PROZAC AND PREMENSTRUAL DYSPHORIC DISORDER: An old remedy for a new
diagnosis

FEMALE TROUBLE

PROZAC AND PREMENSTRUAL DYSPHORIC DISORDER: AN OLD REMEDY FOR A NEW
DIAGNOSIS

PMS, THAT PERENNIAL IN-JOKE AMONG women, has a decidedly serious
cousin: Premenstrual dysphoric disorder (PMDD), a severe form of PMS that
afflicts some 5 percent of menstruating women. PMDD has been inching
toward full recognition as a psychiatric disorder since 1994, but women
and doctors alike remain largely ignorant of the condition.

"My PMDD almost led to divorce and suicide," says 31-year-old
Anthea Williams, who two years ago began experiencing extreme mood
swings, intense anger and severe depression the week prior to her period.
When her primary care physician threw up his hands, Williams' Internet
research led her to conclude that she had PMDD. Her physician concurred
and prescribed Prozac. Williams calls the selective serotonin reuptake
inhibitor (SSRI) a "lifesaver."

Eli Lilly, the maker of Prozac, was the first company to receive
FDA approval to indicate an SSRI--Serafem--for the treatment of PMDD. But
Prozac and Serafem are, in fact, the exact same drug. Critics contend
that the new name is a ploy for profitability, as the patent on Prozac
expired last August, while Serafem remains protected until 2007. Eli
Lilly argues that a distinct identity is appropriate, as it distinguishes
PMDD from depression, with which Prozac is most widely associated.

PMDD is included in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) as a disorder that is still under evaluation. Jean
Endicott, Ph.D., director of the premenstrual evaluation unit at Columbia
Presbyterian Medical Center in New York City, testified before the FDA
supporting recognition of PMDD as a distinct clinical entity. Endicott
also conducted PMDD studies with Zoloft, which she says is likely to
receive FDA approval for a PMDD indication in the near future.

"SSRIs are effective for about 65 percent of women [suffering from
PMDD]," says Endicott, who notes that physicians as ancient as Hypocrites
recognized the suffering caused by premenstrual symptoms. "Fortunately,
women are no longer told nothing can be done."

PHOTO (COLOR): MY PMDD ALMOST LED TO DIVORCE AND SUICIDE