No. I’m not joking… I wonder if Dr. Mikael Landen of the Karolinska Institute in Stockholm has any connection to GlaxoSmithKline… I wonder who is funding his ‘research’?
Doctors are testing women taking antidepressants at the first symptom of premenstrual irritability, a move critics worry could lead to even more prescribing of “psychotropic” drugs to women.
A small new study shows antidepressants work within hours to dampen premenstrual anger and irritability. It usually takes several weeks for the drugs to start working in depression, and months before a maximum effect is achieved.
But studies suggest a popular class of drugs called SRIs, or serotonin reuptake inhibitors, work more rapidly to reduce symptoms such as irritability and anger.
Some women are already taking antidepressants continuously for severe PMS, or for part of their menstrual cycle – from ovulation to menstruation.
But the new study asked, how fast do the drugs really work?
“Do you need to take it a few days before the irritability starts, or would it be like taking an Aspirin – take it the same day when the symptoms first surface,” said Dr. Mikael Landen, a psychiatrist at the Karolinska Institute in Stockholm, Sweden.
His team found that women began feeling less irritable within four hours of taking paroxetine, the active ingredient in Paxil. They reported a significant difference by bedtime, or as early as 14 hours later.
“This means that you can almost take an SRI as needed for premenstrual dysphoria,” Landen said. “You don’t have to schedule two weeks every month. You can wait until you experience your symptoms and start medication.”
All the women met criteria for premenstrual dysphoric disorder, the official psychiatric term for severe PMS where women experience “marked” irritability, tension, weepiness, mood swings or a depressed mood that can interfere with day-to-day activities and personal relationships. Three to eight per cent of women are estimated to be affected.
If the proof of concept study is borne out by more research, psychiatrists say it could be a significant breakthrough in the treatment of severe PMS.
But some researchers are unsettled by the notion of otherwise healthy women being handed antidepressants for PMS. The Society of Obstetricians and Gynaecologists of Canada says antidepressants can be used in more severe cases.
“There has certainly been a lot of critique about the way it’s taken something that is part of the normal hormonal changes involved in women’s reproductive cycles and pathologizing them, making them into a medical condition that needs drug treatment,” said Barbara Mintzes, an assistant professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia.
“It’s extra-prescribing of an antidepressant for an inappropriate use to women of childbearing age.”
PMS “is a very vague term,” said Leonore Tiefer, a clinical associate professor of psychiatry at the New York University School of Medicine.
“There are many different ways of experiencing menstruation and occasionally there might be an unusual set of symptoms. But, by and large, I think it’s best to dispute the existence of a PMS condition and certainly not prescribe an SRI.”
A total of more than 27 million prescriptions were dispensed for SRIs and similar antidepressants in 2007, according to prescription drug tracking firm IMS Health Canada. According to IMS, 64 per cent of diagnoses for depression made by Canadian office-based doctors in 2007 were for women. “These visits were likely accompanied by a drug recommendation in the form of a new prescription; a drug sample being provided; or a direction to the patient to continue taking a current medication.”
Women who go on and off low-dose antidepressants for PMS don’t seem to experience the same withdrawal as do about one-third of people who take the drugs for depression, doctors say.
“But you do get side-effects – nausea, agitation, difficulty sleeping. You do see a bit of that,” said Sarah Romans, professor of psychiatry at the University of Toronto and consultant psychiatrist at Women’s College Hospital.
She says women with severe PMS “say stuff like, I’m a Jekyll and Hyde, you don’t want to know me the week before my period. I hide in my room; I’m just like a raging tyrant. My husband just looks at me wrong and I snap his head off.”
But she says there exists so much mythology and ritual around the menstrual cycle that “I think sometimes men are inclined to attribute to a woman’s cycling stuff that doesn’t belong there.”
“Typically she’ll be sounding off about something that’s wrong in the relationship, or she wants him to do something more around the house and they can both say, ah, well, it’s just that you’re PMS-ing.”
“And of course she’s expressing it now during the premenstrual phase, but she’s feeling cross about it and wants it to change all the time. The danger is if she only mentions it at a time when she’s got premenstrual symptoms they can both dismiss it as not based in reality and not a valid complaint,” Romans said. “We dump everything on a woman’s cycle. Anything that troubles a woman can be blamed on her being a reproductive animal.”
In the new study, published in the journal, Neuropsychopharmacology, 22 women 18 and older, all of whom had previously taken paroxetine, were given a 20 mg dose of the drug during two menstrual cycles and placebo during one cycle. The women took their pills once they had felt irritable for two days, and then monitored their symptoms every two hours.
“We found that the symptoms started to get better after four hours and we found significant results at bedtime the first day.” Landen said. The difference was most significant at Day 3.
He says women could take the pills for six or seven days during their cycle for irritability.
“And you don’t have to plan this ahead. It just starts when the symptom arises and stops when you don’t have it anymore.”