Prozac and PMDD

It wasn't long ago that the Food and Drug Administration's (FDA's) scientific advisory group recommended that Prozac should be approved for a severe form of premenstrual syndrome called premenstrual dysphoric disorder, or PMDD.

The recommendation confounds us for several reasons:

1. Relatively few women suffer from PMDD. The FDA has yet to approve a form of treatment for PMS, which affects many more women.
2. The recommendation, and the media coverage surrounding it, was inadequate in its discussion of the differences between PMS and PMDD. If the diagnostic guidelines are blurred, this raises the concern that women and providers will turn to anti-depressant therapy for PMS before other natural options and lifestyle measures are explored.
3. The crucial influences of estrogen and progesteroe on premenstrual mood are overlooked in this recommendation about PMDD treatment. Prozac regulates brain uptake of the neurotransmitter serotonin. Serotonin is key in moderating mood, but it is only one of multiple factors governing premenstrual mood changes.

The FDA is not bound by the advice of its scientific advisors, but is expected to follow the recommendation and approve the labeling and marketig of Prozac as a PMDD treatment. It may not be long before we see television and print ads touting Prozac as a remedy for premenstrual depression, tension, and irritability. There are, of course, millions of dollars at stake in expanding the use of Prozac, which is already widely prescribed.

In the more than 20 years I've spent working with women and providers to offer treatment options for premenstrual syndrome, I've witnessed a variety of twists and turns in the politics surrounding this disorder. Although it is a well-recognised term today, let's not lose sight of the fact that, not long ago, PMS was considered ''all in a woman's head.''

This edict from the FDA advisory committee gives me a sense of alarm that we may be returning to those days. I'm not convinced that substituting a new term, PMDD, and a different medication represents an advance in women's health. For the very few women who suffer from severe PMDD, Prozac may offer hope and relief. For PMS sufferers, there is the risk that Prozac will be offered as an easy, ''one-stop-shopping'' solution.

The lessons from the early days of PMS education and awareness have as much value today as ever. No anti-depressant medication is a blanket therapy for premenstrual mood changes or physical symptoms, any more than the tranquilizers of yesteryear were.