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Whether you’re struggling with a depressed mood or have been diagnosed with a panic disorder or anxiety disorder, there’s a good chance you’ve been prescribed Prozac®. Prozac is one of the most widely-used prescription medications in the United States, with tens of millions of prescriptions written every year. But Prozac isn’t just for treating depression or panic disorder — Prozac for PMDD is also a treatment option.
PMDD is short for premenstrual dysphoric disorder, a combination of emotional and physical symptoms that are more debilitating than everyday menstrual cycle symptoms.
Premenstrual symptoms are a common problem for women, with up to 90 percent of women of reproductive age in the U.S. having discomfort before their period, also known as the premenstrual period.
Premenstrual dysphoric disorder also affects many women of reproductive age — including their ability to function in their daily lives.
But does Prozac for PMDD work?
Prozac, a brand name for the medication fluoxetine, is one of the most commonly prescribed drugs to treat major depressive disorder.
Prozac may also be used on- or off-label as a medication to treat anxiety, panic disorder, obsessive-compulsive disorder (OCD), body dysmorphic disorder, dysthymia, post-traumatic stress disorder (PTSD), certain eating disorders (like bulimia) or premenstrual dysphoric disorder.
Learn more in our blog on Prozac for Anxiety.
Prozac belongs to a class of drugs called selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors, or SSRIs, work to prevent the reabsorption of the neurotransmitter serotonin, which helps modify the levels in your brain.
This increase in serotonin helps improve your mood and treat symptoms of depression, panic disorder and other disorders.
Prozac can cause a range of side effects, as is the case with any medication.
These side effects can include:
Feeling nervous or restless
Having trouble sleeping (or insomnia)
These common side effects tend to be mild and usually improve or go away completely within the first few weeks after starting the medication.
More serious effects can come from taking Prozac, although these are rare. These adverse effects include low sodium blood levels, teeth grinding, serotonin syndrome and seizures.
Prozac also comes with an increased risk of suicidal thoughts or behavior, especially if you have a history of suicidal thoughts due to depression or mood disorders.
If you are concerned about either the common side effects or more adverse effects, talk to your healthcare provider before taking Prozac to treat a depressed mood.
Prozac dosage will vary based on what your healthcare provider believes is the proper treatment for you and your symptoms. Typically, an initial dosage will be around 20mg a day, with a maximum of 80mg a day prescribed.
Monoamine oxidase inhibitors (MAOIs), another type of depression medication that includes phenelzine, isocarboxazid, tranylcypromine, selegiline and others interact negatively with Prozac. You should not take Prozac if you’ve taken a monoamine oxidase inhibitor in the last two weeks.
You can learn more about how fluoxetine and Prozac work, risks and more in our complete guide to fluoxetine.
Premenstrual dysphoric disorder (PMDD) is a more severe, oftentimes debilitating form of premenstrual syndrome (more commonly known as PMS).
PMDD can affect up to eight percent of women of childbearing age, generally between the ages of 16 and 49 years old.
PMDD is characterized by both emotional and physical symptoms that start the week before your period, typically within seven to 10 days.
Emotional symptoms of PMDD include:
Nervousness or agitation
Feeling out of control
Loss of interest in activities
Thoughts of suicide
The physical symptoms may include:
Swelling or tenderness of the breasts
Gastrointestinal issues like nausea, vomiting or constipation
Reduced sex drive
While both the emotional and physical symptoms of PMDD may be similar to those of PMS or your period, it should be noted that the symptoms of PMDD are much more severe and debilitating. These symptoms can affect your ability to function in your work, relationships and daily life.
PMDD can also cause severe anxiety, mood changes and depression.
Some people may experience more emotional symptoms than physical symptoms, or vice versa.
You may be more prone to PMDD if you have anxiety, depression, PMS or a family history of PMS, PMDD or mood disorders.
Although a severe and chronic condition, the exact cause of PMDD is unknown. However, many believe it is a response to hormone levels changing during your period.
Throughout a regular menstrual cycle, levels of the hormones estrogen and progesterone, produced by the ovaries, rise and fall.
PMDD is believed to be caused by these fluctuations as the hormones interact with certain brain chemicals and can affect mood. Specifically, estrogen and progesterone interact with the neurotransmitters dopamine and serotonin — the “feel good” chemicals that play a role in mood and mood disorders.
PMDD symptoms start during the luteal phase, which is between ovulation (the ovary releasing a mature egg) and the first day of bleeding. If you are not pregnant, your body’s levels of estrogen and progesterone decrease and symptoms of PMS may kick in.
At ovulation, the ovaries begin to increase progesterone. It is then converted into allopregnanolone (ALLO), which continues to rise along with progesterone until your period starts, at which point they rapidly drop.
ALLO interacts with GABA receptors in parts of the brain that control anxiety, agitation and irritability. Women with PMDD appear to have an abnormal reaction to ALLO, which typically has a calming effect.
After ovulation, estrogen levels drop. Estrogen has been known to interact with several brain chemicals that can affect mood and aspects of behavior, in particular, serotonin.
Serotonin regulates your mood, sleep and appetite as well as how you acquire, process and perceive information. Women with PMDD have clinically shown to have low moods, crave specific foods and show impaired cognitive performance during their luteal phase, signaling they may be experiencing an exaggerated drop in serotonin.
Women with PMDD almost always have normal hormonal levels, indicating that this condition isn’t necessarily caused by a hormonal imbalance.
Researchers at the National Institutes of Health discovered that people with PMDD have genetic changes that make their cells overreact to estrogen and progesterone, which may be responsible for PMDD symptoms.
Your healthcare provider will consider a PMDD diagnosis if you experience at least five of the following symptoms, beginning seven to ten days before your period:
Marked irritability or anger
Anxiety or tension
Reduced interest in friends, work and other activities
Fatigue or lack of energy
Sleeping too much or having trouble sleeping
Feeling out of control
Physical symptoms, such as bloating, breast tenderness, joint or muscle pain and headache
There’s a better chance of diagnosing premenstrual dysphoric disorder after at least two menstrual cycles have been completed to better track the symptoms of PMDD and rule out other diagnoses.
Because of the connection between serotonin and PMDD symptoms, SSRIs are the top medication prescribed to treat premenstrual dysphoric disorder.
Reviews of randomized clinical trials showed that antidepressants that slow down the reuptake of serotonin were effective in treating PMDD in both long-term uses and use only during the luteal phase of the menstrual cycle.
Fluoxetine for PMDD is especially effective. A large clinical trial found that a daily dose of 20mg of fluoxetine throughout two menstrual cycles was efficient in reducing tension, irritability and unease or dissatisfaction.
Currently, fluoxetine is one of three SSRIs approved by the Food and Drug Administration (FDA) to treat PMDD.
If you suffer from physical or emotional symptoms and fit the criteria for diagnosis, a healthcare professional may prescribe Prozac for PMDD.
Lower doses of 10mg a day of Prozac for PMDD (fluoxetine) have been found to alleviate the symptoms quicker than those dosages for depression, meaning that women may not have to take the drugs every day as they would for treating depression.
Dosage amount, as well as frequency, will vary by each person and their unique symptoms and diagnosis.
Although there isn’t sufficient data to determine how long Prozac for PMDD would need to be used, preliminary studies of fluoxetine suggest that treatment is continuous.
While SSRIs like Prozac are often the top treatment for PMDD, there are other treatment options.
You may not be prescribed Prozac for PMDD if you are allergic to fluoxetine, have suicidal thoughts or behavior, have taken an MAOI in the past 14 days, have diabetes, are breastfeeding or take it to treat bipolar disorder on its own.
PMDD symptoms typically begin at ovulation. Hormonal medications like birth control prevent ovulation from happening and may help stop PMDD symptoms.
Some hormonal medications include:
Birth control pills. Hormonal birth control pills can help reduce PMDD symptoms in some while making symptoms worse in others. Birth control pills containing drospirenone are approved by the FDA for PMDD treatment but healthcare professionals can prescribe other birth control pills “off-label”. Your healthcare provider might advise you to take an active pill every day to prevent you from having a period. Birth control pills may not be a safe option if you’re over the age of 35 and have certain medical conditions. They also may not be safe to use if you smoke.
Gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists, such as leuprolide, stop your ovaries from producing estrogen and progesterone. While this can be a huge help for PMDD symptoms, it also temporarily puts you into menopause, which can cause PMDD-like symptoms, including anxiety, depression and trouble concentrating.
Prozac isn’t the only depression and anxiety medication that can treat PMDD.
Other SSRIs and antidepressants that may be prescribed include:
paroxetine (Paxil®, Pexeva)
While other antidepressants are also effective, not as much research has been done to say anything definitively.
You can schedule an online evaluation through Hers’ online services to figure out if medication is the right treatment option for you.
Making a few adjustments to everyday life can have positive impacts for some:
Exercise. Getting aerobic exercise in every day, like walking, running, swimming or biking, can improve mood and energy levels.
Stress relief. Keeping your stress levels in check is always good for your health. While you may not be able to avoid it completely, keeping your main stressors in check or taking up mindfulness meditation can certainly help manage stress levels.
Supplements. Some supplements including vitamin B6, calcium, magnesium supplements and herbal remedies have all been studied for use in PMDD and could prove beneficial.
Talking with a therapist could help you manage the emotional challenges that come with PMDD. Cognitive-behavioral therapy (CBT) works to help you develop new behaviors and thought patterns.
Research has also shown that CBT helped with the long-term treatment of PMDD and its symptoms in clinical studies.
If you’ve been struggling with anxiety disorders, panic disorder, bipolar disorder or the symptoms of depression (a depressed mood, feeling worthless or hopeless, loss of interest in your usual activities and more), your healthcare provider may prescribe Prozac.
But if you’re also struggling with or have many of the symptoms of PMDD, your healthcare provider may prescribe Prozac.
PMDD is generally described as more severe and debilitating premenstrual symptoms. Symptoms of PMDD can include, but are certainly not limited to, mood swings, depressed mood, anxiety, feeling hopeless, physical symptoms such as headache, bloating, joint or muscle pain and more.
SSRIs like Prozac are typically used to treat PMDD, possibly in conjunction with lifestyle changes and therapy.
Living with PMDD can be overwhelming and significantly impact your everyday life. While there’s no single treatment for PMDD, a combination of approaches can help you manage the symptoms and get back to your life.
Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.
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