Taking Control of PMS, PMDD and Depression (Tangee).ppt

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1. Taking Control of PMS, PMDD
and Depression
Gurjit Kaur, D.O.
April 24, 2004

2. What is PMS?

PMS (premenstrual syndrome) is a common
condition which can affect as many as 75% of
women with periods

Multiple physical and emotional symptoms which
occur ONLY in the 2 weeks before one’s period

Symptoms include anger, fatigue, bloating,
cramps, irritability, anxiety, breast tenderness,
changes in appetite or sleep or headaches

3. What is PMDD?

PMDD (premenstrual dysphoric disorder)

Severe form of PMS which occurs in 3-8% of
women in their late 20s to mid 30s (1 out of every
20 women)

The key difference between women PMS and
PMDD is that PMDD is more severe and serious
enough to interfere with a woman’s usual daily
activities and personal relationships

4. What causes PMDD?

Unknown cause

Fluctuating hormone levels before one’s
period affects the chemical balance in the
brain

Risk factors: stressful life changes, previous
history of mood disorders and family
history

5. What are symptoms of PMDD?
Feeling sad or tearful
Anxiety or irritability
Decreased interest in usual activities
Difficulty concentrating
Feeling tired or lacking energy
Sleeping too much or too little
Changes in appetite
Feeling overwhelmed
Physical symptoms

6. How is PMDD treated?

Diet and lifestyle changes (salt, sugar,
caffeine, dairy products and alcohol)

Counseling

Exercise

Yoga

Medications

7. Which medications are used most
often?

Selective serotonin reuptake inhibitors
(SSRIs)–first line (Zoloft, Sarafem, Paxil)

Anxiolytics

Diuretics

Oral contraceptives (Yasmin)

NSAIDs

8. What else can I do?

Calcium—1200 mg calcium reduces anxiety, fluid
retention, pain and food cravings

Magnesium—may be useful in decreasing fluid
retention
Vitamin B
6—may help with mood symptoms in
doses of 50-100 mg daily

Vitamin E—may relieve mood and physical
symptoms

9. What else can I do?

Evening primrose oil—may relieve breast
tenderness, irritability and ankle swelling

Chaste tree—decrease breast tenderness. Not safe
during pregnancy

Black cohosh—relieve anxiety and breast pain. ?
long term efficacy

Dong quai—No convincing trials. Not safe for
women on coumadin or contemplating pregnancy

10. What else can I do?

St. John’s Wort—may help with mood
symptoms

Acupuncture

Kava kava—not recommended due to liver
toxicity

11. Depression

Lifetime risk is 7-12% in men and 20-25%
in women

Recurrence rate of 40% after first episode
over 2 years; 75% after 2 episodes over 5
years

Health care provider for symptoms, exam
and lab testing

12. Treatment for Depression

Antidepressants

SSRIs—Prozac, Zoloft, Paxil (first line)

Tricyclics—Elavil

Wellbutrin

Effexor

Initial therapeutic response in 2-6 weeks

13. Treatment for Depression

St. John’s Wort

Wild yellow flower

St. John the Baptist

Effective for MILD
depression only

2-4 grams 3 times daily no
longer than 8 weeks

Decreases depression and
anxiety, improves sleep
and muscle pain

14. Treatment for Depression
Ginkgo biloba—thought to improve
memory; evidence conflictual
Exercise—Reduces stress and anxiety by
improving energy and sleep. Effective for
mild to moderate symptoms
Acupuncture—Chinese method of healing
by improving the flow of energy which is
useful for long term pain

15. Treatment for Depression

Reflexology—applied pressure to specific
points on the hands and feet

Meditation—form of relaxation to clear the
mind by focusing on one thought

16. Coping with Depression
Support and involvement of family and
friends
Educate yourself, family and friends about
mental health problems and depression
Recognize that depression can be expressed
as hostility and rejection
Seek professional aid (physician, therapist
and support groups

17. Summary

PMS is the more common condition, but
PMDD is more severe in its symptoms

Depression is a serious but treatable illness

Health care provider for diagnosis

Multiple treatment options for each of these
conditions involving lifestyle changes,
medications and counseling

18. Where can I get more
information?

Cleveland Clinic Disease Management
Project (www.clevelandclinicmeded.com)

National Institutes of Health (
www.nlm.nih.gov/medlineplus)

American College of Obstetricians and
Gynecology (www.acog.com)