary and as the days passed it would get worse and
worse, to the point where I couldn’t function,” she says. “I wouldn’t get out of bed to dress myself or eat or go anywhere. If people called or texted me I would just ignore them.
“I had friends and family who worried about me but I explained that I just needed to be left alone. My Mum would come and check on me but she knew she would have ‘her Hannah’ back once the depression had passed. Like me, she had a feeling that the doctors were wrong – that my problems were somehow linked to my periods – but no one would listen. I’d been diagnosed as clinically depressed and that seemed to be that.”
She was even given lithium by a GP who told her she had some kind of ‘mood disorder.’ The powerful drug is usually given to people who suffer from bipolar disorder or schizophrenia. “It made me feel awful – really sluggish and I put on weight,” she recalls.
Hannah struggled on for more than 20 years with her illness. She decided not to have electroconvulsive therapy because of the long-term side effects such as permanent memory loss. Instead, she tried everything to cope with her overwhelming depression every month, always hoping for a solution.
It wasn’t until last September, when Hannah was chatting to an old colleague on the phone, that something clicked. She told her friend about her symptoms and she suggested they might be brought on by hormonal changes.
“She’d worked for NHS Direct before and told me about a condition called Premenstrual Dysphoric Disorder [PMDD],” she says. “It’s a very extreme form of Premenstrual Tension (PMT) brought on by a hormonal imbalance. I’d never heard of it but when I began researching the condition on the internet, it all made sense.
“I felt so relieved. After all these years I finally understood what was really wrong with me. And I wasn’t going mad.”
Unlike PMT, which causes symptoms such as headaches, bloating, pain and discomfort in the abdomen, backache and breast pain, with PMDD emotional symptoms are more dominant. Pain can be extreme and coupled with nausea and panic attacks. Sufferers also experience suicidal thoughts, frequent crying, anger, feelings of being out of control and trouble thinking or focusing.
The symptoms typically occur during the two weeks before menstruation, and go away once it starts. They are thought to be caused by an increased sensitivity to the natural changes in hormone levels.
It explained Hannah’s symptoms of feeling fine and then deeply depressed every fortnight. But because PMDD only affects between 3-5 per cent of women worldwide, many GPs have never heard of it.
Hannah’s research led her to Professor John Studd, a worldrenowned expert on PMS who set up the first-ever specialist unit at the
‘It does makes me feel angry that there are women like me being given unnecessary drugs’
Chelsea and West minster Hospital in London. The professor, who now runs a private practice, conducted extensive studies into the effects of hormone therapy – in particular the use of the female sex hormone oestrogen – on PMDD.
He discovered that in 94 per cent of cases, oestrogen either dramatically reduced symptoms or eliminated them altogether. It was a huge breakthrough and meant that women with the condition who, like Hannah, had been told for years that their problem was psychological, or who had been given the wrong treatment, could be helped.
“Women with PMDD often describe having a Jekyll and Hyde type personality,” explains Prof Studd. “About 10 days before their period starts, they have this total change of personality. It can be very destructive – particularly when it comes to their personal relationships. People might tell them to pull themselves together, but they can’t as they have no control over the way they feel.”
Prof Studd’s research has also revealed that not only are women with PMDD intolerant of the hormone progesterone – previously one of the most popular types of treatment for PMS through the contraceptive pill – it actually makes their symptoms worse.
After Hannah went to see Professor Studd at The London PMS and Menopause Clinic in October last year, she began hormone treatment – a combination of an oestrogen implant and a coil that administers small doses of progesterone, which helps to make the body more tolerant to progesterone, the hormone largely responsible for PMDD symptoms. She says there has been an improvement though the treatment costs around £2,000 (about Dh12,400) a year.
“At last I feel like I have found the answer and can reclaim my life,” Hannah says. “My depression is not as bad and only lasts around five days now. I still feel low and cry but don’t become bed bound. I have been able to carry on working part-time at a family law practice and they have been very understanding. I have even started a serious relationship. My boyfriend John knows all about my PMDD and it hasn’t put him off at all. If I am having a bad day he is there for me.
“It does make me feel angry that there are women like me being given unnecessary drugs and told they have mental illnesses such as clinical depression, bipolar or even schizophrenia, when it is an extreme reaction to hormones that can be treated. I wasted 20 years of my life but at last now I feel like I can start living.”