DALLAS -- September 23, 1997 -- Women suffering from a severe form of premenstrual syndrome that adversely affects relationships and work may have fewer emotional problems when treated with the antidepressant sertraline, a researcher at UT Southwestern Medical Center at Dallas reported today in The Journal of the American Medical Association.
Lead author of the study, Dr. Kimberly A. Yonkers, assistant professor of psychiatry and obstetrics and gynecology at UT Southwestern, and colleagues at 11 other medical centers around the country, studied more than 200 women with premenstrual dysphoric disorder (PDD). The disorder causes emotional suffering and functional impairment in 3 percent to 5 percent of menstruating women. Women in the study took either sertraline hydrochloride, a selective serotonin reuptake inhibitor, or a placebo daily. Levels of medication varied depending on the individual's needs.
Yonkers said the study by members of the Sertraline Premenstrual Dysphoric Collaborative Study Group showed the drug to be "highly successful in treating premenstrual dysphoric disorder."
According to the study, 62 percent of the women treated with sertraline showed "marked or much improvement" in their symptoms. Thirty-four percent of the placebo group showed improvement. (Approximately one-third of patients in psychiatric studies routinely react favorably to placebos, Yonkers said.) In addition, "significant benefit of [sertraline] over placebo was apparent by the first treatment cycle."
Yonkers explained that serotonin reuptake inhibitors seem to work by provoking a chemical reaction in the brain that results in enhancing the usual functioning of a protein in the brain known as serotonin. Seratonin is a brain chemical associated with "feeling good."
The study showed "definite improvement" in 14 of the 20 symptoms associated with PDD. These symptoms range from severe physiological problems like food cravings and poor concentration, to mood symptoms like depression, mood swings, irritability and anger, to relationship and productivity problems.
Yonkers said the sertraline treatment proved particularly successful with women suffering emotional problems.
Depression and mood improved in 44 percent of those on sertraline vs. 29 percent on placebo; anger and irritability was reduced in 31 percent on sertraline vs. 12 percent on placebo; relationship problems improved in 42 percent on sertraline vs. 15 percent on placebo; ability to resume hobbies and social activities improved in 38 percent on sertraline vs. 17 percent on placebo; and productivity improved in 38 percent on sertraline vs. 18 percent on placebo.
"The rigor of the study, including the inclusion of screening and treatment at the 12 different centers, supports the validity of the diagnosis," she said. "I was actually astonished at the level of dysfunction in this group."
Dallas patient Heather Miller, a mother of two, said she wasn't surprised by the results. Miller, who counts herself lucky to have a supportive husband, two lovely children, close relationships with nearby relatives and friends, and a part-time job working with children, said she felt like her world was falling apart before the treatment.
"I turned into a witch 12 days a month, and I didn't even care," she said. "I loved to yell and scream on `those days.' I guess I felt so bad that yelling actually made me feel better."
Now Miller looks back with horror on the days before sertraline helped smooth her premenstrual moods and alleviate her breast pain.
"If things hadn't gotten better, this thing would have definitely affected my marriage and ruined my relationship with my kids," she said.
Besides helping women overcome the emotional and physical pain of PDD, Yonkers said she hopes the study will help convince people that problems like PMS and PDD need to be taken seriously.
"This research describes the disorder and further shows medicine's capacity to help women with premenstrual dysphoric disorder," Yonkers said. "This was a great early step, but there's lots more to be learned about the disorder and its treatment."
Other authors of the study were Dr. Ureil Halbreich from the State University of New York at Buffalo School of Medicine and Biomedical Sciences; Dr. Ellen Freeman from the University of Pennsylvania School of Medicine; Dr. Candace Brown from the University of Tennessee, Memphis, College of Medicine; Dr. Jean Endicott from the New York State Psychiatric Institute; Dr. Ellen Frank from the Western Psychiatric Institute and Clinic in Pittsburgh; Dr. Barbara Perry from the University of California, San Diego, School of Medicine; Dr. Teri Pearlstein from Brown University School of Medicine; Dr. Sally Severino from the University of New Mexico Medical Center; Dr. Anna Stout from Duke University Medical Center; Dr. Andrea Stone from the University of Massachusetts Medical Center; and Dr. Wilma Harrison from Pfizer.
The study was funded with a grant from Pfizer.
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This news release is available on our World Wide Web home page at http://www.swmed.edu/news/newspubs.htm/
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JAMA