PMS (Premenstrual Syndrome) is a condition characterized by unwanted symptoms such as mood swings, fatigue, food cravings, irritability, and depression. These symptoms tend to occur during the second half of a woman’s menstrual cycle and tend to subside approximately a couple days after the start of the menstrual period. As of now, these current symptoms are best managed through proper self-care.
Some women though, have a more difficult time handling their PMS than others. Fortunately, scientists are working on developing new treatments for those who have severe PMS. Recently, a group of international researchers have suggested that taking a low dose antidepressant, specifically with an SSRI, may prevent premenstrual symptoms (PMS) among women.
Research: Low Dose Antidepressants for PMS Prevention & Treatment
Scientists from the University of Bristol, University of Sao Paolo-Riberiaro Preto, and UCL used rodent models and found that SSRI antidepressants can inhibit certain enzymes in the brain. Their inhibiting effects on particular enzymes reduce the likelihood of PMS symptoms. It should be stated that this group of researchers believe that the culprit for PMS is related to a drop in the levels of progesterone, a hormone produced by the ovaries that functions as a sex steroid.
When a woman fails to produce adequate amounts of progesterone, it affects levels of allopregnanolone, a calming steroid that is derived from progesterone breakdown. When these levels dramatically drop, the body recognizes an imbalance in steroid production and a woman experiences “PMS” which could technically be considered a natural withdrawal from progesterone. It is certainly possible that the level of allopregnanolone would then lead to increased anxiety and irritability.
- Source: http://www.europeanneuropsychopharmacology.com/article/S0924-977X(14)00328-9/abstract?cc=y
- Source: http://onlinelibrary.wiley.com/doi/10.1111/bph.12891/abstract;jsessionid=8B774421820B167FB09B37A5EC12EC38.f03t04
How researchers will use Antidepressants to Prevent PMS
Researchers suggest that they could target PMS with intermittent treatment from an SSRI medication. A lead researcher from the University of Bristol was quoted as saying, “The work is important because it introduces the possibility for targeted, intermittent therapy for PMS with minimal side effects.” They primarily plan on using a “low dose” of antidepressants for a short duration or just during the timeframe in which PMS symptoms would be likely to occur.
- Low dose: It is unclear as to the particular dosage they will suggest. The “low dose” may be even lower than a “starting dose” but this was not mentioned. We will find more information as researchers reveal more regarding human trials. If I were to make a suggestion to these researchers, I would find the lowest possible dose that normalizes progesterone levels. Even if this means taking the lowest available dose and cutting the pill into fourths.
- Short-duration: They plan on giving someone an antidepressant medication for a couple of weeks (or slightly longer) just to manage the PMS. In other words, a person will not need to stay on the drug for years or even months. Rather they will use it just for the time-window in which they expect their PMS to occur.
It is important to note that the only studies these researchers have published currently involve rats. This does not mean that the treatment will have the same response among humans. To better understand whether antidepressants improve PMS in humans, the team will be conducting human clinical trials in Brazil.
Potential problems of using antidepressants for PMS
There are several problems associated with utilizing an antidepressant solely to target PMS. Although it may work well for certain individuals, for others using this type of treatment may be more detrimental than beneficial.
- Choosing the antidepressant: It is difficult to determine which antidepressant to use. Some drugs like Pristiq only have one dose and the lowest dose is actually pretty “high” and potent. Other medications have low dose formulations, but even at their lowest dose, the formulation may be too potent for the individual. Therefore individuals may need to cut their pills and/or encourage drug companies to make especially low doses solely for the treatment of PMS.
- Differing reactions: It is important to recognize that not everyone will benefit from taking an antidepressant. Additionally, it can be difficult to determine which antidepressant would be most universally beneficial since everyone has different biochemistry and thus will have different reactions. A drug may help with PMS, but may make some people feel increasingly depressed or moody as a result of serotonergic alterations.
- Dosing: It is difficult to determine what effective doses will be for certain drugs. A low dose of one drug may be significantly more potent than a low dose for another. Additionally there are many individual factors that come into play when determining what is a low dose or a high dose. Someone who’s in good shape with a low weight may feel the effects of a “low dose” whereas someone who is overweight may barely notice anything when they take the same dose. It will be a challenge to configure proper dosing for PMS.
- Side effects: Even at low doses, people need to be aware of antidepressant side effects. These can include weight gain, sexual dysfunction, dizziness, nausea, appetite changes, etc. Although lower dosing will certainly help reduce the likelihood that side effects are severe, many people will likely report experiencing unwanted side effects. It should also be mentioned that many antidepressants cause depression and suicidality, possibly making a person feel worse.
- Withdrawal symptoms: Researchers suggest that they will use an “intermittent” treatment for PMS with antidepressants. If a person continuously cycles on and then cycles off of an antidepressant, they are likely to experience withdrawal symptoms. Although the duration of treatment would only be short-term at a low dose, withdrawal symptoms will still be something to consider. Constantly altering serotonergic functions to treat PMS seems like a person will constantly be playing neurochemical roulette. (Read: Antidepressant Roulette).
Suggestion: Target Progesterone without an Antidepressant
Despite the fact that these researchers know antidepressants can improve symptoms of PMS by altering ovarian steroid levels, it doesn’t mean that they are going to be the best treatment option. Certainly it’s easier to use an existing treatment that is already established as being “safe,” but why not specifically target the progesterone? Companies that make antidepressants are already pushing their drugs through clinical trials to treat PMS.
Although some work, most end up doing more harm than good. If pharmaceutical companies made an especially low dose for PMS, they’d certainly be on a better track. However, why don’t they simply come up with a better treatment that targets ovarian steroid levels for a couple weeks so the women don’t experience any PMS? There are likely much better options that could be developed as short-term treatments than antidepressants.
Antidepressants are not some drug that a person should take for a short-term condition like PMS. They are able to change the brain within 3 hours of the first dose, are associated with wicked discontinuation symptoms, and can have significant unwanted side effects. From a hypothetical standpoint, if I was a woman, no matter how bad my PMS, there’s no way I’d take an antidepressant to treat it; the risks outweigh any short-term benefit.
Have you noticed improvements in PMS while on antidepressants?
If you have been taking antidepressants, have you noticed less PMS symptoms? It would be interesting to conduct a study on women already taking antidepressants to determine whether it helps their PMS symptoms. Since we know that PMS is likely influenced by ovarian steroid levels, it would also be interesting to test these levels in women taking an antidepressant vs. unmedicated women.
It is important to also not rule out the fact that antidepressants may be helping PMS symptoms by boosting levels of serotonin. In some people, elevating serotonin levels can produce an antidepressant effect and/or artificially-induced neurochemical mood boost. Although SSRIs aren’t addictive, they are artificially altering neurotransmitter levels in attempt to make people “happier.”
Therefore one could argue that the reduction in PMS from antidepressants is a result of their antidepressant effect rather than their ability to improve progesterone levels. If you are taking antidepressants, feel free to share whether you’ve experienced more, less, or no changes in your PMS symptoms.