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Taking Control of PMS, PMDD and Depression

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

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Taking Control of PMS, PMDD and Depression

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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 B6—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)

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