Taking Control of PMS PMDD and Depression Gurjit

Taking Control of PMS, PMDD and Depression Gurjit Kaur, D. O. April 24, 2004

What is PMS? Ï Ï Ï PMS (premenstrual syndrome) is a common condition which can affect as many as 75% of women with periods Multiple physical and emotional symptoms which occur ONLY in the 2 weeks before one’s period Symptoms include anger, fatigue, bloating, cramps, irritability, anxiety, breast tenderness, changes in appetite or sleep or headaches

What is PMDD? Ï Ï Ï PMDD (premenstrual dysphoric disorder) Severe form of PMS which occurs in 3 -8% of women in their late 20 s to mid 30 s (1 out of every 20 women) The key difference between women PMS and PMDD is that PMDD is more severe and serious enough to interfere with a woman’s usual daily activities and personal relationships

What causes PMDD? Unknown cause Ï Fluctuating hormone levels before one’s period affects the chemical balance in the brain Ï Risk factors: stressful life changes, previous history of mood disorders and family history Ï

What are symptoms of PMDD? Ï Ï Ï Ï Ï Feeling sad or tearful Anxiety or irritability Decreased interest in usual activities Difficulty concentrating Feeling tired or lacking energy Sleeping too much or too little Changes in appetite Feeling overwhelmed Physical symptoms

How is PMDD treated? Diet and lifestyle changes (salt, sugar, caffeine, dairy products and alcohol) Ï Counseling Ï Exercise Ï Yoga Ï Medications Ï

Which medications are used most often? Selective serotonin reuptake inhibitors (SSRIs)–first line (Zoloft, Sarafem, Paxil) Ï Anxiolytics Ï Diuretics Ï Oral contraceptives (Yasmin) Ï NSAIDs Ï

What else can I do? Ï Ï Calcium— 1200 mg calcium reduces anxiety, fluid retention, pain and food cravings Magnesium—may be useful in decreasing fluid retention Vitamin B 6—may help with mood symptoms in doses of 50 -100 mg daily Vitamin E—may relieve mood and physical symptoms

What else can I do? Ï Ï Evening primrose oil—may relieve breast tenderness, irritability and ankle swelling Chaste tree—decrease breast tenderness. Not safe during pregnancy Black cohosh—relieve anxiety and breast pain. ? long term efficacy Dong quai—No convincing trials. Not safe for women on coumadin or contemplating pregnancy

What else can I do? St. John’s Wort—may help with mood symptoms Ï Acupuncture Ï Kava kava—not recommended due to liver toxicity Ï

Depression Lifetime risk is 7 -12% in men and 20 -25% in women Ï Recurrence rate of 40% after first episode over 2 years; 75% after 2 episodes over 5 years Ï Health care provider for symptoms, exam and lab testing Ï

Treatment for Depression Ï Antidepressants SSRIs—Prozac, Zoloft, Paxil (first line) { Tricyclics—Elavil { Wellbutrin { Effexor { Initial therapeutic response in 2 -6 weeks {

Treatment for Depression Ï St. John’s Wort { { { Wild yellow flower St. John the Baptist Effective for MILD depression only 2 -4 grams 3 times daily no longer than 8 weeks Decreases depression and anxiety, improves sleep and muscle pain

Treatment for Depression Ginkgo biloba—thought to improve memory; evidence conflictual Ï Exercise—Reduces stress and anxiety by improving energy and sleep. Effective for mild to moderate symptoms Ï Acupuncture—Chinese method of healing by improving the flow of energy which is useful for long term pain Ï

Treatment for Depression Reflexology—applied pressure to specific points on the hands and feet Ï Meditation—form of relaxation to clear the mind by focusing on one thought Ï

Coping with Depression Support and involvement of family and friends Ï Educate yourself, family and friends about mental health problems and depression Ï Recognize that depression can be expressed as hostility and rejection Ï Seek professional aid (physician, therapist and support groups Ï

Summary PMS is the more common condition, but PMDD is more severe in its symptoms Ï Depression is a serious but treatable illness Ï Health care provider for diagnosis Ï Multiple treatment options for each of these conditions involving lifestyle changes, medications and counseling Ï

Where can I get more information? Cleveland Clinic Disease Management Project (www. clevelandclinicmeded. com) Ï National Institutes of Health (www. nlm. nih. gov/medlineplus) Ï American College of Obstetricians and Gynecology (www. acog. com) Ï