Jory Goodman M.D.

Attention, Please

Premenstrual Syndrome Update

A reminder about the simplest pharmacologic treatment extant.

Posted Feb 17, 2013

More than 15 years ago I published my data on the simplest approach to the treatment of the emotional misery of PMS. Unfortunately it hasn't penetrated, so I'll do it again.

The emotional/psychological distress of PMS is induced when a woman's estogen levels plummet abruptly. This is accompanied by a surge of monoamine oxidase (MAO), the enzyme which digest biogenic amines. These include dopamine, noradrenalin and serotonin to name a few. Thus, the woman's primary feel good brain chemicals are dissolved suddenly by MAO. The results do not need description.

Some SSRIs have been pushed for PMS (and everything else known to humankind). They don't work well and the model they describe is specious. In effect they do cause some acute domapine blockade and can result in a numbing effect which is not really salutary.

Use of the medications buproprion HCl or buproprion HBr in a pulse pattern usually ameliorates or abolishes the emotional/psychological symptoms of PMS.  A woman must monitor her calender, and needs to have a fairly regular cycle. For those with no ongoing mood, anxiety, ADHD or other reason to take the meds regularly a calculated dose is begun 7-10 days before the onset of symptoms and continued for 10-15 days. Obviously the precise patterns are determined to fit the woman; duration of symptoms, etc. The 7-10 day lead allows for some variations in cycle. The sudden addition, or increase in these meds boosts dopamine and noradrenalin, and downstream serotonin, to stay ahead of the surge of MAO. Quite simple really. Specific dosage regimens are individually determined. The results and benefits are remarkable.

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