Usually, at the RE's office, new patients are told that fertility medications may make them "a little moody". This is not exactly true--ask any IF veteran, and she will tell you that they have the potential to make you VERY moody. At no time was this more clear to me than during my two month stint on Lupron Depot to treat my endometriosis. After throwing my body into sudden menopause, complete with hot flashes and night sweats, I also realized I now felt extremely upset all the time. If something wonderful happened, I still felt upset. If something upsetting happened, I felt inconsolable. I was in a constant state of wanting to yell and/or sob and/or punch someone in the face. Not only is that bad for business in my line of work, it was also extremely unpleasant. Clearly, I needed to develop new coping strategies to avoid jail time--and fast!
William James to the rescue!
When I first studied psychology in my undergraduate days, I learned about William James and his theory of emotion. One of the founders of the field of psychology, James believed that emotions resulted from the experience of a physical stimulus--e.g., you see a dangerous situation, begin running, and then become afraid--rather than the other way around--you see a dangerous situation, become afraid, and then start running. To be honest, this theory never made a great deal of sense to me. I was convinced that my body responded to my thoughts and emotions, and not vice versa. However, that all changed when I started becoming a habitual user of fertility drugs.
As I described above, while taking fertility medications, I had many physiologically-based experiences that caused my emotions to careen out of control. And unfortunately, I know I'm not alone. In my practice I've heard many instances of normally calm and mild-mannered women, once on the "sauce", suddenly finding themselves screaming and harming their normally beloved crystal. Yes, being infertility treatment is stressful--but many of the reactions I've seen are so far away from the person's normal coping strategy that it's safe to assume medication was a factor.
These experiences have made me question my assumption that emotions are always a direct result of our thoughts. Now, I believe that James was really on to something--sometimes are feelings are based on bodily experiences and sensations, and not the other way around. James himself suffered from a great deal of physical illness during his life, so perhaps he experienced this first hand.
You may be thinking to yourself (especially if you happen to be taking fertility medications right now), "Okay, Dr. Smartypants, who cares? Why are you telling me this? How is exactly is William James going to help me now?" The important point is this--infertility medications mess with your body's ability to react appropriately to the stimuli around you. So if your body feels physiologically upset--adrenalin and cortisol levels elevated--your brain will look at your current circumstances to try to find a reason. If it can't find a really obvious one, it is just going to assume it's one of the things going on in front of you right now. And if you start reacting to relatively innocuous stimuli as if they are the source of your body's upset sensations, well, that's when the trouble starts. But even worse, if you get into a truly upsetting situation, your body will push the panic button and trigger the flight or fight response. During that physiological experience, it's very hard to stay calm and keep a clear head, which many of our modern-day crises require us to do.
In my Lupron Depot days, I experienced this constantly. My natural reaction was to respond to the events going on before me, as if they were the thing that was causing all my inner turmoil. But after a few weeks, I realized that no matter how I reacted or how I changed things in my life, I still felt just as upset as before. Because of my hormonal changes, I was now in an constant state of flight or fight arousal. The only way I could survive would be to use my brain to overrule my emotions and my body's natural tendency to respond. Otherwise, I was going to be in for countless pointless arguments with store clerks and crying jags at the mall--not to mention alienating my husband, family and friends.
Rule No 1--Don't react!
As a psychologist, I am very interested in feelings, especially initial reactions. I normally advise people to pay close attention to those emotions and try to be true to them if they can. However, when you are taking infertility medications, I recommend the opposite strategy. My first rule of coping with the emotional side effects of being on infertility drugs is this: Don't react! The medications have decreased your ability to appropriately respond to your environment. So you have to try very hard not to respond to any seemingly upsetting event right away. Take a breath, and before you say or do anything, cognitively evaluate the situation. Is it really as big of a deal as it feels like right at this moment? Will getting outwardly upset help this situation in any way at all? If the answers to those questions are yes and yes, then you can take the brakes off and respond. But I think you will be surprised at how many times the answers to those questions will be no's. By putting your thoughts back in charge, you can select a more productive course of action.
Rule No. 2--Enlist the support of others
Another important coping strategy is to get a significant other, such as a spouse or partner, family member, or friend to help you evaluate your emotional responses to current life situation. This should be someone who understands your predicament, and agrees--in advance--to be available to you to process your feelings. When you are upset, they can remind you to calm down and go over the details of what just happened to help you figure out the best reaction. Husbands can be great for this, but sometimes men have difficulty truly understanding how hormones can have such a large effect on emotions. Because they don't typically experience the hormone fluctuations that women do even in a normal menstrual cycle, they haven't lived this "from the inside". So it may be necessary to enlist the backup support of a friend or family member just in case they have a hard time understanding the gravity of the situation.
Rule No. 3--Avoid stressful situations
If you are in a treatment cycle at the moment, chances are you are probably doing this anyway, but I'll add a quick reminder that now is not the time to voluntarily take on anything stressful. So perhaps you might want to postpone that incredibly complicated house renovation, or having the queen over for dinner. In infertility treatment, stress is plentiful, so you can be sure there will be enough stress to keep you occupied!
A final note to all the newbies out there....
If you've just begun infertility treatment, chances are you have taken or will be taking Clomid soon. In my experience, this drug is one of the worst in terms of causing emotional side effects. I frequently refer to it as "suicidal ideation in pill form", and I'm only joking a little. If you are taking Clomid and suddenly find yourself feeling very depressed and upset, it may be a result of the medication. (Of course, if it doesn't resolve relatively quickly after your cycle is over, you should definitely get those symptoms evaluated by a mental health professional.) I hope that Clomid will be the key to your success, but if it isn't, take heart--the FSH drugs don't seem to cause such severe reactions.