Posted by Lori RN, psychiatry on March 27, 2001, at 8:09:40
In reply to Re: PMDD - Premenstrual Dysphoric Disorder, posted by Terry on March 11, 1999, at 15:51:23
The best advice I've read so far on this disorder comes from the Sarafem website and includes keeping a journal of daily moods/emotions/and behavioural responses for a 3 month period (number of days in the month is based on the length of your cycle). You can then discuss mental status changes with your doctor or psychiatrist to confirm or negate the diagnosis of PMS or PMDD. It is interesting to note that only a small percentage of women suffer from PMDD, and that many have an underlying depressive disorder that is signifigantly impacted during the pre-menstrual period. Or, others may have undergone many recent life changes as in one of the letters I have read above, which will most certainly have an effect on mood and coping. The thing is, treatment is very much individual and may require many modalities (maybe just medication, or combinations of medication, counselling, and lifestyle changes). It is important, as with any illness, not to diagnose yourself, but to seek medical advice. I realize that this may be difficult as the disorder is somewhat stigmatized and not widely accepted as a real medical condition. Persevere. Recent FDA approval of Fluoxetine in treatment is encouraging and Lilly is working hard to market their brand (Serafem) and in doing so, PMDD is becoming well known. Psychiatrists have been treating PMS with SSRIs for years and it has been recognized as a dysphoric/dysthymic disorder in the psychiatric community for quite a long time. If your family doctor does not recognize PMDD, ask for a referral to a psychiatrist and go armed with your 3 month journal. Be sure to include a thorough history of your pre-morbid personality, any lifestyle changes or recent stressors, a synopis of your normal coping ability, and describe your behaviour on a normal continuum and during mood swings. Suggestions I have picked up in the area of lifestyle changes include:
Additions of Calcium supplements
Vitamin B6 - 10 mg daily
Exercise 3-5 times per week
Balanced diet with increases in whole grains and fruit and vegetables, decreased in salt, sugar, alcohol, and caffeine
Relaxation exercises, music, visual imagery, whatever works for you.
I am not just a spokesperson for the PMDD club for women, I am also a member. I take 10mg of Prozac daily, and I'm working on the above lifestyle changes. Of signifigance, the reduction in caffeine alone has made a huge difference in my concentration and response to stress, particularly at work. Avoiding alcohol also makes a difference, as alcohol in itself is a depressant and is also contraindicated with the use of SSRIs. Jan, if your medication is not working, you need to visit your doctor again and be assessed. Obviously, you need more effective treatment.
Lastly, remember it is your responsibility to be actively involved in your treatment. If changes need to be made, you are the only one who can make them, medication alone is not always effective. You also need to be open and honest with your health care professional, help them to help you.
Hope this was helpful.
poster:Lori RN, psychiatry