Feel Like Dr. Jekyll and Ms. Hyde Certain Times of the Month?

From the WebMD Archives

Sept. 29, 2000 -- Virtually every woman knows when her period is coming. The bloating, the breast tenderness, the "munchies," and mood swings are known and typically endured because the symptoms are relatively mild for most women. For approximately 5% of women, though, this time is true agony.

Fortunately, relief can be found, surprisingly enough, in the form of a type of antidepressant drug. Prozac is an example of a drug in this category, known as selective serotonin reuptake inhibitors, or SSRIs. However, several other SSRIs have also been used successfully.

In a recent study, British investigators found that patients with severe PMS report significant relief from their symptoms. The study was a review of several major studies and was reported in the journal The Lancet. Among the over 900 patients involved, those on SSRIs were nearly seven times as likely to report relief as those on a placebo.

"We reviewed 15 high-quality trials, which found that SSRIs are effective for both physical and behavioral symptoms associated with PMS," lead author Paul Dimmock, PhD, tells WebMD. Dimmock is a research fellow in obstetrics and gynecology at Keele University and North Staffordshire Hospital in Stoke-on-Trent, England.

How do you know if your premenstrual syndrome is severe? According to Diana L. Dell, MD, it could be, if the following conditions are present:

  • You have at least five of the following problems during the week before your period: depression, anxiety, irritability, or rapid mood swings; decreased interest in usual activities and in socializing; fatigue; a sensation of feeling overwhelmed; food cravings; changes in sleep patterns; physical symptoms such as breast tenderness, headaches, or bloating
  • These symptoms have occurred within most cycles in the last year
  • These symptoms significantly interfere with your quality of life
  • The symptoms are resolved when your period starts, or shortly thereafter
  • You have kept a diary of your symptoms and confirmed whether they occur premenstrually
  • Your physician has ruled out other medical conditions

If the first three conditions are met, you may want to talk to your doctor, says Dell, an assistant professor of ob-gyn and psychiatry at Duke University in Durham, N.C.


However, says Dell, many physicians prescribe these medications for severe PMS -- also called premenstrual dysphoric disorder -- only during the last two weeks of the menstrual cycle. Since the dose required to treat this condition is lower than that for depression, most women taking SSRIs for this reason don't report side effects.

Meir Steiner, MD, who wrote an editorial accompanying the article, notes that there is not yet much information on the use of medications for PMS in two important groups of women: those on birth-control pills and women younger than 18 years. Steiner is a psychiatrist who is a professor of both psychiatry and ob-gyn at McMaster University in Hamilton, Ontario, where he directs the Women's Health Concerns Clinic at St. Joseph's Hospital.

Should you worry about insurance hassles if your physician prescribes a medication typically used for depression? That risk is less likely now that severe PMS is a distinct medical condition, David C. Fein, MD, tells WebMD. "Insurance companies may be less likely to flag such patients as being at-risk just because they get [an antidepressant] prescription," says Fein. He is an ob-gyn in private practice in Dallas and has additional training in the treatment of mood disorders.

Dell and Steiner have served as speakers for several companies that manufacture SSRIs; neither has any other financial interest in these companies.

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