Premenstrual syndrome may be all in your head, after all.
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A growing body of evidence indicates some anti-depressants may ease the emotional distress of premenstrual syndrome, an intriguing clue that the symptoms may be linked to brain chemistry rather than hormones.
A study published recently in the Journal of the American Medical Association reported that some drugs in a class of anti-depressants known as Selective Serotonin Reuptake Inhibitors reduced the irritability, moodiness, depression and anxiety associated with PMS in about two-thirds of the subjects. The drugs, which include Zoloft and Prozac, work by inhibiting the level of the neurotransmitter serotonin in the brain.
News of such studies gives hope to women like Alicia Kaener of Hollywood, Fla., who says she can go from a crying jag to a grumpy fit in seconds during the days before her period.
“Most of the time I just muddle through. What else can you do?” she said. “Sometimes I’m so nasty with the kids I think I should do something. So if I knew there was actually something the doctor could do, maybe I would go.”
But although the research seems promising and many doctors are incorporating anti-depressants into their treatment of PMS, they caution that it’s no panacea. In fact, such drugs may not be the first line of defense. Most doctors advocate starting with a calendar to track symptoms–to be sure you’re not mistaking depression that gets worse during a period for true PMS, which doesn’t produce symptoms for most of the cycle.
The second step should probably be an array of accepted conventional treatments–improving the diet, exercising and using vitamin B6 to treat emotional symptoms. Once those have been tried, a doctor may prescribe drugs such as diuretics to relieve bloating or anti-depressants to improve mood.
“The problem is, nobody knows what causes it, so it’s really just trial and error,” said Dr. Paul Gluck, a Miami obstetrician-gynecologist. “There’s not an answer for PMS that works on every woman. Many people will get better with the holistic approaches. . . . It’s when you get to the severe emotional symptoms that these things seem to be helping.”
Researchers don’t know yet what causes PMS or exactly why the anti-depressants seem to work. In fact, they have trouble agreeing on what the syndrome is. PMS is generally defined as a constellation of symptoms that appear in the two weeks before a woman begins to menstruate. About 150 symptoms have been linked to PMS, everything from bloating and breast tenderness to mood swings and irritability.
With such a broad definition, women’s experiences can vary dramatically. Some doctors have tried to group symptoms into broad patterns or varieties of PMS. Others believe a single symptom is sufficient to diagnose PMS and that, ultimately, there may be different causes for different symptoms. A severely disruptive form of PMS that involves at least five mainly emotional symptoms has been recognized as a mood disorder.
“That’s why 20 years ago you had textbooks that said it was all in your head,” said Dr. Arthur Shapiro, a reproductive endocrinologist at the University of Miami. “Of course, those textbooks were probably written by men. . . . But we need to get a better handle on it.”
The murky definition of PMS makes it difficult for researchers to track the effectiveness of the treatments they study. For years, doctors prescribed birth control pills and progesterone in an effort to correct hormonal imbalances thought to cause PMS. But more recent studies have found that hormones are no more effective than a sugar pill.
So doctors turned to anti-anxiety drugs and anti-depressants in the hope that they would alleviate the most trying symptoms of PMS: the emotional swings that can disrupt relationships.
“It’s when you have mood swings and you can’t concentrate at work and you feel guilty about screaming at the kids, that women start to come in to the doctor,” said Dr. Angela Pedraza, a psychiatrist at North Broward Medical Center in Pompano Beach, Fla., who is conducting a clinical trial for the drug Zoloft. “That’s why this seems like such a promising treatment approach.”
While that’s encouraging, research needs to be done to see which symptoms the drugs are most effective at treating and what the appropriate dosage is, said Pedraza.
“We’re making progress,” said Pedraza. “At least we’re not being ignored, like we have been for years.”
The definition of premenstrual syndrome is so vague that doctors admit to confusion over what causes it and how to treat it. PMS can involve any of 150 symptoms that occur in the 10- to 14-day period before menstruation, including bloating, sore breasts, fatigue, food cravings, mood swings, depression, irritability and forgetfulness.