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A happy time of the month

MagazineDecember 2000 (Vol. 11 Issue 9)A happy time of the month

In a recent copy of the Lancet, a review of 29 medical studies concluded that antidepressants like Prozac are an effective first line treatment for women with severe cases of premenstrual syndrome (PMS), also known in medical parlance as premenstrual dysphoric disorder (PMDD)

Now I've read everything. In a recent copy of the Lancet, a review of 29 medical studies concluded that antidepressants like Prozac are an effective first line treatment for women with severe cases of premenstrual syndrome (PMS), also known in medical parlance as premenstrual dysphoric disorder (PMDD).

The study, from Keele University and North Staffordshire hospital in Stoke-on-Trent, concluded that SSRIs were nearly six times more effective than placebo in treating both the physical and behavioral symptoms of PMS. As with earlier studies, the review found that the only class of antidepressants which work with PMS are the SSRIs. The older tricyclic antidepressants seem to have no effect (Lancet, 2000; 356: 1131-6).

Behind this impressive story lurks a few more sobering statistics. For instance, two and a half times more women stopped taking their SSRI drug due to side effects than did the placebo group or those taking the tricyclic antidepressants. The most common side effects suffered were insomnia, gastrointestinal disturbances and fatigue. The higher the dosage, the greater the number of side effects.

An editorial accompanying the study (Lancet, 2000; 156: 1126-7) was full of congratulations to a profession for no longer trivialising this female disorder as all in the sufferer's head. But that is precisely what this research is doing. The main effect of these results is to more firmly establish PMS as a psychological disorder on a par with depression. It works because the women don't feel bad anymore or they may still feel bad, but they don't mind feeling bad anymore now that they've got their 'happy' pills.

The Prozac-PMS success story has produced some fairly tortured reasoning as to the likely cause of this condition. Because this drug, which slows the elimination of serotonin, seems to work on women with PMS, doctors are now theorising that it must be low serotonin that causes PMS. They've also invested Prozac with rather impressive anthropomorphic powers. Since taking SSRIs only during the second half of the menstrual cycle is just as effective as taking the drug throughout the month, doctors think drugs like Prozac must act in a more specific way for women with PMS than normally somehow working at the 'interface' between hormones and the neurotransmitter system. In other words, the chemicals which collectively make up Prozac must somehow 'know' that a woman getting her period isn't just your ordinary depressive, and are then able to get rid of that entire disparate collection of symptoms that makes that time of the month hell on earth for many women.

The most worrying aspect of these results is the number of women whom medicine is likely to turn into junkies. A good number of women could be taking this drug for at least two weeks of every month for 10 to 20 years. Social Audit's Charles Medawar has shown that SSRIs, like all antidepressants and tranquillisers, are highly addictive (see WDDTY, vol 1 no 4). This could have ramifications not only on the women themselves, but also on any children they may have if they are unable to get off the drugs during pregnancy.

The most criminal aspect of using this drug for this condition is that it ignores the proven evidence that PMS is a deficiency disease. A solid body of evidence shows that taking certain nutrients and changing diet cures even severe PMS (see WDDTY vol 8 no 6). The Lancet editorial acknowledges that vitamin B6 is twice as likely as placebo to relieve symptoms; calcium carbonate has been shown to reduce symptom scores by 48 per cent. But these are not quick fixes, and they require an understanding and knowledge of nutrition to administer.

My biggest worry is what doctors are going to do with teenagers and young adults who show up in their offices complaining of bad PMS symptoms. The Lancet editorial cautions that it would be "prudent to await further studies before prescribing SSRIs for PMDD in younger girls". Since when has medicine ever been prudent when reaching for the prescription pad?

!ALynne McTaggart


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