Premenstrual Dysphoric Disorder and Prozac

[assister49]

For the better part of the last year, I have been experiencing mood swings – from feeling normal to being depressed – crying and being extremely emotional. I have been behaving in ways uncharacteristic of myself within my relationship to SO (e.g. jealous, suspicious, anxious, irrational worries, etc.) and have been experiencing feelings of unimportance (having no purpose) and low self-worth. I also noticed that these feelings/moods follow my menstrual cycle and of course, affect my sex drive. About a week or two before my period, my mood slides down and the behaviors and feelings start, and my sex drive decreases. Then after my period ends I go back up and experience a couple weeks or so of feeling great (normal) and have great sex and feel confident and secure in my relationship, don’t behave obsessively – generally back to myself.

I finally went to my Dr. today and she diagnosed me with Premenstrual Dysphoric Disorder, which is basically PMS, or a form of it. She said this is typical for the years prior to menopause, and then she prescribed Prozac (20mg) to be taken daily only during the couple weeks when I am down and not during the rest of the month.

I have not had a problem (that I noticed) with PMS in my younger years, but now that I am looking closer to the big 50, things are getting worse. I have never had depression before (except situational during my divorce 5 yr back) and have never taken any antidepressants – and frankly it scares me to take this medicine.

Has anyone had any experience with this therapy for PMS or PMDD before? I looked on the net and it seems to be common (although I have not found anything for the on again – off again regiment, only the daily dose).

Thanks in advance for your help!

 

[trinityjons]

But it takes Prozac and other SSRI's a few weeks to even kick in. So if you started the medication the first day you felt bad, you would be through your rough patch before it started working. Do some more reading on Prozac in general. This dosing regimen doesn't make sense to me based on what I know, but I am not a physician.

 

[entitled]

i'm with trinity on this one. That dosing of Prozac just doesn't work - or at least it didn't for me.

i was diagnosed with PMDD as well after having a tubal done. (The doc that performed the surgery didn't do it right - which is fairly common - and basically sent me spiralling into premenopause. That caused the symptoms to start.) i've suffered from PMS since reaching puberty, so already knew some of the tricks to deal with it. Even these on top of the funky antidepressant dosing didn't work.

One option is to talk to your doctor about taking the full dose during the worst part of the cycle, and a lesser dose during the 'normal' period. That way the drug is still in your body and will work better when needed. That helped me for a while. Then I started having side effects from the drugs. My body usually doesn't react to medications normally so this was no surprise.

Another option is to turn toward herbal remedies. I'm taking different herbs now instead of the chemical pills and for the most part they've been working. There's still a mood change and people still avoid me for a time but it's not nearly as bad as not having anything.

 

[Cathleen]

I agree with the others, SSRIs can take a few weeks to reach efficacy levels. I did a 'google' on the half life of prozac and found this:

The liver breaks down Prozac. Each
individual’s ability to break down the medication is
different. On average, Prozac has a half-life (time it
takes to eliminate one half of the drug from the body)
of two to three days, but may be found in your system
for several weeks after you stop taking it. Studies have
shown that the levels are fairly low after one to two
weeks. An active metabolite of Prozac called
norfluoxetine has a half-life of seven to sixteen days,
but can remain in the body for a much longer time
period. Please talk to your doctor before you stop
taking Prozac. The benefits of taking the medication
for your specific situation, and any possible adverse
outcomes of not taking it, should be discussed with
your doctor.


I have a book written by Dr. Christane Northrup called
Woman's Bodies, Women's Wisdom. It is like a tool box of information about our bodies. You might want to check it out at the library, when I did I knew I had to buy a copy. I will look through and see if there might be something more specific, but she has huge amounts of information on the subject of perimenopause and menopause (the book is about 800 pages!).

I can relate to some of what youdescribe - it sure is another interesting time in a woman's life!

 

[ReadyOne]

1. The half-life of Prozac increases with the duration of treatment. Apparently it affects the metabolic path to progressively prolong its metabolization. Initial doses have half-lives of 1-3 days, long term use can change them to 4-16 days.

2. The studies show the "two weeks before the period" thing works (at least for some). http://www.fda.gov/bbs/topics/ANSWERS/ANS01024.html
and http://pi.lilly.com/us/sarafem.pdf

3. The mechanism of action in chronic depression seems to be different than for PDD. Long term depression wants long term change in brain chemistry.

For the short term (cyclic) depression of PDD, it may be enough to just nudge the chemistry a bit at one point in the PDD cycle. It may be the delta (change) in serotonin that has a temporary effect, and that a temporary effect is all that is required to affect the PDD cycle, since PDD its not a steady state as in CD.

And it may be that after a few months of regime, the residual levels of fluoxetine make the (temporary) effect easier to produce. Therefore, I'd go a few months before I abandoned the therapy if it doesn't seem to be working.

Then again, residuals may not accumulate as fast with the 2 weeks on 2 weeks off dosing if the two weeks off is enough to keep the extended half-life from developing.

 

[ksmybuttons]

Poof!

 

[assister49]

I've been using a progesterone cream for the past couple of years as I figure I'm perimenopausal. It has really helped with the ups and downs.

The husband says it helps and he's really the one who knows.

I have heard of pills and patches, but not creams. Where to you apply it? Is it a daily thing?

A.

 

[Guest]

I haven't heard of Prozac being used for this in this manner, only Effexor and Wellbutrin for the SSRI's. Otherwise, Risperdal and Seroquel.

However, the basic principle is sound, despite the lag time of SSRI's and other psychotropic meds to take effect.

Don't be put off by the fact of taking meds.

 

[Vixandra]

Spend 1 1/2 years working with a doctor in a Family Practice clinic and saw a lot of women be perscribed anti-depressants for PMS meds and it helped the majority of them alot.

And some people respond very well to PRN (as needed) medications.
After a hellacious fall/winter of work and my BCP's throwing me all out of wack, it took me going on Zoloft to balance things back out again (though it was the third med my dr tried). Was on a rather high dose to start with then slowly backed it down and was eventually using it as I needed it. If I was quick on the anger trigger that day or could feel I was going to be I took one, if I knew I'd be okay, I'd not.

Talk with your dr- if you're uncomfortable with the Prozac then let her/him know and see what else you can do to. They should be more then happy to help you find something else.
I would say to try the Prozac first- if it doesn't help after two months go in for a change of meds. But give it a try first, lots of women have been helped by it.

 

[ksmybuttons]

Poof!