QUESTION:
Dear Dr. Heller,
I have suffered from PMDD for about 17 years now and I really hope that Zoloft can help. I have previously been prescribed Prozac, Seroxat (Paxil) and venlafaxine (Effexor) by doctors for general depression but have been unable to tolerate any of them. However, I certainly noticed an improvement in the PMDD, and having read up about SSRI's can see why this may be the answer I am looking for. When I see my psychiatrist in January I am going to ask him to prescribe me Zoloft. In the meantime can you point me in the direction of any research on treatment of PMDD with Zoloft. Also I am very keen to understand how an SSRI might help PMS - would Zoloft actually affect the levels of estrogen and progesterone in the body, and are the chemical pathways related in any way.
Thank you for any help you can give me. I have lost half my life to depression and I really, really hope that Zoloft may be the 'miracle cure' for me.
ANSWER:
Prozac is the only medication "approved" by the US FDA for treatment of
premenstrual dysphoric disorder - PMDD. It's marketed as "Sarafem."
SSRI medications like Prozac and Zoloft affect the serotonin system, not the hormone
systems.
I believe PMS is a fluid retention disorder that aggravates any underlying psychiatric
problems that may be present. When these psychiatric problems are aggravated by PMS, and
the individual would have responded to an SSRI, using the SSRI makes a huge difference.
SSRI medications like Prozac and Zoloft do not help a high percentage of women with PMDD.
I go into this concept at length in "Biological Unhappiness." Virtually all
women with PMDD or severe PMS can get profound relief by treating the underlying
psychiatric diagnoses and the fluid retention. Here is the
screening
test I use for these underlying diagnoses.