The Brain in Love: 12 Lessons to Enhance Your Love Life (26 page)

PMS, Depression, ADD, Substance Abuse,
Denial, and Being a Jerk

Get away, get away, get away, get away
Get away cause I’m pms-ing

—“PMS,” MARY J. BLIGE

C
elia and Greg fell madly in love for five weeks. They met on
Match.com
shortly after Labor Day. On the surface they seemed like a perfect couple. They were both well educated, caring, hardworking, and had similar lifestyle habits. The attraction was amazing, even between their families. Greg loved Celia’s little girl, and Greg’s teenage girls got along very well with Celia. With new love comes hope. They were together most days and on the phone for several hours a day when they were apart. Five weeks into the passionate relationship things started to abruptly change. Celia started to back up. She became distant, irritable, and short tempered. Nothing Greg did seemed right. Even though she was fully involved with moving the relationship forward, she felt the need to backtrack. Greg felt disoriented. What happened?, he wondered. Initially, he felt anxious at the change. He had met few women as wonderful as Celia, few women that took his breath away. But he did as Celia wanted. That still didn’t seem good
enough and Celia broke off the relationship. Greg felt very sad. Then Celia started her menstrual period. She was horrified by her behavior and for losing Greg. When she called him, he was happy to hear from her, but hurting from what happened. He was gun shy. Premenstrual tension syndrome (PMS) is real and causes real problems in the brain and in relationships.

It is not just PMS that can ruin relationships. Other brain problems, such as depression, ADD, substance abuse, anxiety disorders, obsessive-compulsive disorder, and personality disorders also interfere with love. Understanding and treating these problems is critical to healthy relationships and healthy sex. In this chapter, I will explore the most common brain ailments interfering with love and sex that we see in our clinics and give you a way to think about how to get the best help for them. Some people will need psychotherapy; some will need medication; others will need more directed guidance with supplements or other alternative treatments. I will also help you decide if and when you need to seek professional help. In lecturing around the world, I am frequently asked the following questions: When is it time to see a professional about my brain? What should I do when a loved one is in denial about needing help? How do I go about finding a competent professional?

A Quick View of Common Brain Problems Affecting Love and Sex

PMS

When I saw patients with PMS after I started my brain-imaging work in 1991, I just had to look. Now I know more about PMS than I want to. I have five sisters and two daughters. Plus, I have an ex-lover (I’ll call her Laura) who suffered from severe PMS. She loved me passionately for the first seven days of her menstrual cycle, was very neutral on me for the next fourteen days, and just seemed to hate me for the last seven days or so of her cycle.
Laura’s behavior the first seven days of her cycle kept me hooked into the relationship. Our relationship was being
intermittently reinforced
, a psychological term about learning behavior; when someone is reinforced occasionally or intermittently, it causes them to want to stay in a relationship, hoping for more.

Over the past years we have scanned many women with PMS just before the onset of their period, during the worst time of their cycle, and then again a week after the onset of their period, during the best time. Even though brain-SPECT scans are very consistent from day to day in most people, they can radically change in women with PMS. I knew from my own experience with Laura that likely the PMS brain changed over the month. When PMS is present, we see dramatic differences between the scans. When a woman feels good, her deep limbic system (emotional brain) is calm and cool and she has good activity in her temporal lobes (mood stability and memory) and prefrontal cortex (judgment). Right before her period, when she feels the worst, her deep limbic system and anterior cingulate gyrus (worry center) is often overactive and she has poor activity in her temporal lobes and prefrontal cortex!

I have seen two PMS patterns, clinically, and on SPECT, that respond to different treatments. One pattern is increased deep limbic activity often accompanied by poor activity in the temporal lobes, which correlates with cyclic mood changes and anger. This finding often responds best to anticonvulsant medications, such as Depakote, Neurontin, Lamictal, or Tegretol. These medications tend to even out moods, calm inner tension, decrease irritability, and help people feel more comfortable in their own skin.

The second PMS pattern that I have noted is increased deep limbic activity in conjunction with increased anterior cingulate gyrus activity. The anterior cingulate, as we have seen, is the part of the brain associated with shifting attention. Women with this pattern often complain of increased sadness, worrying, repetitive negative thoughts and verbalizations (nagging), and cognitive inflexibility. This pattern usually responds much better to medications that
enhance serotonin availability in the brain, such as Lexapro, Zoloft, and Prozac. Here are two examples.

Brittany
. Brittany was a thirty-eight-year-old married female referred for evaluation of suicidal thoughts, depression, and temper flares. She also experienced problems with anxiety, excessive tension, and overeating. These problems occurred primarily during the last ten days of her menstrual cycle and abated two to three days after the onset of menses. On several occasions she separated from her husband within the seven days prior to the onset of her period; on one occasion, she lashed out at him physically. The patient and her husband confirmed the cyclic changes to her symptoms. Both Brittany and her husband kept a symptom log over the next month. On Day 27 (of a twenty-nine-day cycle) Brittany called the clinic saying that she was having problems with suicidal thoughts and depression. She was scanned the same day. Her SPECT study revealed significant increased activity in the anterior cingulate gyrus and marked decreased activity in the left temporal lobe and prefrontal cortex bilaterally. She was then scanned on Day 8 of the next menstrual cycle when she was symptom free. Her follow-up scan revealed improved temporal lobe and prefrontal cortex function but persistent cingulate hyperactivity. Due to the clear temporal lobe problems, Brittany was placed on the anticonvulsant Depakote, which stabilized her temper outbursts and suicidal thoughts. The serotonergic antidepressant Zoloft was then added a month later due to persistent premenstrual sadness. Three years later she remains symptom free.

Anne
. Anne was a thirty-three-year-old married female referred for evaluation of suicidal thoughts, depression, anxiety, and irritability. These problems occurred predominantly during the last week of her menstrual cycle and significantly let up several days after the onset of menses. She had experienced a postpartum depression after the birth of one child but not after the birth of her other two children. Anne and her husband confirmed the cyclic
changes to her symptoms. Both she and her husband kept a symptom log over the next month. On Day 25 (of a twenty-eight-day cycle) Anne called the clinic complaining of severe agitation and moodiness. She was scanned the same day. Her SPECT study revealed significant increased activity in the anterior cingulate gyrus and deep limbic regions. She was then scanned on Day 10 of the next menstrual cycle when she was symptom free. Her follow-up scan revealed excess activity in the anterior cingulate gyrus and deep limbic system. Lexapro was very effective in calming her symptoms. Two years later she remains symptom free during the premenstrual period.

Mood Disorders

Mood disorders severely affect libido and relationships. Depression is often associated with low libido, negativity, and a higher divorce rate. The “up” or manic phase of bipolar disorder can be associated with impulsivity, hypersexuality, and hyperreligiosity.

Depression

Burl, a fifty-two-year-old contractor, husband and father of two boys, was referred to me because he was tired all the time. His family physician ruled out the physical causes of fatigue and thought he was stressed. Additionally, he had trouble focusing at work and had trouble sleeping. His caffeine use went way up, but it didn’t help his energy, just made him edgy. His sex drive was gone, his appetite was poor, and he had no interest in doing things with his family. Burl would cry for no apparent reason and he even began to entertain suicidal thoughts. Burl had a serious depressive illness.

Depression is a very common brain illness. Studies reveal that at any point in time, 3 to 6 percent of the population have a significant depression. Only 20 to 25 percent of these people ever seek help. This is unfortunate because depression is a very treatable problem.

The following is a list of symptoms commonly associated with depression:

• sad, blue, or gloomy mood
  

• low energy, frequent fatigue
  

• lack of ability to feel pleasure in usually pleasurable activities
  

• irritability
  

• poor concentration, distractibility, poor memory
  

• suicidal thoughts, feelings of meaninglessness
  

• feelings of hopelessness, helplessness, guilt, and worthlessness
  

• changes in sleep, either poor sleep with frequent awakenings or increased sleep
  

• changes in appetite, either markedly decreased or increased
  

• social withdrawal
  

• low self-esteem.
  

Early detection and treatment is important to a full and complete recovery. My imaging work has revealed that there are multiple types of depression and treatment needs to be specifically tailored to the type. See my book
Healing Anxiety and Depression
(written with Lisa Routh).

Bipolar Disorder

Patricia is a twenty-eight-year-old married mother of two children. She had a period of depression six months earlier and had been prescribed an antidepressant by her OB/GYN. Initially she felt much better. Then she started slowly having trouble sleeping. Her thoughts raced, she became more irritable and much more sexual. She was used to having sex several times a week with her husband, but now wanted it every day. She propositioned three of her male coworkers, which was out of character. Two of her coworkers took her up on her offer and she ended up contracting herpes, which she gave to her husband. On the verge of divorce, they came to see me. Patricia had bipolar disorder triggered by the antidepressant,
which is not an uncommon scenario. It is sad to think that an improperly treated psychiatric illness can tear apart families. With the right treatment, which included a mood stabilizer and fish oil, Patricia and her husband did much better.

Bipolar disorder is a mood illness where people cycle between two poles of emotion. There may be periods of depression that alternate with periods of high, manic, irritable, or elated moods. Mania is categorized as a state distinct from one’s normal self, where there is greater energy, racing thoughts, impulsivity, a decreased need for sleep, and a sense of grandiosity. It is often associated with periods of hypersexuality, hyperreligiosity, or spending sprees. Sometimes it is also associated with hallucinations or delusions. In treating the depressive part of the cycle, both pharmaceutical and supplemental antidepressants have been known to stimulate manic episodes. It is important to vigorously treat this disorder, as it has been associated with marital problems, substance abuse, and suicide.

Here is a list of symptoms often associated with bipolar disorder:

1. Periods of abnormally elevated, depressed, or anxious mood
   

2. Periods of decreased need for sleep, feeling energetic on dramatically less sleep than usual
   

3. Periods of grandiose notions, ideas, or plans
   

4. Periods of increased talking or pressured speech
   

5. Periods of too many thoughts racing through the mind
   

6. Periods of markedly increased energy
   

7. Periods of poor judgment leading to risk-taking behavior (separate from usual behavior)
   

8. Periods of inappropriate social behavior
   

9. Periods of irritability or aggression
   

10. Periods of delusional or psychotic thinking.
    

Bipolar I, which used to be called manic depressive illness, is thought to be the more classic form of this disorder. In recent years, a milder form of the disorder, called Bipolar II, has been
described; it is associated with depressive episodes and milder “hypomanic” issues.

The treatment for bipolar disorder, both I and II, is usually medication, such as lithium or anticonvulsants such as Depakote. Recent literature suggests that high doses of omega-3 fatty acids, found in fish or flaxseed oil, can also be helpful.