BetheChange Fluoxetine for premenstrual dysphoric disorder or PMDD

[BetheChange]

I found this forum via a Psychology Today article that discussed serotonin withdrawal syndrome.

 

I am hoping to find alternative/complementary/holistic methods to cope w/ Premenstrual dysphoric disorder or PMDD (although my mood changes usually occur during my cycle) that I have been experiencing off and on for a couple of years now. I am in my early 40s and know my hormones are changing and I am experiencing more extreme mood changes such as lethargy, fatigue, irritability, anti-social and I don't like how that has felt. I have always had some PMS but the PMDD is new to me.

 

I decided to give fluoxetine 20 mg a try as it can be given intermittently for day 14-28 of cycle and I must say my mood, energy and body aches did improve; however, I have gone throuh 3 cycles now and have experienced a "cold-virus" a day or two after finishing the pills. At first I thought it was just a cold but then I had it again and now again. I am now thinking it is W/D each time my body adjust to being w/out the drug.

 

Symptoms: starts w/ scratchy throat, some congestion, body aches esp joints, sweats, extreme fatigue, headachy, dizziness (at beginning), irritable, anti social...

 

I don't plan to continue because even after a very short experience w/ this drug I am flabbergasted by the effects it has and they outweigh the benefits for me.

 

(as an aside: I also have monthly migraines associated w/ cycle and I usually can halt w/ sumatriptan.)

 

I think more frequent exercise and also some better nutritional support is going to be for me to deal w/ this more holistically. I also wonder if St. John's tincture would be helpful.

 

Suggestions are welcome.

All the best to all of you. I hope you all find a solutions to your unique situations.

[strawberry17]

I'm glad you've decided not to continue with the fluoxetine, as someone who has been struggling to taper off it for years, I just do not understand why it would be prescribed for PMDD and taken for just a few days each cycle, maybe I'm missing something

 

I think you're definately doing the sensible thing and I wish you sucess! I have heard good reports of St Johns Wort (although don't take it if you use the contraceptive pill as it interferes with that) but both my husband and a friend have in the past got on with SJW, don't however take it at the same time as fluoxetine and also might be worth waiting a couple of weeks since your last Fluox tablet before taking SJW as fluoxetine takes longer to wash out of the body than other antidepressants.

[BetheChange]

Thank you for your thoughtful reply. I think the blessing in diguise is that I was on it intermittently and could experience the adverse effects it was having sooner than later. The first two times I thought I was just having bad luck w/ catching colds but now I think it is W/D. My last dose was last Tuesday and I started feeling a "cold" coming on late Thurs and definitely Friday....had sweats again this morning (Monday) and also slight cough from some congestion...it really does feel like a cold but three months in a row around the same exact time it too much of a coincidence. I called my doc today and told her I will not continue on this med.

 

Thanks for the words about St. Johns. I am definitely going to investigate that. I know it takes longer for those types of remedies to "work" but know I will not have to cope w/ very unpleasant side effects.

 

One of the reasons it is given it intermittently is that it does take longer to leave the system and the thinking is that it will prevent W/D because your system can adjust itself....but I am not sure if some people would be more sensitive to W/D and I am one of them.

 

All the best to you.

 

Just fyi, below are some references (but not that many) that show that intermittent use can be helpful and usually side effects are few. It sounded like a good idea to me but now I know better....at least for myself.

 

Recurrence of symptoms of premenstrual dysphoric disorder after the cessation of luteal-phase fluoxetine treatment.

Pearlstein T. Joliat MJ. Brown EB. Miner CM.

American Journal of Obstetrics & Gynecology. 188(4):887-95, 2003 Apr.

Current subscription at Christiana Hospital Library; Check TDNet for holdings: http://www.tdnet.com/cchs

OBJECTIVE: The aim of this study was to use the data from two clinical trials to evaluate premenstrual dysphoric

disorder symptom severity after the discontinuation of fluoxetine treatment.

STUDY DESIGN: A retrospective analysis of two clinical trials was performed. Patients were treated with fluoxetine or

placebo for three cycles, with the use of several different dosing regimens, followed by single blind placebo treatment

for one cycle. Assessments of relapse included the daily record of severity of problems, the Sheehan disability scale,

the premenstrual tension scale-clinician rated, and the clinical global impressions-severity.

RESULTS: Premenstrual dysphoric disorder symptoms significantly increased after fluoxetine discontinuation. The scores

did not return to baseline; however, the fluoxetine group was no longer significantly superior to placebo.

CONCLUSION: The two trials demonstrate that, after three cycles of treatment, premenstrual dysphoric disorder symptoms

recur within the first cycle after treatment discontinuation. The rapid recurrence of symptoms further supports the view

of premenstrual dysphoric disorder as a clinical entity distinct from depression.

Status

 

Review of fluoxetine and its clinical applications in premenstrual dysphoric disorder. [Review] [121 refs]

Pearlstein T. Yonkers KA.

Expert Opinion on Pharmacotherapy. 3(7):979-91, 2002 Jul.

The largest number of antidepressant treatment trials in premenstrual syndrome and premenstrual dysphoric disorder

(PMDD) have been conducted with fluoxetine. Fluoxetine and other selective serotonin re-uptake inhibitors (SSRIs)

clearly reduce premenstrual emotional and physical symptoms and improve premenstrual psychosocial functioning.

Fluoxetine was the first SSRI to be approved by the FDA as a treatment for the emotional and physical symptoms of PMDD.

Fluoxetine 20 mg has been reported to be effective for emotional and physical premenstrual symptoms with continuous

daily dosing (every day of the menstrual cycle) and with luteal phase daily dosing (from ovulation to menses). In

addition, premenstrual emotional symptoms have been reported to improve with fluoxetine 10 mg in luteal phase daily

dosing and with 90 mg 2 and 1 weeks prior to menses. Fluoxetine is generally a well-tolerated treatment for PMDD and

discontinuation effects have not been reported with intermittent dosing regimens. [References: 121]

 

Weekly luteal-phase dosing with enteric-coated fluoxetine 90 mg in premenstrual dysphoric disorder: a randomized,

double-blind, placebo-controlled clinical trial.

Miner C. Brown E. McCray S. Gonzales J. Wohlreich M.

Clinical Therapeutics. 24(3):417-33, 2002 Mar.

[Clinical Trial. Journal Article. Multicenter Study. Randomized Controlled Trial]

UI: 11952025

BACKGROUND: Because the symptoms of premenstrual dysphoric disorder (PMDD) are limited to the luteal phase of the

menstrual cycle, the potential benefit of luteal-phase dosing has been hypothesized.

OBJECTIVE: This multicenter, randomized, double-blind, placebo-controlled, parallel-group trial evaluated the efficacy

and tolerability of enteric-coated fluoxetine 90 mg given once or twice during the luteal phase for the treatment of

PMDD.

METHODS: Study drug was given 14 and 7 days before expected menses during the luteal phase of 3 menstrual cycles. After

a screening period and single-blind placebo lead-in period, eligible women were randomized to I of 3 treatment groups:

enteric-coated fluoxetine 90 mg on both days (LPWDx2); placebo 14 days before menses and enteric-coated fluoxetine 90 mg

7 days before menses (LPWDx1); or placebo on both days (PLC). The primary efficacy measure was change from baseline in

mean luteal-phase scores on the Daily Record of Severity of Problems (DRSP). Secondary efficacy measures included scores

on the Rating Scale for Premenstrual Tension Syndrome, Clinician-Rated (PMTS-C); the Clinical Global Impression

(CGI)-Severity scale; and the Patient Global Impression (PGI)-Improvement scale. Quality of life was assessed using the

Sheehan Disability Scale.

RESULTS: Two hundred fifty-seven women were randomized to treatment. At the end of the study, the LPWDx2 group had

statistically significant improvements in DRSP total, DRSP mood subtotal, DRSP social functioning subtotal, PMTS-C,

CGI-Severity, PGI-Improvement, and Sheehan Disability Scale work and family life scores compared with LPWDx1 and PLC

(each measure, P < 0.05). There was also a statistically significant improvement in the score on the social life section

of the Sheehan Disability Scale with LPWDx2 compared with PLC (P = 0.037). Across all treatment groups, 5 patients

discontinued due to nonserious adverse events. Rates of discontinuation for any reason did not differ between the 3

treatment groups.

CONCLUSION: The findings of this study support the efficacy and tolerability of enteric-coated fluoxetine 90 mg given

twice during the luteal phase of the menstrual cycle for the treatment of PMDD.

 

Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria.

Steiner M. Korzekwa M. Lamont J. Wilkins A.

Psychopharmacology Bulletin. 33(4):771-4, 1997.

Some women experience premenstrual mood symptoms that severely disrupt their lives and relationships. These women often

require pharmacologic treatment. Selective serotonin reuptake inhibitors, particularly daily fluoxetine, have been

proven superior to placebo in several randomized controlled trials. Twenty-four women with confirmed premenstrual

dysphoric disorder (PMDD) and with a history of affective disorders or alcoholism were treated with fluoxetine 20 mg/day

(continuous), and 24 women with PMDD and no psychiatric history were treated with fluoxetine 20 mg/day for 14 days

premenstrually only (intermittent). Both groups received treatment for three menstrual cycles. Sixteen women (66.7%) in

the continuous dosing group and 18 women (75.0%) in the intermittent group were classified as treatment responders.

Intermittent dosing of fluoxetine seems to be effective and mostly free of side effects in women with PMDD and,

therefore, may offer an attractive treatment option for a disorder that is itself intermittent.

[dalsaan]

Hi bethechange

 

Are you taking fish oil? That can also be very good. We have info on it in the symptom and self care forums

 

Dalsaan

[Altostrata]

Hello, BetheChange.

 

Prescribing antidepressants for PMDD might work for some people because antidepressants are hormonal disruptors. For some, the disruption -- which can cause sexual dysfunction, too -- seems to work.

 

For others, not so good. That you get withdrawal symptoms demonstrates this treatment is not for you. Each time you get withdrawal symptoms, you stress your nervous system. Eventually, this will make your life significantly worse.

 

Do try non-drug means to deal with your PMDD. There are many that do not have the risks of Prozac.

[Nadia]

Hello BetheChange,

 

Have you looked at the womentowomen.com site? You might find some better alternative therapies to balance your hormones there. I'm also in my early 40s and suspect some of my issues have to do with hormonal changes.

 

Certainly I would echo what others have said about not taking antidepressants for this... I think they don't get to the root of the problem and have the potential to create more problems than they solve.

 

Good luck to you!