NYC psychotherapist Colette Dowling, LCSW, author of the following article on Premenstrual PMS treatment has written 8 books on women's psychological issues, including "You Mean I Don't Have to Feel This Way?": New Help for Depression, Anxiety and Addiction, and The Cinderella Complex. Premenstrual PMS TreatmentColette Dowling, LCSWPremenstrual PMS treatment is the subject of the following article. Premenstrual mood changes, including depression, anxiety and irritability, are essentially a biochemical problem, not an emotional one; they result from the impact of reproductive hormones on the brain. When you experience symptoms during the week or so before your period, these represent a temporary chemical dysregulation in the limbic and prefrontal mood pathways caused by the normal fluctuations of hormones and peptides across the menstrual cycle. As Sichel and Driscoll write, in their excellent book, Women's Moods, many of the symptoms of Premenstrual Mood Change are exactly the same as those of other mood or anxiety disturbances. When you have Premenstrual Mood Change (popularly known as PMS), your brain is telling you that for some reason it is unable to maintain its usual chemical balance during the last week of the cycle. However, when your brain recovers its intrinsic regulating abilities within a day or two of menstruation--lo and behold!--the Premenstrual Mood Changes are gone and you feel well again! It's important to understand that these changes have nothing to do with you being good enough or strong enough. They are simply your brain alerting you to a chemical condition. Forunately prmenstrual PMS treatment is availble. Every woman who suffers from PMS 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. Irritability plagues her. She may fight with her husband, say terrible things to her children. She has no patience with the bank teller and chews out the school crossing guard. Moreove, she knows her irritabilty is irrational and hates herself for it. Today it's known that up to 60 percent of women suffer from Premenstrual Mood Changes. The symptoms of PMS--which may include depressed mood, anxiety and irritability, 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 by premenstrual mood changes 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 A study on Premenstrual PMS treatment was conducted by researchers at Virginia Commonwealth University. Published in 2006, this was the first study 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 of premenstrual PMS treatment, 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 Premenstrual Mood Change 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 Premenstrual Mood Changes 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 emotional components of PMS. * * *
See Colette's article on how to deal with premenstrual cravings. Colette Dowling, LCSW, received her MSW degree at The Smith College School for Social Work. Following graduate school she completed psychoanalytic training at The Institute for Contemporary Psychotherapy, in New York. Ms. Dowling is a licensed clinical social worker with a private therapy practice in Manhattan. She 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.
Click here to learn about Colette's psychotherapy practice.
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An extensive discussion of premenstrual PMS mood treatment can be found in Colette Dowling's book, "You Mean I Don't have to Feel This Way?": New Help for Depression, Anxiety and Addiction.