Review of "Moody Bitches: The Truth About the Drugs You're Taking, The Sleep You're Missing, The Sex You're Not Having, and What's Really Making You Crazy"

Earlier this week, Moody Bitches: The Truth About the Drugs You're Taking, The Sleep You're Missing, The Sex You're Not Having, and What's Really Making You Crazy was recommended to me by a friend, along with a short video by the author. I found it at the local library and it was definitely worth the read.

The premise of "Moody Bitches" is that the hormonal fluctuations and corresponding mood changes that women experience throughout the month and over the course of their lives are normal, and in most cases a sign of health, not disease.

We [women] are designed by nature to be dynamic, cyclical, and, yes, moody. ... We evolved that way for good reasons; our hormonal oscillations are the basis for a sensitivity that allows us to be responsive to our environment... There is tremendous freedom and peace available to us if we learn how are brains and bodies are supposed to work. Moodiness -- being sensitive, caring deeply, and occasionally being acutely dissatisfied -- is our natural source of power. (8)

However, as a society, we often pathologize this experience. One in four American women take psychiatric medications - powerful drugs with serious side effects. Holland, a psychiatrist, is certainly not opposed to treating mental illness with medication, but believes that many women would be better served by life style changes than medication. It isn't our brains that are sick, but rather our environments.

In the first part of the book, "Moody By Nature," Holland explores how women tend to be more aware of their own feelings and more empathetic towards others than men (24). Holland presents evidence that this is likely to be caused by differences in male and female brain development, as well as the influence of hormones, for example, high levels of testosterone has been linked to decreased empathy (24). These biological reasons are likely part of the reason  women are more than twice as likely as men to be diagnosed with depression and anxiety disorders (social factors, like willingness to seek help, must also be accounted for) (26). Perhaps the most persuading evidence that these differences are biological is that they are most strongly observed in women between adolescence and menopause (26).

Hormone changes that govern the menstrual cycle also effect mood. Leading up to ovulation, most women experience positive moods. After ovulation, moods tend to dip under the influence of progesterone. Hormonal fluctuations can also cause insomnia, which may explain why many more women than men report sleepless nights. Near the end of the luteal phase, many women experience negative moods, PMS.  3-8% of women fit the diagnostic criteria for PMDD, an extreme version of PMS, 15-20% of women experience very unpleasant but subclinical PMS, and 15-20% of women do not experience any PMS (the rest fall somewhere in the middle). Women who experience PMS, especially bad PMS or PMDD, are more vulnerable to depression during and after pregnancy and menopause (26).

Holland believes that even the symptoms of PMS - being impatient, annoyed, angry, or sad - can be harnessed for good. She points to a study of women on antidepressants, which found that as depressive symptoms improved, women had less motivation to make major lifestyle changes and fix dysfunctional aspects of their lives (30). However, Holland also recognizes that these symptoms can be debilitating. In her own practice, she has had success treating people with SSRI's for the week proceeding women's menstrual cycles, as well as using hormonal birth control (35).

Holland hardly pushes hormonal contraception as a fix though. She writes that

It is extremely hard to predict who is going to do well on the Pill... patients who are typcialy very moody and erratic... often do better on the Pill, having fewer mood swings and minimal PMS... But many of my patients find that they cannot tolerate how emotional the Pill makes them, and after trying several different brands over the years, they abandon the idea... . (43)

While 71% of women who start hormonal contraceptives report no mood changes, and 12% noticed improved moods, 16% of women experienced worse moods. Additionally, hormonal contraceptives decrease sexual desire and inhibit orgasms. Some of these changes to desire may be permanent (45).

I thought "Moody Bitches" was a very good book. Holland goes on, in the second part, to detail the hormonal and mood shifts prevalent in falling in love, having children, and menopause. In the third (and longest) part, she explores natural solutions to mood fluctuations. I thought the third portion was especially interesting, although preachy at times. "Moody Bitches" was especially interesting to read while practicing NFP. I have a greater appreciation for how the hormones which govern my fertility also impact my mood.