Premenstrual Dysphoric Disorder_12.flv


Very important to emphasize that with in epidemiology on this is that
people that have Premenstrual Dysphoria ah, no higher rates of Axis II disorders
It doesn’t seem to be related at all to issues of character or personality style or anything like that And it’s unique in that it it occurs with great regularity Women have their period on a regular
basis say, this Thursday it’s gotta hit, you know or friday and for some of them it’s just one day a month and for some of them it’s ten days a month. but within each individual woman, it tends to be about the same number of days each month. It’s also characterized as what dawns offset abrupt within hours of
getting depressed and hours having it going away. Totally different than any kind of other mood disorder and we think . And it’s the only mood disorder that responds to the anti-depressants within hours. Premenstrual exacerbation major
depression even if people are not prone to PMDD if they’re in the throes of a major
depression it’s not unusual to have some increase depressive symptoms premenstrually. And so if this is generally dealt with
pretty successfully by either adding an SSRI or if they’re on an SSRI
is bumping the dose up a little bit So like, if they’re on twenty milligrams of
prozac you brought that up to ten milligrams of prozac or something like
that during that period of time that they have increased symptoms. 90% of women who successfully commit
suicide it’s done premenstrually, so this really can throw
gas on fire with depression. It’s always best to find non-pharmacological
approaches if that works reducing caffeine and alcohol almost certainly
has a lot to do with improving the quality of sleep, which clearly has a lot to
do with mood regulations. Exercise as well. the Serotonin antidepressants
necessarily any interest except Wellbutrin could be used that this is the one depressive disorder that this is not
speculative this is really just a fact is due to significant abrupt decrease availability in serotonin. okay so those are the drugs that work. If you used drugs that don’t target serotonin than they’re no better than placebo. There are case reports of St. John’s Wort being affected both that no hard data about that. Must target Serotonin intermittent versus
continuous if the woman only has it for this discreet period of time, 4 days a month, they make it either start taking that
moment start feeling depressed also frequently I should say this, that depression, but it’s often irritability or anxiety mixed in with that. Or if they are highly regular and
they say yes going to have a thursday they can start taking it on wednesday it’s probably better to use a short half-life drug you can use prozac but it’ll stay in your system longer. but the the the obvious advantage is
that you don’t incur the side effects that you do Emotional blunting or
sexual dysfunction or what have you. if you just take it for 4 days a month Continuous would be the people that have
ongoing depression and they just have a bump up the depressive symptoms premenstrually. Actually starts working and in a coupla two or three hours and really the timeframe for onset symptom reduction really closely parallels with
reuptake inhibition starts, okay. So, you know, here’s let me give you sort of a theory about this and by the way, this is my prozac cup that my mother gave me this
week She thought I needed it, so, I feel better already, okay. Anyway, even when people have a so called
reactive depression or say something happens this horrible like the death of
a child for instance, okay, there are acute onset severe mood changes, and you know, most of the time it’s grief, of course it can deteriorate into major depression so if
there’s abrupt changes in mood but something more hardcore for biological symptoms of depression
like pervasive anadonia, severe sleep disturbances weight loss don’t happen immediately You may get some initial insomnia, but the early-morning awakening doesn’t happen immediately it was presented to happen
is over a period of probably weeks as the depression sort of heats up,
if you start getting changes not just at the level of the synapse, but in in
the internal chemistry of cells and then when you use an
antidepressant it immediately blocks reuptake within a few hours and restores normal a
amounts of the neurotransmitter but it takes also days to weeks to have a get back on
track. But here we have a disorder that doesn’t have anything to do at least
theoretically but my money is on this is correct – with there being these
massive changes in internal micro chemical micro environment of the cell Has to do within hours you don’t have any serotonin. Okay, we have a little bit okay but they don’t
have as much. Now what what is going on here? There are two theories and one of them is this – and these are not just made up, there is data to support this. There is an enzyme, there is a gene, that makes this enzyme called Tryptophan hydroxylase and what happened here’s what appears to happen in women who have Premenstrual Dysphoria is when they enter this phase of their
cycle it causes gene silencing.
This is a gene that gets shut down big time maybe not completely but it’s not
available and in order to make serotonin you have to have tryptophan amino acid then
tryptophan hydroxylase converts that into 5HTP,
we’ll talk about later which is then immediately converted
into serotonin So you take an enzyme out and you can eat a ton of tryptophan it won’t make any difference
You can’t make ok so there’s something about SSRIs that reactivates the
the production of this normal enzyme that converts tryptophan into serotonin. the other thing – I want to show off here, I learned how to pronounce this word – Altopregnenolone and this is a steroid hormone.
steroids are made from cholesterol. And it’s made in the brain and it says Potent GABA-A agonists next class we’re gonna talk about anxiety
disorders and the GABA system, well, you probably remember this from the first class. Remember the most common inhibitory neurotransmitter in the brain is GABA, okay, and agonists turn something on, so we have is
naturally available is everybody that specific some degree is its helping to dampen down the brain. It’s
like a natural andogenous tranquilizer okay. So, it says low levels
of people with major depression is measured in cerebral spinal fluid, and and it normalizes when the depression gets better, so there’s some
relationship to that. but mark reduction of of this molecule in premenstrual dysphoric and a rapid increase
of it with SSRIs. And so this is probably what accounts for that
common anxiety that oftentimes will go along with the depressive symptoms premenstrual dysphoria, okay. Now, here, two studies, okay double-blind placebo-controlled study
collapse the data and you have taking uh… twelve-hundred
milligrams of calcium a day, which is equivalent of four Tums uh… yet fifty-five percent improvement with uh… Tums versus
thirty-six with placebo. it’s probably not a bad idea to
get some extra calcium especially if you’re a woman but I have to caution you that both of these studies were
sponsored by the maker of Tums so take that with a grain of salt.

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Comments

  1. Most women like myself are progesterone intolerant . I have pmdd. Doctor panay of Chelsea and Westminster has the only cure…hrt treatment instead of ssris. Anti depressants would drive these women crazy. I'm currently due for a totally hysterectomy to remove my ovaries which produces my progesterone …..I'm currently on oestrogen and syneal spray,to shut down my ovaries. Each month I have to shed my womb therefore taking progesterone…..this is my madness…..
    Hysterectomy will mean I can avoid progesterone for ever. Pmdd sufferer for over 20 yrs.

  2. SSRI'S are terribly addictive and require increases as the drug becomes ineffective. I am currently trying to wean off Prozac. I would never have taken SSRI'S had I known how terribly hard it would be to withdraw from them.

  3. I am allergic to antidepressants and oral contraceptives they trigger Complex migraines which put me in hospital and I have PDD . I have been trialed on a few types of  antidepressants and one mood stabilising drug which put me in a coma like state for nearly 24 hours to my horror I discovered that these reactions to such medicines can be fatal and these reactions are indications I am intolerant.  

    I have never in 33 years been diagnosed with a mental illness and have been assessed multiple times.
      Be careful where you direct your recommendations, as a psychiatrist nearly killed me with his.

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