Within weeks of starting my supplement plan, I noticed a significant positive shift in my mental health. I can honestly say that with Sandra’s help, my life has changed for the better.

Lifelong depression and severe premenstrual anxiety

Many women experience premenstrual anxiety and depression in a moderate or severe form. Typically these are hormonal imbalances which are driven by nutrient deficiency and/or excess, which when resolved can lead to calm, uneventful, natural cycles.

Lifelong depression and severe premenstrual anxiety

Sandra Ishkanes is a Functional Medicine expert specialising in women’s hormonal health. She works like a health detective to root out the underlying causes of hormonal imbalances and takes a whole-body approach to healthcare, combining nutrition, lifestyle and cutting-edge medical testing.


OT was 33 years when she got in touch with me seeking help for her long-standing daily anxiety and depression, which became much worse before her period. She felt low 80% of the time and even worse in the week before her period, where she would have an emotional meltdown. She had tried all kinds of approaches to manage her low moods including counselling, anti-depressants and hormonal birth control, none of which were successful.

She said:

“I have suffered with anxiety and low grade depression for as long as I can remember although I only realised that there was a name for how I felt when I was in my late teens. Whilst at college, I hit my lowest point and had some counselling but I think i only had a few sessions. The counselling did not work for me as it felt very “standardised” rather than looking to help me work through my own personal issues. I struggled with my mental health all through university but managed to distract myself with friends and work.

Recently I made positive changes to my diet, but I still suffer with anxiety and depression. I started taking sertraline as I again hit rock bottom. I stopped taking sertraline around 8-12 months ago as I was having bad side effects including severe night sweats. My anxiety and depression is also heightened a week leading up to my period and I am now looking for a more natural way to manage my symptoms as I hate how I feel most of the time. This state of being can be so frustrating at times as I know that I am very fortunate in my life but my mood is always low.

I believe my menstrual cycle has an effect as I have a few days around the time I am ovulating where I feel “normal” or better than I usually do.”

Health History

  • regular cycles every 28-29 days
  • severe premenstrual anxiety, irritability, crying spells, mood swings, depression and lethargy
  • premenstrual food cravings, fatigue, headaches and breast tenderness
  • periods are light
  • periods last 2-3 days,
  • feels much better once period has ended for the next 3-4 days
  • then mood goes back to baseline, low but functional
  • mood better around ovulation
  • vaginal dryness
  • stomach upset by greasy foods
  • cravings for fat and meat before her period

Nutrition History

  • High carbohydrate breakfast e.g. apple and cinnamon porridge with oat milk
  • Low on protein
  • Low on vegetables
  • Low on fat
  • Has 3 meals a day but they are quite small

Significant Test Results

  • Vitamin D deficiency
  • Vitamin B12 deficiency
  • Folate deficiency
  • Low iron
  • Omega 6 too high
  • Omega 3 too low
  • Blood sugar too high

Root Cause Analysis

OT’s mood was low in general, which indicates a deficiency of serotonin and dopamine, and this was confirmed by a neurotransmitter questionnaire.

Depressive, anxious syndromes can be caused by nutritional deficiencies from poor diet, including

  • 5HTP derived from animal protein which creates serotonin
  • tyrosine derived from animal protein which creates dopamine.
  • magnesium
  • calcium

Additionally, it was very clear that her low mood was cyclical, improving at ovulation when oestrogen is higher, and crashing premenstrually. It was also clear that her oestrogen was too low in general and progesterone was too high premenstrually, as evidenced by

  • light periods
  • short periods – 2-3 days
  • breast tenderness
  • vaginal dryness

Factors contributing to low oestrogen in OT included

  • inadequate fat intake: steroid hormones such as oestrogen (and vitamin D) are made from cholesterol which is derived from dietary fat, which she could not digest and absorb
  • inadequate B vitamins which prevents the synthesis of oestrogen from testosterone

First Consultation Protocol

  • I recommended a low carbohydrate, moderate protein, high fat nutrition plan which was rich in fish and eggs, with a high level of vegetables and beneficial fats, and personalised to OT’s requirements.
  • OT was asked to follow my 7 food rules as closely as possible.
  • I recommended that OT purchase a Seasonal Affective Disorder lamp and expose her eyes the bright light every morning. Bright light therapy has shown to help with winter blues, regulating energy in the daytime and the sleep cycle at night.
  • Vitamin D: calibrated dose of emulsified vitamin D drops
  • Gynovite: a multivitamin with high doses of B vitamins targeted for low oestrogen
  • 5HTP to increase serotonin
  • L-tyrosine to increase dopamine
  • Body balance oil to increase fat intake
SymptomScore out of 6
Depression every day4
Depression before period6
Anxiety every day4
Anxiety before period4
Meat cravings before period5
Craving for fat before period5

Follow-up Consultation 1 Results (+4 weeks)

  • 4 weeks later OT, for the first time, did not have the usual pre-menstrual emotional meltdown of breaking down and crying, and was feeling emotionally well during the month.
  • She did have 2 short depressive episodes, but said that at the same time her workload was excessively stressful.
  • Her anxiety had improved slightly, and she was still finding it difficult to fall asleep.
  • Her skin had improved a lot.
  • Pre-menstrual fat and meat cravings had reduced.
  • She was enjoying eating more vegetables and protein, she wasn’t hungry between meals and most significantly she wasn’t having any mid-morning cravings for food.
  • The Gynovite supplement caused digestive issues so I switched it to Optivite PMT.
SymptomScore out of 64 week score / 6
Depression every day42
Depression before period62
Anxiety every day43
Anxiety before period43
Meat cravings before period52
Craving for fat before period52

Follow-up Consultation 2 Results (+8 weeks)

  • 4 weeks later and all of OT’s symptoms had resolved.
  • Again she had no breakdown before her period and her day-to-day emotional life was absolutely fine.
  • She had a couple of anxious moments related to work stress, but that was all.
  • All her cravings had gone. She was still having a little anxiety before sleep and I adjusted her protocol to help with that.
  • She was finding it difficult to stomach the oil so I switched the oil to capsules instead.
SymptomScore out of 64 week score / 68 week score / 6
Depression every day420
Depression before period621
Anxiety every day430
Anxiety before period430
Meat cravings before period520
Craving for fat before period520

Client Review

“Within weeks of starting my supplement plan, I noticed a significant positive shift in my mental health and I am confident that this will continue going forward.

I can honestly say that with Sandra’s help, my life has changed for the better.”


I have struggled with anxiety and depression for as long as I can remember. Having tried everything from counselling, antidepressants and even Reiki, I was beginning to feel as though I would have to live with my anxiety and depression forever.

I made contact with Sandra following a recommendation from a friend and I am so glad I did. During the initial call, Sandra made me feel at ease straight away.

Within weeks of starting my supplement plan, I noticed a significant positive shift in my mental health and I am confident that this will continue going forward. I can honestly say that with Sandra’s help, my life has changed for the better.

Thank you Sandra!

My Review

Despite the fact that I see significant improvements in client’s health every day in my work, it still sometimes takes my breath away when I see the power of functional medicine in action.

I always expect to see results within 4 weeks, and OT’s progress was no different. She was committed to the process right from the start and did an incredible job of following her plan.

As she said to me, and I agreed – “I wish I could have done this years ago, and I dread to think what my life would have been like if I hadn’t done this work with you”. It saddens me to think of all the women that are suffering through their cycles and not getting the help they need, and I am so pleased to have seen OT recover so quickly.

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