PMS & Mood Changes
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PMS

Q: I am curious about mood swings and PMS. Lately (since having my second child), I notice that I get mildly depressed prior to my period.  For instance, I don't have as much patience with my children (4 and 2), I don't enjoy playing with them as much and am "grumpy" according to my husband. It just lasts for a few days and then I feel fine and more energetic.

Dear Chris --
If you are indeed "fine" all the days of your cycle except these days that you describe (10 days or less), and if you absolutely certain you could confirm that with written monitoring of energy, mood and irritability (your three "target symptoms"), then you by definition have "PMS".  Like, duh, you knew that. 

But the point is, you by definition don't have something like "bipolar disorder".  We start there because from here, it gets much more complicated, or can.  For example, you note that this started after your second child was born.  Somehow that event, perhaps the hormonal event itself, "sensitized" your brain to the "normal "fluctuations of your menstrual cycle -- at least that's our current model of this problem. 

And the point of all that is that you don't need treatment for "bipolar disorder" with the symptoms you describe.  I'll confess that I think your mild PMS is related to the same fundamental problem that causes much more severe symptoms, for all or almost all of a monthly cycle, in other women, that do call "bipolar disorder".  But since we understand neither, in terms of actual causes, that issue is moot for now. 

It's moot because there are "treatments" for you, and they don't look like the treatments for bipolar disorder.  As you've probably learned, there's a lot of excitement now about using serotonergic antidepressants for PMS (e.g. what used to be called Prozac and is now marketed as "Serafem"; editorial comment withheld).  The evidence there is very good.  Whatgets passed over in that excitement is evidence for other treatments. 

There is onestudy showing that moderately high doses of calcium (like two Tums twice/day) is effective in controlling symptoms like yours.  Just one study, but it was a large (466 women) "randomized controlled trial", meaning it had a placebo group -- and that distinguishes this approach from almost everything else you'll hear about out there, including evening primrose oil and exercise.  However, neither of those seems to carry much risk, so not too much harm in trying them, and certainly that's true for the exercise approach, which as you know has many other potential benefits! If you'd like to see more references about the calcium story, go to the Hormones and Mood section of my website -- where I've reproduced this letter but added the rest of the references!

Which brings us back around to the "Sarafem" (and other SRI's) approach.  How about risk there?  Well, as you may know, antidepressants are known to make bipolar disorder worse.  So if PMS is like bipolar disorder (i.e. like a tiny version of it) somewhat, then is there potentially some risk if women with PMS are given an antidepressant?  A risk of making the PMS worse, making it more like "bipolar disorder "itself?  This has not been reported nor even suggested anywhere else that I've read, so realize this is my worry and could be completely unfounded.  At the same time, if there are "treatments" out therewith no risk at all, in fact strong potential for other benefits -- namely exercise, and to a lesser extent the calcium approach, which could decrease osteoporosis risk and carries only a mild risk of causing a kidney stone insusceptible women -- then why not start with those!?  

Here is the kind of chart you'd want to keep, no matter what treatment approach you take (for a fancy version, personalized to your symptoms, print one from this site-- but a hand version works fine and the important thing is not to miss recording!):

Date Day of cycle

Flow

Symptom 1 (0-4) Symptom 2 (0-4) Symptom 3 (0-4)
e.g.    

irritability

ability to enjoy kids

energy

12/2/00

1

P 4 1 1
12/3

2

P 0 3 3
12/4 3 P 0 4 4
12/5 4 P 1 3 3
12/6 5 s 0 3 4
   etc....          
12/22 21   0 3 4
12/23 22   2 2 1
12/24 23   4 2 2
12/25 24   3 1 0
12/26 25   3 1 1
12/27 26   3 0 0
12/28 27   4 0 0
12/29 28 S 3 0 1
12/30 1 P 0 3 3

Note that this woman began to have her symptoms rather suddenly on Day 22,with equally sudden return to "fine" on the first day of menstrual flow.  (I hope that's not your timing, as it would make for a tough Christmas). 

Surfing around looking for websites on PMS, as you may have seen, there are many.  About 90% are trying to sell a product.  The vitamin B6 site doesn't mention the nerve damage that has been associated with this treatment.  The bottom line: be careful, especially if somebody's trying to sell you something.  Here are some of the better sites I found (there are surely many more; you can write and tell me if you find better stuff to put inhere -- thanks):

  • HerSupport.com 's letter
  • Basic information
    (from Pampermesoftly.com -- who will sell you all sorts of junk from their store, but keep that out of the way of their information)
  • A background on "PMDD" , the more severe form of PMS
     (However, note that this was funded by who?  Eli Lilly.  Who's that? maker of "Sarafem")

Dr. Phelps


Published December, 2000

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