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Winning the War on PMS

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What About Sarafem? continued...

"This condition was only recently included in the DSM-IV, the manual of psychiatric disorders," says Shifrin. "This is a huge advance."

"In this syndrome the patient's primary complaint is severe depression, anxiety, irritability, and mood swings, while PMS is characterized by more physical symptoms," says Jean Endicott, PhD, director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center, in New York City. "The second diagnostic criteria for PMDD is the presence of severe symptoms leading to psychosocial impairment."

She estimates 3% to 8% of women with regular menstrual cycles have clinically significant symptoms that meet the criteria for PMDD, while about 60% have PMS.

You can't walk into a doctor's office, say you have bad periods, and walk out with a prescription for Sarafem, Endicott explains. Instead, your doctor will ask you to keep careful records for two menstrual cycles, charting your symptoms and when they occur. The main reason is that is many women who seek help for a PMS problem turn out to have depression and mood swings throughout the month, although it gets worse premenstrually. "If that's the case, their diagnosis and treatment will be different."

Sarafem can be useful for the rare patients who fit the definition of PMDD, physicians say. "For the handful of patients who experience extreme discomfort and are incapacitated, Sarafem does seem to be a useful alternative. It's a half-strength dose of the lowest dose of Prozac. If I select my patients carefully the response to Sarafem is almost uniformly successful," Goldstein says. "However, it is only suitable for a small percentage of people. You want to try other alternatives first."

Rosenzweig agrees. "After you've tried supportive therapies such as lifestyle changes and mind/body methods, if the patient is still distressed and in need of more help, they should be evaluated to see whether Sarafem could help them. Diet and the relaxation response and Sarafem aren't an "either-or" choice. In some patients they may all work together to alleviate premenstrual symptoms."


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