Wednesday, May 19, 2010

PMS, Prozac and Civlized Behavior

Hello dear readers,

I am, on a daily basis, asked to deal with PMS.

Since I have been in practice ( 27 years, yikes!) I have struggled with this diagnosis. When I was first in practice, and the only female gyn for many miles in any direction, I was prevailed upon to diagnose and treat PMS. It was a young problem. An English physician, Katarina Dalton, had at that time, successfully argued PMS as a murder defense in London, and this diagnosis was brought to the world stage.

Since it is a syndome, it is comprised of a number of symptoms. No objective findings are apparent for a definitive diagnosis. Calendars were kept, vitamins, exercise and every hormone in the book was used. All to no real avail. PMS is the witch within, waiting to pounce on unsuspecting males, coworkers, children, and the public.

The dawn of what I call modern mental health began when Prozac was brought to market. Here was a drug that had little toxicity, and could successfully treat depression and anxiety. The world changed. Even though your insurance company did not cover you for "nervous and mental disorders" it was worth it.

No longer was bad behavior tolerable. Self control, and its attendant civility crept into society. The behavior seen in The Honeymooners, was now considered abusive.

Your body only has so many finite resources to deal with your day to day activities. In biology, we define stress as adaptation to change. There are internal stressors, your body functions, and overall health. There are external stressors in your life. When a woman has a menstrual cycle, there are hormonal changes that are normal that occur, but contribute to internal stress. In my opinion, this is the straw that breaks the camel's back of civility, and the inner witch emerges. She is irritable, bitchy, not a nice person, sharp tongued, and quick to anger. We teach our children, not to pick up their shoes, but that women are crazy and not to be trusted.

There are three basic treatment methods for PMS. One is to control the menstrual cycle to lessen the burden of internal stress, another is to reduce external stressors from your life, and the third is to increase your stress management resources. Go to the mountaintop and commune with nature, do yoga, exercise, meditate, deep breathe, read a book. Remove yourself from society. Turn off the cell phone, TV, and don't watch the news.
Those are starters.

If a patient is unable or unwilling, or too wacky, I will offer her fluoxetine, the active ingredient in Prozac. It has been shown to be very helpful, and can be taken just around the menses. I ususally advisea woman if she feels good on the days she is taking the medicine, and then feels a let down the other days of the month, I advise her to take it every day. No sense only having a few good days.Manipulation of menstrual cycles will work, especially in adolescents, and young adults. I am always hesitant to prescribe psychotropic medications to this age group.

The bottom line is that the inner witch is no longer allowed to come out. She must be controlled, or you will wind up alone. Nobody wants to be around her. Your children will want to live with your ex husband. So my advice is to get a grip. There are lots of ways to get to being a civil person. Pick one or many, but do it.

Until next time..............

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