Hello!
I am seeking some clarification on supplementation. Here's a brief overview of my situation:
History: I am a 34 year old female, NKDA, with no major health history or mental health diagnoses. I am unmarried and have 1 child, who is 4.5 years old.
About 18 months ago I began looking into supplements and nootropics to help me deal with my stress levels which were, at the time, spiraling out of control. The environmental conditions I have been in for the past few years have been pretty challenging (I went through a divorce, I am a single mother, I am a nursing student, my own mother was diagnosed with an autoimmune condition and had to move in with me, etc.), so the source of my stress reactions is certainly understandable, to a certain degree. Nevertheless, I was needing a way to manage it all before I completely lost control. I also have a history of struggles with depression, anxiety, and binge eating disorder. In all cases, however, my symptoms have been manageable enough that I have never sought out any more help than intermittent counseling. This, along with making sure I get regular sleep and exercise and eat a healthy diet, has generally been sufficient to bring me back into a stable and happy mind set. At baseline, I'm a pretty optimistic and joyful person. Over the past five years, though, life events have been difficult enough to strain my mental health to a near breaking point. That's when I began looking into supplements. I was on the verge of seeking pharmaceutical relief (ie SSRI's, etc.), but I have always been hesitant to go that route if I can avoid it.
Symptoms/Changes I am seeking:
1) Luteal phase mood and physical symptoms consistent with PMDD (sleeping difficulty, depression, hopelessness, loss of libido, food cravings, extreme anxiety, body aches, fatigue, breast tenderness, extreme irritability). I actually have been aware of the correlation between the luteal phase of my cycle and my bouts of depression and anxiety for about 10 years now. It's not a subtle shift. I feel like an entirely different person during the luteal phase of my cycle each month, and it does not feel like I am myself at all. The effects are not always debilitating, but they sometimes can be. They last anywere from 5 days to a full two weeks. This last month, for instance, I could tell, just by the shift in my mood, the day that I ovulated. The next two weeks were horrible. I spent hours last week crying and sturggling to sleep and trying not to overreact and yell at people. Life lost all color and felt completely overwhelming. Today, day 5 of the follicular phase of my cycle, I have a hard time even remembering what was so upsetting. Looking back at my history of occasional bouts of depression, it is clear that my hormonal cycle has always played an important role. There have only been a few times in my life that I have had any kind of mood disturbance that actually lasted longer than two weeks. The first trimester of pregnancy was one. Post-partum was another.
2) Occasional bouts of mild anxiety, lack of motivation and foggy thinking not associated with the luteal phase of my cycle. These are not actually so much symptoms as just areas that I am seeking to optimize. As a single mother and a nursing student (I also work part time), my schedule is often insanely full and, at times, I am required to function at a high mental level on not enough sleep and irregular exercise. I have been an A student throughout much of my schooling. Lately, I have been struggling a bit to keep that level of academic performance up.
3) I am also seeking generalized health and longevity enhancement. As I mentioned, I am currently living with my mother who suffers from CIDP, a rare autoimmune condition. She is also obese, depressed, and has celiac disease. She has a history of endometriosis and PMDD symptoms, much like mine, but she also never had an official diagnosis. She had a total hysterectomy at 37 because her symptoms were so severe. Her daily presence is a powerful motivator to maintain my health.
Things I have tried:
1) Getting enough sleep/keeping a regular sleep schedule: this is the most effective intervention I have found for myself. Unfortunately, it's not always possible. Sometimes I have a sick child during the night, or have to wake up for clinicals at 4am, or study for a test all night. I have also had to come to accept that I have a high sleep requirement. I need 8-9 hours of sleep to function optimally, and getting 7 hours for even a couple of nights has a noticeable impact on my mood and cognition.
2) Exercise: this is an obvious one. When I get regular exercise, I do much better. Right now I am doing a once/week HIRT program for muscle mass maintenance and hormonal benefits and also doing my best to find time for brief daily cardio like walking in between those sessions. When I am not in school, I have no trouble with a regular exercise routine. I use to teach martial arts and love to exercise. Time constraints really are a problem for me during the semester.
3) Cold exposure: I started taking daily cold showers about 2 months ago. I have noticed an energizing and mood lifting effect. This habit fell apart completely during my most recent luteal phase meltdown. This last month was a bad one for me.
4) Caffeine and L-theanine: I generally drink 1-2 cups of strong coffee daily, and take NOW brand L-theanine with it. Improved concentration, uplifted mood, and decreased fatigue for about 3-5 hours are the noticeable effects. Coffee has an upper limit of effectiveness for me. It will overcome mild-moderate sleep deprivation in the morning, but once the effect wears off around noon another cup makes no difference. I can fall asleep right after drinking it.
4) Phenibut: I know that this is not really a supplement, but actually a pharmaceutical. I also know that that distinction is pretty pointless. Phenibut was one of the first "nootropics" that I tried. I put nootropic in quotes because I'm not sure it really qualifies. It is a potent anxiolytic and sleep aid, though, for me. I am very sensitive to it, and take about 150-300mg at bedtime. More than that will make me too groggy the next day. I have taken Phenibut 1-3 nights/week for about a year now. I time it to coincide with anxiety inducing events like practical exams, or else take it when I know that I desperately need to have a good long catch-up sleep that night.
5) Armodafinil 62.5 - 125mg: As you can tell by my dosage, I am pretty sensitive to this stuff too. I have been using it intermittently to get me through when I just have to study or work and I have not had enough sleep or cannot drum up the motivation or concentration. The 62.5mg dosage is generally sufficient to counteract mild sleep deprivation for several hours, or else to boost cognition and focus when I have had adequate sleep. The 125mg dosage will overcome a pretty severe sleep deficit for about 6-8 hours. Unfortunately, I find that the effectiveness decreases and the side effects increase with repeated usage. I can generally use this for 2-3 days in a row, max, and then need to take a pretty good long break (say, a week) before effectiveness completely returns.
3) Alcohol: of course, in moderation. A good strong IPA in the evening has kept me from completely losing my cool more than once. I drink 1-4 drinks/week, usually. I find that I develop tolerance rapidly. If I drink a beer every evening for 3 evenings, I stop feeling much effect. At that point, I generally just stop drinking for several days and the effect returns.
4) Holy Basil - Himalaya brand: I've taken this intermittently in the AM, prior to meals. Generally on a week, off a week for about a year. I think that I have noticed some anxiolytic and appetite suppressant effects.
5) Rhodioloa - NOW brand 500mg: I usually alternate this with Holy Basil. Once again, I think I've noticed some mood stabilizing effects, but I'm not sure.
6) Bacopa: I tried this for about a weak and actually felt terrible. Really depressed. Should have tracked what time of month it was, but I didn't.
7) 5-HTP - NOW brand 50 mg: I usually take this at bedtime twice a week. No noticeable effect.
8) Alpha GPC - NOW brand 300 mg: Taken daily for about 5 months now. No noticeable effect.
9) NAC - NOW brand 600mg: 1 day in the AM for the past 2 months. No noticeable effect.
10) Calcium - NOW Brand 1200mg: I just started this yesterday. It is an often recommended supplement for PMDD, so I thought I would give it a try.
11) Ginkgo Biloba - NOW Brand 60mg: I have been taking this intermittently as well, I'd say 3/4 weeks of each month, twice a day (AM and noon).
Lately, I have been considering Curcumin for antiinflammatory and longevity effects, and Ashwaganda for longevity and adaptogenic effects.
My questions:
1) How the hell does anyone go about differentiating the effects of all of this stuff? As you can see, my experiments have been somewhat haphazard, and I have a difficult time deciding what has worked for me and why. Since I began this experimentation 18 months ago, I have actually seen a lot of improvements in my mood issues. My overall levels of anxiety and depression have decreased and my emotional stability has increased. I have a difficult time deciding which, if any, of these interventions to attribute the improvement to. On the flip side, I feel like my mental grogginess has, at times, increased. I have some concern that regular use of pharmaceuticals like Phenibut and Armodafinil could be depleting neurotransmitters. On the other hand, my father is narcolpetic and takes Armodafinil daily and has been doing so for years. He's sharp as a tack, so I may be letting unreasonable fears intrude. I think a cheif difficulty for me, in determining effects of supplements and drugs is the fact that my baseline biochemistry is already going through a constant fluctuation which I AM SURE is having an effect on my mood and cognition. The PMDD symptoms predated any supplementation regime, and have persisted through it. My symptoms do vary each month, and some months I have only 5 days of farily manageable symptoms. Other months, like this last one, are two weeks of horror. I don't think I changed anything major in my routine. How do I account for this fluctuation when trying to determine what is working for me?
2) Is my fear of SSRI's warranted or not? If I were to see a psychiatrist for PMDD the first line treatment would be low dose SSRI's during the luteal phase of my cycle each month. SSRI's appear to work for PMDD by a different mechanism than they do for major depression, and the effects are evidently pretty immediate, which allows for patients to only take them for those two weeks each month.
That was really long. I apologize and appreciate any and all input.