Sarafem and non-medication PMDD mood remedies.
April 17, 2013 3:04 PM   Subscribe

It seems I have PMDD. My doctor just prescribed Sarafem for this without offering any other options. Is there anything else I can try first, or should I just go for the medication because it might not be bad?

32 year-old woman here. I never used to experience PMS, but over the last few years, it has crept up on me. The symptoms are now unbearable every month. For about a week leading up to my period, I feel like a worthless piece of garbage: depressed, anxious, brooding, bitter, basically just an all-around miserable person who hates life. This comes up every four weeks, like clockwork. The day after my period starts, the moods lift and I feel like myself again.

I am self-aware enough throughout this time to be aware that it's happening, and I try not to take these feelings out on those around me, but that doesn't make the experience any easier to deal with on my own. And that isn't even getting into the physical symptoms, which are bad enough, but the mood stuff is what's really getting to me. I withstood it long enough to recognize that this is a pattern that isn't going away, and something needs to be done to fix this.

So I went to the gynecologist and told her of these symptoms, and she brought up Sarafem, which I had never heard of. She explained that it is basically a low dose of Prozac, and something that I would take daily. She didn't exactly foist it upon me, but she wrote me a prescription and left it up to me whether or not I want to give it a try. I am open to trying it, but I am worried about side effects and am not keen on starting a medication I need to take every day forever if there's another way to handle it that might work. She made it sound like side effects would probably not be an issue, since it's a low dose (20mg). But I am wary.

So basically my question is/are:

Have you tried Sarafem?
What is/was your experience on it?
Have you used anything else that has alleviated PMDD that I should try first?
posted by anonymous to Health & Fitness (20 answers total) 9 users marked this as a favorite
For me, intense regular cardio exercise significantly improves, though doesn't completely obliterate, hormone-related mood swings, as well as the intense associated cramps I developed in my mid-20s. If I'm exercising daily, I get mild cramps and mild-ish mood swings; if I'm not, I feel like I'm going crazy and have debilitating cramps that put me in bed and/or make me throw up from pain.

On preview what liketitanic said.
posted by celtalitha at 3:10 PM on April 17, 2013

I also have a friend who swears by light therapy (which I've never tried). That said, the medication probably wouldn't be bad, either; at this point (I have two small children - my cycles haven't returned yet, but I don't have time for a strict exercise routine or an hour in front of a lamp every day either, so when they do I'll have to reassess) I'd probably go ahead with the meds.
posted by celtalitha at 3:12 PM on April 17, 2013

What helps me is to try and be really serious about managing my stress all month long. That comes with all the usual advice: exercise, be nice to yourself, eat well, get some sunlight, yoga, have fun. What else is going on in your life? Any troubles I'm having whether they be with a psych issue or with general life stress get amplified +1000000 in premenstrual times. Deal with anything that might be chipping away at your mental reserves.
posted by Katine at 3:20 PM on April 17, 2013 [3 favorites]

My psychiatrist put me on Modicon birth control pills and the difference is amazing. My PMDD was as bad as yours sounds like, and with the bcp's it's all but gone.
posted by scratch at 3:21 PM on April 17, 2013

This is why I take my birth control pills continuously so that I don't have a period. No mood swings, no misery. It doesn't work for everyone, but it works for me and has for years.
posted by chaiminda at 3:24 PM on April 17, 2013

I don't have a problem taking medication to alleviate issues but your GYN is off the rails here and you need to either see your primary care doc or see a new GYN. Prozac is very effective in the treatment of PMS, but at a tiny dose: 2mg instead of 20mg. (And FWIW I wouldn't hesitate to take that low a dose daily.)
posted by DarlingBri at 3:59 PM on April 17, 2013 [1 favorite]

Chaste tree berry extract has been clinically proven to help, and it's done wonders for me.
posted by Specklet at 4:09 PM on April 17, 2013

Undiagnosed PMDD person here. I have depression issues so I take Celexa daily. Doesn't help with PMDD.

I highly recommend taking Vitamin B supplements daily.
I was very skeptical when a friend suggested this. So I tried it for a month not expecting anything. And I noticed a HUGE difference the next time PMS came around.

I agree with DarlingBri, 20mg isn't a tiny dose of Prozac. I used to take that dose exactly for depression a dozen years ago.

Good luck!
posted by luckynerd at 4:26 PM on April 17, 2013 [1 favorite]

Sarafem/prozac probably can't hurt. In my experience, it is the gentlest of the SSRIs and you probably won't even notice a 20mg dose. But what you would hopefully notice is that it is taking the edge off while you work on other things to improve your mood and reactions to your hormonal roller coaster.

Side effects should be minimal, it is the longest-acting of the SSRIs (it actually inhibits its own metabolism), so you shouldn't have any issues with discontinuation. Prozac is even sometimes used to help people discontinue off of other shorter acting SSRIs. And even if you do have any effects of discontinuing, they don't last. They are just unsettling.

Look into something like cognitive behavioral therapy. There might be something else going on that is making you less able to cope with the ups and downs. I'm not saying you need to go into therapy, but just reading about it and how it works might help you figure out if you would benefit from something like that.
posted by gjc at 5:25 PM on April 17, 2013

Not diagnosed, but exercise and using a sunlamp help me a lot. Hope you find something that helps you feel better!
posted by zahava at 5:44 PM on April 17, 2013

I have diagnosed PMDD. I haven't taken Sarafem/Prozac as an adult, but other SSRIs have helped my PMDD to an extent. Sunshine and a vitamin-tastic diet both definitely help. I also went through a course of cognitive behavioural therapy for other reasons, and the positive effects of that therapy crossed over into PMDDland.

It's probably worth giving the Sarafem a try. You may even be able to start with a smaller dose, and work your way up only if needed. I wouldn't worry that you'd have to be on the medication forever, because that's probably not the case. Also, there's no lifetime obligation in trying Sarafem. You don't have to keep taking it, if you don't like it. But, if it turns out that medication is what works best for you, allow me to suggest this: It's better to be on a medication forever, than it is to be ill forever.

Good luck figuring out what works best for you. PMDD is rotten.
posted by Coatlicue at 7:08 PM on April 17, 2013

20mg is the recommended starting dose for Sarafem, which is indicated for PMDD.

The article linked to above is about an experimental UK regimen. The OP's gynecologist is giving the standard of care in the USA, so let's not get hung up on that part of the question.
posted by treehorn+bunny at 7:15 PM on April 17, 2013 [1 favorite]

And in terms of anecdote, I have taken 20mg of Prozac and noticed no side effects.
posted by treehorn+bunny at 7:17 PM on April 17, 2013

Wellbutrin can be prescribed for PMDD, and can just be taken around the time it occurs (so, maybe 1-2 weeks out of the month, as opposed to everyday).
posted by vivid postcard at 7:26 PM on April 17, 2013

I was on a daily, low dose regimen of Prozac for my PMDD and decided that it wasn't worth the side effects. I use exercise to reduce the physical symptoms (bloating, fatigue, etc.) and the anxiety/tension/depression and the results have been good but not perfect. I have read clinical studies (and my psychologist recommended this for me at first) that suggest taking Prozac only during the worst of your cycle can be efficacious as well, but you should talk to your gynocologist about this option before trying it. This wasn't an option for me as my periods are inconsistent, but it may be an option if your periods are regular and you don't want to stay on antidepressants all month.

And avoiding fatty/sugary foods as well as caffeine around my cycle helps despite my body screaming for them.
posted by Young Kullervo at 8:07 PM on April 17, 2013

There's some evidence (but not great evidence) that taking B6 (50 or 100 mg) throughout the cycle can help a bit. Some other studies suggested B6 plus magnesium.

I took Prozac for a few years and I don't think I had much PMS at the time. (Now I do have some.) But it's hard to say whether that's due to age/changing live circumstances or the Prozac.

You can have side effects from Prozac at 20mg. But you can also choose not to keep taking it if the side effects aren't working for you.
posted by needs more cowbell at 9:58 PM on April 17, 2013 [2 favorites]

I have a PMDD diagnosis, which I got within the last year, at age 43, when I finally realized I was only fully sane about half the month and that I could track it against hormone changes.

A few months ago, I finally went on Prozac (same as Sarafem, but apparently cheaper). This is what my doctor and I worked out: he wrote me a 10 mg prescription for tablets that I take a pill cutter to and cut into fourths (seriously) so I take 2.5 mg per day around my period. I'm still working out the scheduling details of when to take it in my cycle, but right now I'm starting 5-7 days before my period is due and stopping a couple of days in. This is something you really have to deal with a doctor about (not all pills can be split, for example.)

It's sort of life changing so far. Before, I would go through these phases where I felt like I had a sunburned brain someone was scraping up with sandpaper. I'd forget words. I couldn't concentrate. I would lose things. I'd get paranoid and hostile--freakishly so. I'd get *weird* in clear, demonstrable ways where I would look back later and realize that was not normal. I could barely hear what people were saying thanks to the non-stop static.

It seems to take two to three days for me to feel a difference, so I think I need to start taking it closer to ovulation because I waited too long this month and spent a full day feeling like a cross between Gollum from Lord of the Rings and a Cathy Guisewite character.

Even that tiny, tiny dose makes it hard for me to have orgasms. Not impossible, but difficult, which is why I take the smallest dose imaginable for as short a time as I can swing it.

I did a bunch of research on this before I started, and I have a supportive doctor, so that helped. But so far I really like it, I like that it's such a small dose, and I like that it's not all month, and I like that I'm controlling the scheduling.

(On preview I see DarlingBri mentioned the very low dose too!)
posted by A Terrible Llama at 1:51 PM on April 18, 2013 [2 favorites]

Late to the party (I just joined), but I'd like to strongly recommend Raspberry Leaf Tea. I deal with general mood issues, not PMDD per se, but my mood issues tend to peak at ovulation and before menstruation. The raspberry leaf turned my life around, which medication never did. I drink a cup every day from ovulation until the day my period starts (I don't need it during my period or the week after).

Bonus: if I drink the tea consistently, my normally monster periods are much lighter. Bonus bonus: raspberry leaf is apparently full of antioxidants.

I wish raspberry leaf were more widely known and researched (it has been studied in the context of pregnancy since some women take it to shorten labor, but it hasn't been studied much if at all in terms of mood issues). It was really a miracle fix for me. It started helping right away, but it took a whole cycle to have its full effect.
posted by Comet Bug at 1:59 PM on May 17, 2013 [2 favorites]

Mod note: From the OP:
Thanks everyone for the suggestions and advice. A special thank you to needs more cowbell for posting that study of the effects of magnesium and B6 on PMS symptoms. Since asking this question, I have had shockingly good results taking a combination of magnesium and B-complex supplements (the supplement includes B6).

I don't take a large dose of either. I'm taking a smaller dose of both than is mentioned in the study. I got a bottle of MegaFood Magnesium and a bottle of MegaFood Balanced B Complex. I take one of each pill, crushed, after breakfast on most days. The results were almost immediate and have been consistent for three months now. I had never taken vitamin supplements until trying this, and I didn't really expect it to do anything, but it has made a huge difference. I still have the physical PMS symptoms, but my moods now feel healthy and reality-based.

So at least for the time being, I'm back to feeling like myself. People close to me have confirmed that they have noticed the positive change as well. If I go back to experiencing PMDD symptoms eventually, I feel better about trying medication, but in the meantime I am thrilled with these results that I wouldn't have thought possible from just taking vitamins. Thank you all so much. I hope others are helped by the information in this thread.
posted by taz (staff) at 11:07 PM on August 10, 2013 [3 favorites]

I'm one of the people upthread recommending Prozac, which I still endorse, but purely coincidentally this month I started taking B complex and Magnesium supplements (no meds) and had a really easy time PMDD-wise. It's only one cycle but I thought I'd add as a data point that I had the same experience.

There is a lot of good information on this site if you can get past the mild sexism and exclamation points. The studies that it points to seem to go to mostly peer-reviewed journals. It's badly organized but if you prowl around there's good information in there.
posted by A Terrible Llama at 6:18 AM on August 12, 2013

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