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Health

The Opposite of Light

On deciding to medicate my premenstrual dysphoric disorder.

The Opposite of Light
Illustration by Alisha Davidson

“You’ll be OK,” my friend Eliza said when I got my period on the evening of December 15. We were leaving for New York City that night, and I was nervous about how my cramps and mood swings would put a damper on the next day’s activities, which included a big trip to the Museum of Natural History that I’d planned with my partner, Tony, and his seven-year-old daughter, Willa.

“Probably not,” I responded as I packed the Advil and THC salve into my bag in Hudson. I knew how I could seem absolutely fine one moment, only to have an out-of-control premenstrual dysphoric disorder meltdown come on. But I was hopeful, since the PMDD episodes usually came pre-bleeding, and, though I’d experienced some major irritability, I hadn’t had what I’d call “an outburst.” Maybe I’d gotten out of December scot-free. Could I be so lucky?

The next morning, I’d woken up so excited. The four of us — Tony, Willa, Eliza, and me — ate breakfast at the Waverly Diner, which was lovely, and I was relieved at how normal I was feeling. Then, outside the diner, walking to the subway, Tony told me his way to get to the Museum of Natural History was faster than what I’d suggested. I felt the physical PMDD symptoms kick in hard and fast.

Tony describes it as a black cloak dropping over my entire body; he calls it the female Incredible Hulk. In a millisecond, my body is prickling with paranoia, pulsing with rage, heavy with sadness and anger. We walked underground and Eliza asked if I was OK as Tony walked away from me momentarily. I began crying telling her how angry I was. She looked concerned, her eyes so loving. And a little fearful, the same way Tony looks at me during PMDD, the same way I look at myself, a way that breaks my heart.

The Museum of Natural History is not the ideal venue for a PMDD episode — I already felt simultaneously disconnected from reality, while reality felt high definition, which was only exacerbated by the fossil of the Tyrannosaurus rex. I couldn’t trust myself or my emotions.

I noticed my crumpled-up ticket in the coat of my pocket. My hand was in a sweaty balled fist. It was shredded and wet. Was that a panic or anxiety attack? A rage attack? Tony tells me he knows exactly when I am in PMDD because I use the words always and never, tell him he’s an “asshole,” and text the phrase “WTF” with a bunch of exclamation points and question marks. This has happened without fail every month. We now have a deal that I am not allowed to text him swear words during PMDD week, even in acronym form. But FTS! (Fuck that shit.) Just kidding.

First up at the museum was the butterfly conservatory. I watched the metallic butterflies and could barely stand their beauty. Then we attended a 4-D movie titled Dark Universe, narrated by Neil deGrasse Tyson (who Tony says should narrate the PMDD-episode descriptions of my book). The description of the film: “Dark Universe examines the invisible dark matter underlying galaxies that, together with dark energy, accounts for that other 95 percent of the universe’s total energy and mass.”

The movie began, and there were sparkles of pink and blue falling over us. I could not retain one fact. Tony leaned over and began sternly speaking to me, because any time he reached out, I ignored him. He started saying that he knew this was PMDD energy coming at him. That it was familiar. That he wanted to have a good day with his daughter. Was I able to have a good day? Because if not, I should go my way for the day and he should go his.

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As he spoke, I cried harder. I felt so guilty, so shitty, so mad at myself, and yet I could not stop. I was completely raw and enraged. Toward the end of the film I repeated to myself: Take his hand, take his hand, take his hand, and then I did. I hoped I could soften, but I was so far gone, and then, even after I’d come back to myself for twenty minutes, the wave of PMDD came back and took me under. Boogie-boarding.

I felt raw. My reality not matching anyone else’s. As Sheila Heti describes her PMDD in her forthcoming novel Motherhood, there was “a tall thick wall between myself and the world, preventing me from seeing, while giving me the impression that I was truly seeing.”

Walking through the mummy exhibit, Willa gently said my name out of nowhere while reaching for my hand. That’s all she said, my name — not as a question, just a statement. “Chloe.” I found this ridiculously moving, but anytime I opened my mouth a sob almost escaped, so I just squeezed her hand and she squeezed mine back in return.

***

Tony and Willa did not sit with me on the Amtrak home. I sat alone by the window, with Eliza across the aisle. I took my shoes off, put my headphones in, and cried while Tony and I texted about what hell the trip had been.

That night, after I had calmed down, we sat in the living room and talked for two hours. We were both exhausted by this cycle. My energy during those episodes felt violent. They were destructive to my relationship. I could not live this way anymore. We made a list titled “PMDD Tools” for what to do next time, including things like: Leave the situation! Take a bath! Go to bed! And the next morning I even wrote myself a letter from myself in a non-PMDD episode. There was so much repair to do from the day. The repair went on for the next few days.

Tony and I slept in the guest room because Willa fell asleep in his bed before we could. Something I noticed that night was that we unusually stayed on one side of the bed, and he never turned away from me, not once, kept pulling me only toward him.

In the morning, I woke to my clearheaded, grounded, relatively cheerful self. The Hormonology app resets itself for the next month, and of course I was due to get my period on Tony’s birthday, January 11. Fuck. Me. He was tracking this as well on his own apps and seemed upset and apprehensive about this. “It’s like you’re two different people,” he said. “I don’t know which Chloe I’m going to get.” I couldn’t live this way anymore.

***

My story for a long time was: “I don’t want to be one of those people who are always trying different medications.” I envisioned worst-case scenarios: blowing up 40 pounds seemingly overnight, bitching about side effects, addicted to the lifestyle of throwing meds at a problem. I’d wanted to figure it out on my own, or my ego did.

There’s a photo I recently saw online with a split screen. One side said PMS, with a photo of pulling her hair out, and the other said PMDD, with a woman on the edge of a rooftop. PMDD affects 3 to 8 percent of women of childbearing age, and their symptoms (including insomnia, mood swings, hot flashes, depression, and severe fatigue) subside at the onset of menstruation and disappear until the next menstrual cycle. Between ovulation and menstruation, progesterone drops, and women sensitive to the hormone experience aggression, paranoia, and anxiety. At the symptomatic phase of the condition, women who suffer from PMDD are unable to function at their normal capacity.

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In the year 2000, the FDA approved Prozac as the only antidepressant suitable for treating PMDD. It was rebranded as the more feminine-sounding Sarafem but made with identical ingredients to Prozac. When women with PMDD were given Prozac, 80 percent felt better after treatment. Some women take it only beginning the day they ovulate until the onset of menstruation. When serotonin is blocked in the brain, the result is strikingly similar to PMDD symptoms, so it makes sense that an SSRI would treat both issues.

“When a person first takes an SSRI, serotonin levels begin to increase over twelve to 24 hours. It is not enough to treat major depressives, but it is enough to treat women with PMS or PMDD. Clinically, women say by the time they seek medical treatment for their severe symptoms, many women are so discouraged by the lack of improvement after trying self-help treatments that they don’t expect the medication to work either. When their next menstrual cycle comes with none of their usual premenstrual symptoms, they report being shocked and delighted,” writes Dr. Diana L. Dell in The PMDD Phenomenon.

I reached out to family members, friends and their partners, Instagram followers. I was surprised to find that more of my family and friends than I knew were on antidepressants. It is sad that my parents’ generation did not have this outpouring of resources. You couldn’t search the hashtag #MedicatedandMighty and read captions by beautiful women, celebrities and non-, holding their bright-orange prescription bottles.

My aha moment came when emailing with a family member who said she’s taken Prozac for almost twenty years. She explained how my grandfather had depression and how, with our genetics, it would be worth trying something.

“Chloe, you’ve tried supplements, acupuncture, yoga, meditation, talk therapy. How long do you have to continue to suffer for something genetic that you’ve inherited?” my therapist asked.

***

I procured my first dose of Prozac two days after the New Year. The day was emotionally taxing. I jump-started the morning with a therapy session that I cried through, and my therapist told me not to leave my doctor’s office without a prescription. I was a little offended but understood what she was saying. It had been a year of the PMDD episodes. After therapy, I met Tony at a cafe and accidentally drank too many cups of coffee. Then I hopped on the phone with my friend Lindsey, who is on Prozac, to talk about Prozac. I walked to my doctor’s office, waited about an hour, chatted with the nurse about my PMDD and Prozac, and then my doctor came in and we talked more.

By the end of the day, I was so fucking sick of talking about myself and my problems. I rested my computer on my toilet while I took a bath and watched women on YouTube talk about their PMDD, then walked to Tony’s apartment, where he made us steak and spinach. I crawled into bed early.

Research shows that for depression, SSRIs can take up to six months to begin working, but, as noted previously, if you’re taking one for proper PMDD (I am textbook) the effects can begin within 12 hours. The day after I started Prozac, I was standing in my kitchen making tea, the way I do about seven times a day. I was making my Women’s Cycle tea — because I need all the help I can get — and, I notice, though it is a six-degree day and snowing, I am thinking these positive thoughts about spring. How beautiful spring is. How cool that spring comes after winter! What an amazing cycle! Normally I stand in the kitchen or in front of my space heater and think about how cold it is, how much I hate the cold, how hard it makes everything, how terrible winter is, how difficult life is, what’s the point of anything? Later that day, I noticed music was sounding even better than usual, and I was loudly singing along.

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***

Willa recently asked me what my latest essay was about.

“Complicated things you go through as an adult woman. Problems you may have. Hormones, moods, stuff like that.”

“Oh, so it’s like the opposite of light.”

Tony and I caught eyes.

“What do you mean, ‘the opposite of light’?” I asked.

“Well, it’s the opposite of what I write.”

“What do you write?”

“Like, essays about autumn, for example.”

***

Maybe I was conditioned to think antidepressants were for weaker people. It is true that on some level I probably felt superior for not being on antidepressants. Even though my friends were on them. Even though writers I admired were on them. Even though my family members were on them.

I remember my friend Lindsey once telling me, when considering it, that I seemed really “functional.” This made me smug. I could be a writer, a little nuts, and use drugs recreationally. Last summer, during the worst August of my life, I asked my therapist if she thought I should try medication. “I don’t know,” she said. “You’re functioning pretty well. You’re acknowledging everything, working on it, going to yoga.” Antidepressants were for people whose problems were more serious than mine, for people who couldn’t get out of bed. I see now this was both a compliment and a curse, tricking me into thinking everything was OK.

But I was sick of being utterly terrified of my period. It didn’t feel healthy to dread my ovulation day, knowing it was all downhill from here. I was sick of obsessively checking the Hormonology app, of having to write letters of apology for the rage and words I regret saying the moment I begin bleeding. I was so tired of observing myself. But then I countered that with: Well, I’ve made a career out of observing myself.

***

One morning I found myself Googling “I love Prozac” on the toilet. I woke up with Tony to his alarm (“Here Comes the Sun”) at 7:30 a.m., and we got out of bed around 8. When I woke, my mind wasn’t already full. It was clear and ready for the day. Later, I caught myself skipping in the kitchen. Then dancing in the living room. My acne was flaring because it was period week (also known as “mean season,” as coined by the boyfriend of a woman on YouTube), but it didn’t make me as upset as normal. I found I was having thoughts like: Oh well! It will pass! My car battery was dead, and Tony texted me, Oh no! That sucks! I responded, It’s OK! It will probably start when the weather warms tomorrow.

It occurred to me: Is this how Tony always feels? Not always (he hates that word), but is it his baseline? I had a moment of understanding how frustrating for him I must be if this is his natural state. If I could just give Tony a month where I don’t have an outburst, it would be the best birthday gift I could give him.

***

And then, a miracle: I got my period the day before his birthday, eight days into my Prozac experiment, with barely a glimmer of regular PMS. I was sitting on my therapist’s couch — not crying! — when I began to feel some cramps. “I am glad,” she said, as I pulled my boots on to leave, “that you are feeling more buoyant.”

The next day, we had a lovely morning of sleeping in and coffee, an afternoon walk through the snow at a nature conservatory, and a silly and romantic dinner out. Sure, I took a couple of Advil for cramps and had some minor irritability — but it was so minor, in fact, that I’m not even sure I had any. And after living through what feels like a nightmare on earth, I welcome any regular irritability with open-as-fuck arms.

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“You,” Tony said, across from me at dinner, “are doing really well. Your mood is so even; it’s wild.” I was ecstatic for days after. I’d gotten through my period without collateral damage. It was so … relaxing.

One invaluable lesson I’ve learned is that no one will advocate for you. No one else cares if you go on Prozac, the same way no one cares if you make art or not. Your mental health is your own responsibility, especially when it affects those around you. Prozac has not fixed me and will not fix me. I dislike narratives where the end is the author all happy, having found her thing. Life is more complex; it is February when I’m writing this, and the week leading up to my period has not been sunshine and roses.

“Looks like we’ve arrived at our PMDD destination a little earlier than expected. Please watch your head when exiting the platform,” Tony texted.

“Fuck off. It’s kind of funny, but still,” I responded.

Like Elizabeth Wurtzel writes in Prozac Nation: “I can’t help feeling that anything that works so effectively, that’s so transformative, has got to be hurting me at another end, maybe sometime further down the road.”

But for now, I am letting myself feel what millions before me have already felt: a touch of relief. I don’t feel the “opposite of light” anymore, and for the first time in years, I didn’t experience two weeks in a 4-D dark universe. I have to believe I deserve that. Hell, maybe I’ll even find myself writing an essay about autumn.

Chloe Caldwell is the author of the novella Women and the essay collections I’ll Tell You in Person and Legs Get Led Astray. She is currently working on a book about PMDD titled The Red Zone: A Love Story.