- The Washington Times - Sunday, November 19, 2000

Scores of women suffer the severe mood and physical symptoms of premenstrual dysphoric disorder (PMDD), the most severe form of premenstrual syndrome (PMS). Sarafem, a drug approved in July, finally may provide some relief.

Known scientifically as fluoxetine hydrochloride the same ingredient in the anti-depressant Prozac Sarafem is the only prescription medication available for PMDD. Eli Lilly and Co., the manufacturer of the drug, claims that women taking fluoxetine can expect to experience mood, physical and social im-provement by their first menstrual cycle after treatment begins.

Sixty percent to 70 percent of women in studies have responded well to the medication, says Jean Endicott, a clinical psychologist and director of the Premenstrual Evaluation Unit at New York's Columbia-Presbyterian Medical Center. Ms. Endicott was involved in preparing materials to submit to the Food and Drug Administration during the approval process. "It's worth a try for any woman who has well-diagnosed and -established PMDD," she says.

PMDD's cause is not known, but it may occur when normal cyclical changes in female hormones interact with neurotransmitters, including serotonin, resulting in the mood and physical symptoms that characterize the disorder, according to Lilly information. Although the precise way fluoxetine works to treat PMDD is not known, many doctors believe the ingredient helps restore the balance of serotonin.

Studies suggest that 3 percent to 8 percent of women who have regular menstrual cycles are affected by PMDD, Ms. Endicott explains, although some doctors are just beginning to recognize and treat the disorder.

Women manifest the disorder in a variety of ways, most commonly through a cluster of symptoms that appear regularly during the week before and disappear within a few days after the onset of menstruation, according to information from the New England Journal of Medicine. Symptoms include irritability, tension, a depressed mood, mood swings, decreased interest in usual activities, lethargy, insomnia, and breast tenderness and bloating. Symptoms are severe enough to interfere with daily activities.

"If a woman suspects she might have the condition, she should make daily ratings across a couple of cycles to see if it relates to her menstrual cycle," Ms. Endicott advises. "If if does, she should discuss it with her physician."

Ms. Endicott says that allowing PMDD to go unchecked can result in severe problems with interpersonal relationships. "We all see people who would benefit from this medication," she says. "We want to stress that we are talking about a mood disorder that causes significant psychosocial impairment. It is unfortunate that there are plenty of buttons and cards out there that make fun of PMS, but for [sufferers] and their families, it's really no joke."

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