evolved that way for good reasons; our hormonal oscillations are the basis for a sensitivity that allows us to be responsive to our environment. Our dynamism imparts flexibility and adaptability. Being fixed and rigid does not lend itself to survival. In nature, you adapt or you die. There is tremendous wisdom and peace available to us if we learn how our brains and bodies are supposed to work. Moodiness—being sensitive, caring deeply, and occasionally being acutely dissatisfied—is our natural source of power.
Yet we have been told just the opposite. From a young age, we are taught that moodiness, and all that comes with it, is a bad thing. We learn to apologize for our tears, to suppress our anger, and to fear being called hysterical. Over the course of women’s lives, the stresses and expectations of the modern world interfere with our health and hormones in ways big and small, and the result is the malaise so many women feel. There simply is a better way.
Moody Bitches opens the playbook on how we can take hold of our moods and, in so doing, take hold of our lives. By integrating timeless wisdom with today’s science, we can master our moods. If we can understand our own bodies, our naturally cycling hormones, and how modern medicines derange our exquisitely calibrated machines, then we can make informed choices about how to live better.
Women’s hormones are constantly in flux. They ebb and flow over a month-long cycle and they wax and wane throughout decades of fertility, vacillating with particular volatility during adolescence and perimenopause, the spring and autumn of the reproductive years. Compare this to men’s stable hormone levels throughout most of their lives. Our hormonal variations allow us to be empathic and intuitive—to our environment, to our children’s needs, and to our partners’ intentions. Women’s emotionality is normal. It is a sign of health, not disease, and it is our single biggest asset. Yet one in four American women are choosing to medicate away their emotionality with psychiatric medications, and the effects are more far-reaching than most women realize.
Whether it’s food, alcohol, drugs, cell phones, or shopping, we all rely on something in order to numb ourselves during difficult times. Whatever the chosen substance, it offers a welcome promise: that things will be different and better once it is consumed. But you can never get enough of something that almost works, and because our solutions are usually synthetic, not natural, we come up short. We are uncomfortable in our own skin, with our own desires; we are not at ease in our homes and offices, in our roles as parents or caretakers of our parents. Plowing forward, we think we can outrun the angst if we just stay “insanely busy.”
In my psychiatric practice, my patients, like most women, are starved for information about the drugs they’re taking and how they can change how they’re feeling. Moody Bitches is an answer to both problems. I name names (which medicines I love, and the ones I avoid) and discuss the real side effects I’ve observed—weight gain, libido loss, becoming blasé—and what you can do about them. I share straight talk about enhancing your sex life, the direct link between food and mood, sticking to exercise or sleep schedules, and perhaps the most important piece: tuning in to your body to realign with your natural, primal self.
When I started my practice twenty years ago, women came to me confused by their symptoms and unsure of what to do. They complained of difficulty getting back to sleep or agitation or tearfulness, but they didn’t quite know what was wrong. I helped them put a name to their symptoms and explained that there were medicines that could help. I needed to do more teaching about drug therapy back then, and a lot more hand-holding. I would set aside the last ten or fifteen minutes of the hour-long initial consultation in order to quell the fears of people who were wary of taking something that would alter their brain chemistry.
These days, new patients come to me sure that they need medicine for their nerves or their moods, like most of the other women they know. They want me only to help them figure out which one. The confusion used to be: “I can’t understand why I keep waking up at four in the morning”; “It’s so hard to get out of bed and I don’t really care about anything”; “I’m angry all the time, and I don’t know why.” But over the years, the conversation has morphed, so that now it usually begins with something like this: “Can you tell me the difference between bupropion and venlafaxine?”; “I can’t figure out if I have ADD or OCD”; “Do you know that ad with the woman riding the horse on the beach?”; “Is that new butterfly sleeping pill better than zolpidem?” And the one I hear more than you can imagine from my established patients: “Is there anything new I can try?”
The drug companies started direct-to-consumer advertising in the 1980s. Soon after I started my private practice in the mid-1990s, it became less heavily regulated. Ads started springing up on television and in magazines, trumpeting the latest antidepressants and sleeping pills. I went along for the ride as America’s use of all prescription psychiatric medications tripled during the nineties, as a direct result of this powerful marketing. By 2006 the antidepressant Zoloft (sertraline) had made more money than Tide detergent, and it became clear to me that something new was happening. Drug companies are spending billions of dollars to turn normal human experiences like fear or sadness into medical diseases. They aren’t developing cures; they’re creating customers. The problem is not our emotionality; the problem is that we are being persuaded to medicate it away.
The latest news is particularly terrifying. Aripiprazole, a medicine originally formulated to treat people with schizophrenia, expanded into the depression market and is now our nation’s top-selling medication, and not just of psych meds. America’s number one moneymaking medicine is an antipsychotic. As a psychiatrist, I must tell you, this is insane. There is an ancient Greek word, pharmakon, which held disparate meanings—sacrament, medicine, and poison. It is a common saying in medicine that sometimes the treatment is worse than the disease. There are many medications (chemotherapy is a good example) that are helpful or curative at lower doses but dangerously toxic in higher amounts. It is also true that there are powerful medicines that are appropriately used for one diagnosis but are complete overkill for another. Prescribing antipsychotics to treat depression seems particularly out of balance, especially given the risks of irreversible side effects like diabetes or movement disorders inherent in this class of medicine.
We represent 5 percent of the global population, yet we take 50 percent of the world’s pills. (We also take 80 percent of the world’s painkillers.) Meanwhile, the percentage of people labeled with psychiatric diagnoses is continually growing. Is it possible there really is an epidemic of mental illness and disability happening in our lifetime, or are physicians too quick to reach for their prescription pads instead of offering harder solutions to their patients’ complaints? Medical journals are full of only one kind of ad: pages of information on the newest drugs and exactly how to prescribe them. Four out of five prescriptions for antidepressants are not even written by psychiatrists but rather by general practitioners, and more often than not they’re prescribed for patients without an actual diagnosis of depression. Particularly troubling: surveys of primary care doctors show they routinely overestimate what the antidepressants can do. They’ve been hoodwinked by the ads, like the rest of America.
Just as offering your toddler the choice between the red dress and the blue dress moves the conversation forward, beyond “you need to wear a dress,” the barrage of antidepressant advertising advances the question from Should I take an antidepressant? to Which one should I take? Don’t let pharma-con change the way you manage your moodiness. I’m here to tell you that there are healthier ways to treat depression, anxiety, and irritability that don’t include pills.
It is not solely the right cocktail of neurotransmitters that dictates mood; more than anything, it is how we live our lives.
