Can Antidepressants be Used to Tame Psychological Symptoms of PMS?
Up to 80% of women of reproductive age experience physical and behavioral changes premenstrually. However, these changes are predominantly normal and most often do not result in disabling distress or functional impairment. Still, 20% to 40% of women do experience premenstrual disorders. For 2% to 10% of women, the symptoms are severe enough to impair work and interpersonal relationships. Only in recent years has there been significant recognition and research of the problem. Diagnostic criteria are now evolving, and well-designed studies of treatment efficacy are providing greatly improved treatment information. No single treatment is effective for all women with premenstrual syndrome (PMS), although most women can be helped with careful diagnosis and a systematic approach to potential therapies. The overlap between PMS and atypical depression--in which emotional hypersensitivity, increased anxiety, irritability, and food cravings predominate--is particularly notable. Both disorders are believed to involve the serotonin system, which accumulating evidence shows to have a role in modulating mood and behavior. Results of various preliminary studies that examined markers and activity of the serotonin system are consistent with the hypothesis that abnormalities in central serotonergic activity may be involved in PMS. Clinical studies suggest that approximately 60% to 70% of women who have undergone a careful diagnostic evaluation of severe PMS report significant symptom reduction with the serotonergic antidepressants, although as yet there are no drugs with FDA approval for the indication of PMS. Continued research is essential to confirm and expand the pharmacologic treatments for PMS and to increase understanding of this complex disorder.
Freeman
EW
Departments of Obstetrics/Gynecology and Psychiatry at the University of Pennsylvania Medical Center in Philadelphia, Pa.