One of the most interesting things about PMS is that while as many as 80% of women may experience at least one symptom of it, there is no universally accepted definition of exactly what "it" PMS is.  Therefore, scientific literature is full of theory after theory, and debate after debate without any real answers for women (and frequently their significant others) who really do suffer.

Not expecting to settle any of these debates, feel free to post your comments.  Especially if this is something that affects you--What can be learned from real lived experiences is sometimes more valuable that "data."

An interesting article (Steiner et al., 2006) I came across recently seems to sum up the problem.  Medical practitioners insisting on the biological and psychological (biosphychic) framework for understanding womens health problems seem to have come to the conclusion that the "selective serotonin reuptake inhibitors" (i.e., SSRIs the most popular of which is Prozac) have now been shown to merit "treatment of choice" status.

In this particular article, the authors show several treatment algorithms that start with the use of an antidepressant medication (SSRI) which is then evaluated.  If the SSRI is not effective, either a) the dose is increased, or b) a different dosing schedule is implemented.  In the end, if side effects or lack of therapeutic effects are unmanageable then a psychiatric consultation is made.

This would seem to raise a whole number of issues with regard to women's health, the first of which is simply that of a very narrow view of the causation of the problem within the biopsychic framework as described above.  Nobody can argue that the symptoms of PMS occur premenstrually and therefore the strong nature of the evidence of hormonal mediation but there sure is something lacking if the best that current expert opinion in medical practice boils down to antidepressant medication with referral to psychiatry.  Women deserve better than that!

Another alert.  Many women may not realize that the new medication Sarafem IS Prozac.  The pharmaceutical companies have just done slick repackaging in pink of an antidepressant medication that now has FDA approval for the problem 'PMS.'  It is the same thing that was done when Welbutrin became Zyban for smoking cessation.  I'm not saying that it doesn't work, just that there are probably a lot of women who are walking out of the doctors office not realizing that they have been prescribed an antidepressant.

Reference
Steiner, M., Pearlstein, T., Cohen, L. S., Endicott, J., Kornstein, S. G., Roberts, C., et al. (2006). Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: The role of SSRIs. Journal of Women's Health, 15(1), 57-69.


_________________
Learn About Your Fertility
My Profile


Follow David Picella on Facebook

I could not agree with David Picella more.  Antidepressants are not the only way to treat PMS.  Starting on the Pill is not the only way to treating pms.  Niether gets to the root cause of pms.  By charting your fertilitycycle with MyFertilityCycle.net the women gets a good sense of what may be wrong with her female hormone cycle.  A physician who understands how to read the womans charted fertilitycycle can make recommendations on treatments which gets to the underlying cause of the PMS. An example of this is a low progesterone or low estrogen level after ovulation.  See the graph below which demonstrates the normal changes in female hormones during the fertility cycle.

Sincerely,
Dr Nick Jauregui MD