NYC psychotherapist Colette Dowling,LMSW, the author of the following article on PMS, has written 8 books on women's psychological issues, including The Cinderella Complex: Women's Hidden Fear of Independence, which was published in 23 languages. PMS: How to Deal With ItColette Dowling, LMSWPMS has a long and controversial history. For close to a century women were told that premenstrual mood change was all in their heads. "Get over it you poor, weak creatures," was pretty much the attitude. Every woman who suffers from PMS--premenstrual mood shifts and physical changes--knows what it's like to feel ashamed, helpless and out of control. Her mood swings may feel profoundly disorienting. Who she IS, during that week or 10 days before her period, doesn't quite feel like the "real" her. She may fight with her husband. She may say terrible things to her children. She has no patience with the bank teller and chews out the school crossing gurd. Moreove, she knows her behavior is irrational and hates herself for it. She probably feels guilty when her husband forms negative assessments of her, knowing that her behavior actually IS irrational. Today it's known that up to 60 percent of women suffer from PMS. The symptoms of PMS--which may include irritability, depressed mood, anxiety and mood swings, in addition to physical symptoms such as bloating and breast tenderness--are actually caused by neurotransmitter changes in the brain. These changes are triggered by the drop in estrogen that occurs after a woman ovulates. Lowered estrogen causes mood-altering serotonin levels to drop, too, and that's where the trouble begins. "Hormones are, by definition, substances that act as messengers at target organs", doctors Severino and Moline wrote in their 1989 book, Premenstrual Syndrome. In this syndrome the "target organs" are the brain, breasts, and uterus, with secondary effects occurring at the thyroid and the adrenal cortex. The regulation of menstrual hormones involves complext interactions among brain neurotransmitters, pituitary hormones, and ovarian hormones. Thus, it isn't simply the woman's ovaries that cause her premenstrual difficulties. Her serotonin, dopamine, and norepineprhine are part of the action as well. Somehow, the ovarian hormones interact with the brain's neurotransmitters and the end result is a definite shift in mood. What isn't known is HOW changing levels of ovarian hormones influence a woman's neurons to release neurotransmitters. When this is understood we'll have a better idea of why Betty binges through her periods and Helen finds that she becomes moody and irritated. Why is one woman beleaguered with PMS only a week out of every month and another three weeks? Why do some experience a mild feeling of being in the dumps and others have severe, life-disrupting mood drops? And why do some swing through the whole cydcle, as a minority do, as free and easy as a woman in a Maxithin commercial? One theory is that women who have low serotonin levels to begin with are likely to have their serotonin drop below a tolearble level when their estrogen declines The first research relating PMS symptoms to serotonin deficiencies appeared in the late eighties. Two studies found that in the week before menstruation women with PMS had lower levels of serotonin. Another study found that women with PMS had lower serotonin before the period but not after, and that they were lower than were the serotonin levels in women who don't get PMS. The most recent research on treating PMS was done by Virginia Commonwealth University researchers and reported in the October 2006 issue of the Journal of Clinical Psychiatry. This study is the first one to evaluate the use of low-dose antidepressant medication for women who have moderate-to-severe PMS. It is also the the first placebo-controlled study to include the novel treatment strategy of ’symptom-onset dosing,’ according to Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU’s School of Medicine and the study's lead author. “Our findings suggest that women with less severe forms of PMS...may also benefit from treatment with antidepressant medication, and they may be able to take medication only on the days that they are symptomatic,” Kornstein said. In her study, sertraline taken for two weeks before the onset of menstruation was found to be effective and well-tolerated. The study also found that two other dosing strategies are effective. One involves taking anti-depressant medication daily throughout the menstrual cycle. The other--known as ’symptom-onset’ dosing--requires taking medication only when PMS symptoms begin. This last was a surprising finding since it usually takes 2 to 3 weeks for an antidepressant to build up in the blood stream. The fact that the medication works virtually immediately when used to treat PMS suggests that PMS is a distinct disorder from depression and its treatment involves different brain pathways. Though physical in origin, the mood shifts and sometimes extreme behaviors many women experience, premenstrually, may benefit from a psychiatrist's help. He or she is more experienced at prescribing medication and proper dosing for the treatment of PMS than an OB/GYN or family practioner. Women struggling with the effects of PMS can also be helped by working with a psychotherapist. I have found that women who've experienced PMS on a more or less regular basis often experience lowered self esteem. Almost invariably their relationships are affected. Self image tends to be altered by the once-a-month downturn in self esteem and the consequent relationship difficulties. All of this can be effectively addressed by someone who understands both the physical and emotionalcomponents of PMS. * * *
Colette received her MSW degree at The Smith College School for Social Work. Following graduate school she did four years of advanced training at The Institute for Contemporary Psychotherapy, in New York. Ms. Dowling has a private therapy practice in Manhattan and specializes in the treatment of women and couples. For further information, or to arrange a consultation, call Colette at 718-594-0201, or write dowlingcolette@earthlink.net To hear Colette speaking about what it's like starting therapy with someone new, click the audio button.
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An extensive discussion of women's hormonally induced mood disorders can be found in the Colette Dowling's book, "You Mean I Don't have to Feel This Way?": New Help for Depression, Anxiety and Addiction.
