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

2. What is PMS?  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

3. What is PMDD?  PMDD (premenstrual dysphoric disorder)  Severe form of PMS which occurs in 3-8% of women in their late 20s to mid 30s (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

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

5. What are symptoms of PMDD?  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

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

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

8. What else can I do?  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

9. What else can I do?  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

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

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

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

13. Treatment for Depression  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

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

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

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

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

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