{"id":3005,"date":"2023-09-01T15:33:28","date_gmt":"2023-09-01T15:33:28","guid":{"rendered":"https:\/\/brooksidepress.org\/pa_obgyn\/?page_id=3005"},"modified":"2023-09-01T15:33:28","modified_gmt":"2023-09-01T15:33:28","slug":"mood-disorders","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/advanced-training\/mood-disorders\/","title":{"rendered":"Mood Disorders"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Hcrca_FGQE8\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 9:17<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5a5243d83031112752' value='69e9b5a5243d83031112752'><input type='hidden' id='bg-show-more-text-69e9b5a5243d83031112752' value='Show Teaching Script'><input type='hidden' id='bg-show-less-text-69e9b5a5243d83031112752' value='Hide Teaching Script'><button id='bg-showmore-action-69e9b5a5243d83031112752' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Teaching Script<\/button><div id='bg-showmore-hidden-69e9b5a5243d83031112752' ><\/p>\n<p class=\"p2\">Postpartum Depression<\/p>\n<p class=\"p3\">Liang A<\/p>\n<p class=\"p4\"><b>Clinical Cases Applicability: <\/b>Antepartum mood disorders, postpartum blues, postpartum depression<\/p>\n<p class=\"p4\"><b>Learning Objectives: <\/b><\/p>\n<p class=\"p4\">1. Understand the neurobiological mechanisms underlying postpartum depression<\/p>\n<p class=\"p4\">2. Describe the pharmacology of SSRIs<\/p>\n<p class=\"p4\"><b>What are some sex differences in depression? <\/b><\/p>\n<p class=\"p4\">-Women 2x more likely to develop depression, greatest difference in reproductive years \u2013 suggests sex hormones (estrogen, progesterone, oxytocin) and reproductive events play some role in etiology of depression<\/p>\n<p class=\"p4\"><b>What is the definition of PDD? prevalence? Risk factors? Natural history? <\/b><\/p>\n<p class=\"p4\">-DSM 5 defines peri-partum depression as symptom onset during pregnancy or &lt;4 weeks PP \u2013 but greatest incidence of new PPD occurs 2-3 months postpartum, and can occur within 1 year<\/p>\n<p class=\"p4\">-Prevalence ~10-15%<\/p>\n<p class=\"p4\">-Risk factors: antenatal depression (\u2191 prevalence in 2<span class=\"s2\">nd<\/span>\/3<span class=\"s2\">rd <\/span>trimesters) &amp; depression prior to pregnancy; stressful life events (marital conflict, emigration), poor social &amp; financial support<\/p>\n<p class=\"p4\">&#8211; Often remits on its own within 12 months after giving birth, 6x increased risk for depression later in life<\/p>\n<p class=\"p4\"><b>What are proposed neurobiological mechanisms underlying PPD? <\/b><i>Pathogenesis unknown <\/i><\/p>\n<p class=\"p4\"><b>Genetics: <\/b>increased risk with family history of PPD<\/p>\n<p class=\"p4\"><b>Abnormal neurotransmitter levels\/activity: <\/b>\u2191 brain monoamine oxidase <span class=\"s3\">\uf0e0 <\/span>\u2191 metabolism of neurotransmitters such as dopamine, norepinephrine, serotonin <span class=\"s3\">\uf0e0 <\/span>more rapid depletion of these neurotransmitters <span class=\"s3\">\uf0e0 <\/span>depression<\/p>\n<p class=\"p4\"><b>Significant changes in neural activity in brain regions <\/b>important for self-regulation, empathy &amp; emotion; fMRI studies identify brain regions affected by postpartum depression at rest and in response to infant or non-infant emotional cues<\/p>\n<p class=\"p4\"><span class=\"s4\">&#8211;<\/span>Decreased corticortical and corticolimbic connectivity<\/p>\n<p class=\"p4\">-Weaker connectivity among the amygdala (processes emotions), anterior cingulate cortex (connects the \u201cemotional\u201d limbic system and the \u201ccognitive\u201d prefrontal cortex), dorsal lateral prefrontal cortex (working memory) &amp; hippocampus (long term memory, emotional responses)<\/p>\n<p class=\"p5\">-decreased connectivity between the amygdala and right insular cortex w\/ positive infant cues<\/p>\n<p class=\"p4\"><b>Abnormal growth factors<\/b>: \u2193 Brain-derived neurotrophic factor (supports differentiation, maturation and survival of neurons) concentrations in PPD<\/p>\n<p class=\"p4\"><b>What hormones may play a role in PPD? <\/b>women with a predisposition for depression may be more sensitive to large fluctuations in steroid hormone levels<\/p>\n<p class=\"p4\"><b>Estradiol<\/b>: estradiol levels continue to \u2191 in 3<span class=\"s2\">rd <\/span>trimester, but drop dramatically after birth \u201cestradiol-withdrawal state\u201d<\/p>\n<p class=\"p4\"><b>Cortisol: <\/b>high levels of cortisol during pregnancy secondary to placentally-derived CRH; cortisol stimulates CRH production in placenta (positive feedback); withdrawal from excess cortisol postpartum <b>(figure 1) <\/b><\/p>\n<p class=\"p4\"><b>Oxytocin: <\/b>hypothesized to have anti-depressant properties; women at risk for PPD have lower oxytocin concentrations in 3<span class=\"s2\">rd <\/span>trimester; BUT administering oxytocin does not improve mood<\/p>\n<p class=\"p4\"><b>Why is treatment of PPD important? <\/b><\/p>\n<p class=\"p4\">Negative outcomes for mothers and infants: \u2193 breastfeeding, lack of maternal emotional and behavioral sensitivity to the infant, poor bonding, negative infant temperament, atypical neurodevelopment, and later emotional and behavioral problems for the children<\/p>\n<p class=\"p4\"><b>What are pharmacological treatment options for PPD? Mechanism of action? <\/b>women with PPD take longer to recover &amp; require more therapies than in non-postpartum MDD women<\/p>\n<p class=\"p4\"><b>SSRIs <\/b>\u2013 paroxetine and sertraline usually undetectable levels in breast-fed infants; SSRIs block the SERT transporter to \u2193 presynaptic serotonin reuptake<span class=\"s3\">\uf0e0<\/span>\u2191 serotonin concentration <b>(figure 2) <\/b><span class=\"s5\">Postpartum Depression <\/span><\/p>\n<p class=\"p3\">Liang A<\/p>\n<p class=\"p6\">Figure 1<\/p>\n<p class=\"p6\">Figure 2<\/p>\n<p class=\"p6\">References:<\/p>\n<p class=\"p6\">-Pawluski J, Lonstein J, Fleming A. The Neurobiology of Postpartum Anxiety and Depression. Trends in Neurosciences. 2017 Feb;40(2):106-120<\/p>\n<p class=\"p6\">-Brummelte S, Galea LA. Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and Behavior. 2016 Jan;77:153-66<\/p>\n<p class=\"p6\">-Viguera, A. Severe unipolar major depression: Treatment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (2017)<\/p>\n<p class=\"p6\">-Viguera, A. Postpartum unipolar major depression: Epidemiology, clinical features, assessment and diagnosis. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (2016)<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/112293128\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 10:06<\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Av3HhhQFCmY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 11:37<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5a5247907003845828' value='69e9b5a5247907003845828'><input type='hidden' id='bg-show-more-text-69e9b5a5247907003845828' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5a5247907003845828' value='Hide Transcript'><button id='bg-showmore-action-69e9b5a5247907003845828' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fcfafa;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5a5247907003845828' ><\/p>\n<p>00:00<br \/>\nhey guys I&#8217;m sorry it has been a little<br \/>\n00:02<br \/>\nwhile since I filmed a YouTube video but<br \/>\n00:04<br \/>\nI just wanted to sit down today and do<br \/>\n00:06<br \/>\none because I&#8217;m finally feeling a little<br \/>\n00:08<br \/>\nbit better I just had no motivation<br \/>\n00:09<br \/>\nthere for a while<br \/>\n00:10<br \/>\nyou guys know how it is with PMDD um it<br \/>\n00:13<br \/>\ngets really rough so I&#8217;m just now like<br \/>\n00:16<br \/>\ngetting off of my period so I&#8217;m feeling<br \/>\n00:19<br \/>\na little bit better and I asked you guys<br \/>\n00:22<br \/>\non Instagram what YouTube videos you<br \/>\n00:24<br \/>\nguys wanted to see and I got a lot of<br \/>\n00:28<br \/>\nreally good suggestions so thank you<br \/>\n00:30<br \/>\nguys for that I&#8217;m going to be you know<br \/>\n00:32<br \/>\nworking my way through the list but one<br \/>\n00:36<br \/>\nof the suggestions stuck out to me it<br \/>\n00:40<br \/>\nwas um what are your worst PMDD symptoms<br \/>\n00:42<br \/>\nand so I figured today I would share<br \/>\n00:44<br \/>\nwith you my top 5 worst PMDD symptoms<br \/>\n00:47<br \/>\nand the reason I&#8217;m doing this is because<br \/>\n00:49<br \/>\nI just think it&#8217;s interesting like to<br \/>\n00:52<br \/>\nhear each woman&#8217;s like worse symptoms<br \/>\n00:55<br \/>\nand how we you know get different things<br \/>\n00:58<br \/>\nor how we can relate at this like the<br \/>\n01:00<br \/>\nsame things and all of that stuff so I&#8217;m<br \/>\n01:03<br \/>\njust gonna go in order from like not as<br \/>\n01:06<br \/>\nas bad to like the very very worst so<br \/>\n01:08<br \/>\nlike 5 4 3 2 1 if that makes sense all<br \/>\n01:11<br \/>\nof these symptoms are terrible<br \/>\n01:14<br \/>\nthey&#8217;re my top 5 so they&#8217;re really bad<br \/>\n01:16<br \/>\nand it&#8217;s almost hard to rate them on a<br \/>\n01:19<br \/>\nscale of like not as bad to worse<br \/>\n01:21<br \/>\nbecause they&#8217;re all just so bad<br \/>\n01:23<br \/>\nbut I am going to just jump right in to<br \/>\n01:28<br \/>\nnumber 5 and that is sore breasts I get<br \/>\n01:33<br \/>\nthe worst breast tenderness and pain and<br \/>\n01:35<br \/>\nthey swell up like a whole cup size and<br \/>\n01:37<br \/>\nthey feel like they&#8217;re bruised like like<br \/>\n01:40<br \/>\nI&#8217;m carrying sandbags around in them and<br \/>\n01:42<br \/>\nthey&#8217;re bruised like it hurts so bad and<br \/>\n01:45<br \/>\nI can feel it when I walk like I can<br \/>\n01:48<br \/>\nliterally feel it when I take a step<br \/>\n01:49<br \/>\nit&#8217;s that like sensitive and severe now<br \/>\n01:52<br \/>\nI just wear really tight bras honestly<br \/>\n01:55<br \/>\nduring that time and sometimes I&#8217;ll even<br \/>\n01:57<br \/>\nice my boobs like I&#8217;m not even getting<br \/>\n02:00<br \/>\nit it gets really really bad and for me<br \/>\n02:03<br \/>\nit happens for ten days of every month<br \/>\n02:05<br \/>\nso 10 days warm period I&#8217;ll start<br \/>\n02:08<br \/>\ngetting breast tenderness and it will<br \/>\n02:09<br \/>\nlast all the way up until I start my<br \/>\n02:10<br \/>\nperiod<br \/>\n02:11<br \/>\nso that is no fun at all and I&#8217;m sure a<br \/>\n02:15<br \/>\nlot of you can relate to that but yeah<br \/>\n02:18<br \/>\nnot a good time my second art number<br \/>\n02:21<br \/>\nfour I guess I would say is my increase<br \/>\n02:24<br \/>\nin appetite I get the worst cravings and<br \/>\n02:28<br \/>\nthey are horrible it&#8217;s mostly for pizza<br \/>\n02:31<br \/>\nand chocolate I will literally go out of<br \/>\n02:34<br \/>\nmy way to seek out pizza and I&#8217;m not<br \/>\n02:37<br \/>\neven supposed to eat pizza I&#8217;m gluten<br \/>\n02:38<br \/>\nand dairy intolerant and I will eat it<br \/>\n02:41<br \/>\nanyway that&#8217;s how much I want it like<br \/>\n02:43<br \/>\nthat&#8217;s how bad and overbearing my<br \/>\n02:45<br \/>\ncravings get I&#8217;m just like fuck the food<br \/>\n02:46<br \/>\nallergies like I&#8217;m gonna get pizza and<br \/>\n02:48<br \/>\nthen I end up paying for it later but<br \/>\n02:51<br \/>\nyeah I eat pizza a lot when I&#8217;m PMSing<br \/>\n02:54<br \/>\nit just sucks because like I really do<br \/>\n02:56<br \/>\ntry hard with my fitness and my healthy<br \/>\n02:58<br \/>\neating and I don&#8217;t have a problem with<br \/>\n03:00<br \/>\nit during the rest of the month but then<br \/>\n03:03<br \/>\nlike that two weeks before my period I<br \/>\n03:05<br \/>\nget so like almost out of control and I<br \/>\n03:08<br \/>\njust crave everything and like it&#8217;s<br \/>\n03:11<br \/>\nnormal for us to have cravings but with<br \/>\n03:13<br \/>\nPMDD it&#8217;s like PMS on steroids so<br \/>\n03:15<br \/>\neverything is way way worse and I<br \/>\n03:18<br \/>\nhonestly could not even like Express to<br \/>\n03:23<br \/>\nyou guys how strong my cravings get it<br \/>\n03:26<br \/>\nreally sucks and that&#8217;s just that was<br \/>\n03:29<br \/>\nthat one&#8217;s worse for me than the sore<br \/>\n03:31<br \/>\nbreasts because I can handle the sore<br \/>\n03:32<br \/>\nbreasts but the appetite thing drives me<br \/>\n03:34<br \/>\nfucking nuts because I&#8217;m already bloated<br \/>\n03:37<br \/>\nI&#8217;m already miserable and then to add<br \/>\n03:39<br \/>\nlike all that food into my stomach and<br \/>\n03:42<br \/>\nall the bad food and for me to try to<br \/>\n03:44<br \/>\nprocess that like and it&#8217;s like well why<br \/>\n03:47<br \/>\ndon&#8217;t you just control what you eat it&#8217;s<br \/>\n03:49<br \/>\nlike I almost nearly can&#8217;t like it&#8217;s<br \/>\n03:51<br \/>\njust it&#8217;s so overbearing and that&#8217;s<br \/>\n03:55<br \/>\nsomething I&#8217;m excited about to get my<br \/>\n03:56<br \/>\nhormones leveled out hopefully with this<br \/>\n03:59<br \/>\nnew birth control that I&#8217;m about to try<br \/>\n04:00<br \/>\nwhich I can make a video on later but I<br \/>\n04:04<br \/>\njust literally can&#8217;t stand how bad the<br \/>\n04:07<br \/>\nappetite is like it&#8217;s it I will gain I<br \/>\n04:10<br \/>\nthink I go up six pounds within two<br \/>\n04:14<br \/>\nweeks like I will gain six pounds and<br \/>\n04:16<br \/>\nthen I&#8217;ll lose six pounds and I&#8217;ll gain<br \/>\n04:17<br \/>\nsix pounds and lose six pounds it&#8217;s like<br \/>\n04:19<br \/>\nthis vicious cycle that I&#8217;m always in<br \/>\n04:21<br \/>\nbecause<br \/>\n04:21<br \/>\nI can&#8217;t stop my cravings okay so the<br \/>\n04:26<br \/>\nnext one number three is gonna be lack<br \/>\n04:29<br \/>\nof motivation<br \/>\n04:30<br \/>\nthis one&#8217;s horrible because I can&#8217;t get<br \/>\n04:33<br \/>\nanything done when I&#8217;m doing when I&#8217;m in<br \/>\n04:35<br \/>\nmy PMDD time like my two weeks I just I<br \/>\n04:38<br \/>\nI can do the bare minimum but that&#8217;s all<br \/>\n04:41<br \/>\nI have the motivation for it&#8217;s all I<br \/>\n04:43<br \/>\nhave the energy for I&#8217;m sure a lot of<br \/>\n04:46<br \/>\nyou can relate to that one as well it&#8217;s<br \/>\n04:47<br \/>\njust like nothing interests me nothing<br \/>\n04:49<br \/>\neven fun like I don&#8217;t even have the<br \/>\n04:51<br \/>\nmotivation to go do something fun so<br \/>\n04:53<br \/>\nthat&#8217;s like how bad it gets you know<br \/>\n04:55<br \/>\nit&#8217;s like I just have the motivation to<br \/>\n04:59<br \/>\nlay in bed that&#8217;s about it I still do<br \/>\n05:02<br \/>\ntry to get myself to the gym and I<br \/>\n05:04<br \/>\nobviously get myself to work because I<br \/>\n05:05<br \/>\nhave to but other than that like that&#8217;s<br \/>\n05:09<br \/>\nkind of like where I keep it at and<br \/>\n05:11<br \/>\nthat&#8217;s why a lot of times I can&#8217;t bring<br \/>\n05:13<br \/>\nmyself to make youtube videos during<br \/>\n05:14<br \/>\nthat time or post on Instagram because<br \/>\n05:17<br \/>\nI&#8217;m just so overwhelmed with how sad and<br \/>\n05:22<br \/>\nexhausted and depressed I am that I have<br \/>\n05:25<br \/>\nno motivation and it&#8217;s a typical symptom<br \/>\n05:28<br \/>\nof depression so it makes sense that<br \/>\n05:30<br \/>\nlike with how depressed we get as PMDD<br \/>\n05:32<br \/>\nsufferers that we would experience a<br \/>\n05:35<br \/>\nlack of motivation but that one just<br \/>\n05:37<br \/>\nreally sucks they all suck<br \/>\n05:38<br \/>\nWho am I kidding okay and number two<br \/>\n05:42<br \/>\nwhat so Mike this is close to my worst<br \/>\n05:45<br \/>\none is the fatigue I wrote them all down<br \/>\n05:49<br \/>\non my phones that&#8217;s why I keep laying<br \/>\n05:51<br \/>\ndown is the fatigue that I get so this<br \/>\n05:54<br \/>\nkind of goes along with lack of<br \/>\n05:55<br \/>\nmotivation but it&#8217;s a different symptom<br \/>\n05:57<br \/>\nbecause it&#8217;s just in and of itself it&#8217;s<br \/>\n05:59<br \/>\na whole entity like I get so tired<br \/>\n06:03<br \/>\npeople like will make fun of me because<br \/>\n06:04<br \/>\nI&#8217;m sleeping so much and it kind of<br \/>\n06:06<br \/>\nsucks because honestly I can&#8217;t help it I<br \/>\n06:08<br \/>\ncan&#8217;t help that I get that overwhelm and<br \/>\n06:10<br \/>\ntire like fatigue and I will sleep 14<br \/>\n06:14<br \/>\nhours a night and then take naps during<br \/>\n06:15<br \/>\nthe day and that&#8217;s no exaggeration like<br \/>\n06:18<br \/>\nI was just texting someone the other day<br \/>\n06:19<br \/>\nand he was like 14 hours like you slept<br \/>\n06:22<br \/>\n14 hours and I was like yeah like cuz I<br \/>\n06:25<br \/>\nhad texted him before bed and I texted<br \/>\n06:27<br \/>\nhim when I woke up when he was like you<br \/>\n06:28<br \/>\njust woke up and I was like yeah like I<br \/>\n06:31<br \/>\ncan&#8217;t help it it&#8217;s just like and he<br \/>\n06:33<br \/>\nwasn&#8217;t like making fun of me or you<br \/>\n06:34<br \/>\nbut um people will like be like oh my<br \/>\n06:38<br \/>\ngod you sleep so much and I&#8217;m like I&#8217;m<br \/>\n06:40<br \/>\nsorry like if you had PMDD you would<br \/>\n06:43<br \/>\nunderstand like because our bodies are<br \/>\n06:45<br \/>\nso intolerant to the hormone shifts that<br \/>\n06:47<br \/>\nwe just get so wiped out and I remember<br \/>\n06:51<br \/>\neven before I developed PMDD as like a<br \/>\n06:53<br \/>\n13 year old I when I first got my period<br \/>\n06:56<br \/>\nI I remember like the first time I was<br \/>\n06:58<br \/>\non my period I like came home from<br \/>\n07:00<br \/>\nschool and just fell asleep on the<br \/>\n07:02<br \/>\nloveseat like in the weirdest position<br \/>\n07:03<br \/>\nlike I was in the Hat tired and I have a<br \/>\n07:06<br \/>\nlot of energy as a young girl so that<br \/>\n07:09<br \/>\nwas really unusual for me so I&#8217;ve always<br \/>\n07:10<br \/>\nbeen someone that&#8217;s just completely<br \/>\n07:11<br \/>\nwiped out by PMS slash period the<br \/>\n07:14<br \/>\nfatigue will last like the two weeks<br \/>\n07:16<br \/>\nbefore my period and then like halfway<br \/>\n07:18<br \/>\nthrough my period and then finally one<br \/>\n07:20<br \/>\nday I&#8217;ll wake up and be like okay I have<br \/>\n07:22<br \/>\na little bit of energy and not so so<br \/>\n07:24<br \/>\ntired that I can&#8217;t do anything so that<br \/>\n07:26<br \/>\nis number two then finally number one<br \/>\n07:30<br \/>\nand this one is hard to talk about this<br \/>\n07:32<br \/>\none is triggering so I&#8217;m just gonna put<br \/>\n07:35<br \/>\na trigger warning right here just<br \/>\n07:38<br \/>\naudibly say trigger warning is the<br \/>\n07:42<br \/>\nsuicidal ideation and thoughts and you<br \/>\n07:47<br \/>\nknow thoughts of harming myself I get<br \/>\n07:51<br \/>\nthem almost every month<br \/>\n07:53<br \/>\npretty much every month and they do last<br \/>\n07:55<br \/>\na couple weeks I have to just push them<br \/>\n07:58<br \/>\nout of my brain or just wait until they<br \/>\n08:00<br \/>\ngo away and kind of just chill and you<br \/>\n08:03<br \/>\nknow do something that soothes my mind<br \/>\n08:05<br \/>\nlike watch a show or you know read a<br \/>\n08:09<br \/>\nbook or talk to a friend something that<br \/>\n08:13<br \/>\ndistracts me from like thinking like I<br \/>\n08:16<br \/>\nwant to die because it&#8217;s an awful<br \/>\n08:19<br \/>\nthought and when you have that thought<br \/>\n08:20<br \/>\nit&#8217;s really really overbearing you can&#8217;t<br \/>\n08:23<br \/>\nreally think about anything else no<br \/>\n08:24<br \/>\nmatter how hard you try so it&#8217;s just<br \/>\n08:28<br \/>\nreally hard to feel that way for half of<br \/>\n08:30<br \/>\nthe month every month because it adds to<br \/>\n08:33<br \/>\nthe fatigue it adds to the lack of<br \/>\n08:34<br \/>\nmotivation it just adds to the heaviness<br \/>\n08:37<br \/>\nthat we feel as PVE sufferers and I<br \/>\n08:42<br \/>\ncan&#8217;t even express to you how low I get<br \/>\n08:45<br \/>\nduring these times<br \/>\n08:47<br \/>\nlike like last month I woke up for work<br \/>\n08:51<br \/>\nI was feeling absolutely atrocious I<br \/>\n08:53<br \/>\ndidn&#8217;t think that I could make it<br \/>\n08:55<br \/>\nthrough my shift I ended up making it<br \/>\n08:56<br \/>\nthrough but it was really really hard<br \/>\n08:58<br \/>\nand I was sobbing to my mom and I said I<br \/>\n09:02<br \/>\ncan&#8217;t go to work today like I want to<br \/>\n09:03<br \/>\ndie I just want to die and now it&#8217;s like<br \/>\n09:08<br \/>\nevery month when I feel better and I<br \/>\n09:10<br \/>\nlook back at that version of myself I<br \/>\n09:12<br \/>\nthink how could I possibly feel that bad<br \/>\n09:16<br \/>\nbut then I feel that bad again and again<br \/>\n09:19<br \/>\nand again and again and I remember how<br \/>\n09:23<br \/>\nawful it is and I hate it I hate it with<br \/>\n09:27<br \/>\neverything I have I would never wish<br \/>\n09:30<br \/>\nthis upon my worst enemy like it is the<br \/>\n09:32<br \/>\nworst absolute worst feeling to feel<br \/>\n09:34<br \/>\nlike you don&#8217;t want to be on this earth<br \/>\n09:36<br \/>\nanymore<br \/>\n09:38<br \/>\nyeah that&#8217;s a heavy one and I&#8217;m sorry<br \/>\n09:41<br \/>\nabout that I know that&#8217;s hard to hear<br \/>\n09:43<br \/>\nand it&#8217;s hard to talk about because it<br \/>\n09:45<br \/>\ncan be triggering and it can be really<br \/>\n09:48<br \/>\nheavy to put on somebody to hear that<br \/>\n09:51<br \/>\nand to talk about but it is necessary<br \/>\n09:54<br \/>\nthat we do talk about it because it&#8217;s<br \/>\n09:56<br \/>\nsomething that a lot of women with PMDD<br \/>\n09:58<br \/>\nexperience regularly and so to talk<br \/>\n10:04<br \/>\nabout it is to bring awareness to it and<br \/>\n10:06<br \/>\nso hopefully you know we can get more<br \/>\n10:09<br \/>\nawareness and reduce the stigma of pmed<br \/>\n10:11<br \/>\nand suicidal ideation and all that but I<br \/>\n10:15<br \/>\nhave to say that&#8217;s my number one where<br \/>\n10:16<br \/>\nsymptom it it&#8217;s the worst feeling I I<br \/>\n10:21<br \/>\ncome in I can&#8217;t even put it into words<br \/>\n10:23<br \/>\nhow bad that feeling is where you want<br \/>\n10:25<br \/>\nto die yeah<br \/>\n10:29<br \/>\nI&#8217;m that&#8217;s just pretty much all I have<br \/>\n10:32<br \/>\nto say about that sorry to end on a<br \/>\n10:33<br \/>\nheavier note but yeah that was my worst<br \/>\n10:38<br \/>\nsymptom for sure and it&#8217;s it&#8217;s my worst<br \/>\n10:40<br \/>\nsymptom it&#8217;s what I meant to say and<br \/>\n10:42<br \/>\nyeah so those are my top five worst<br \/>\n10:46<br \/>\ncambini symptoms<br \/>\n10:48<br \/>\nlet me know what you guys think I want<br \/>\n10:50<br \/>\nto hear what your top five worst ones<br \/>\n10:52<br \/>\nare I want to hear if they&#8217;re similar to<br \/>\n10:54<br \/>\nmine if you have different one there&#8217;s a<br \/>\n10:56<br \/>\nlot of symptoms I didn&#8217;t mention in this<br \/>\n10:58<br \/>\nvideo<br \/>\n10:58<br \/>\nthat I get so don&#8217;t think that I don&#8217;t<br \/>\n11:01<br \/>\nexperience other things just because I<br \/>\n11:03<br \/>\ndidn&#8217;t mention them I just wanted to<br \/>\n11:04<br \/>\nmention the top five that I think are<br \/>\n11:06<br \/>\nthe worst for me personally but I would<br \/>\n11:08<br \/>\nlove to hear you guys opinions and<br \/>\n11:10<br \/>\nthoughts and all that so leave a comment<br \/>\n11:12<br \/>\nbelow I would love to hear it and give<br \/>\n11:14<br \/>\nthis video a thumbs up if you enjoyed it<br \/>\n11:16<br \/>\nI love you guys so much thank you for<br \/>\n11:18<br \/>\ntuning into my videos and subscribing<br \/>\n11:20<br \/>\nI&#8217;ve noticed some new faces around here<br \/>\n11:22<br \/>\nlately and it makes me really really<br \/>\n11:23<br \/>\nhappy that you guys are interested in my<br \/>\n11:25<br \/>\ncontent so thank you and thank you so<br \/>\n11:28<br \/>\nmuch for all your love and support on<br \/>\n11:30<br \/>\nInstagram okay that&#8217;s enough gushing for<br \/>\n11:32<br \/>\nnow I love you and I&#8217;ll talk to you in<br \/>\n11:35<br \/>\nmy next video bye<\/p>\n<p><\/div>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration 9:17 Duration 10:06 Duration 11:37 &nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":160,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3005","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/3005","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=3005"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/3005\/revisions"}],"predecessor-version":[{"id":3006,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/3005\/revisions\/3006"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=3005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}