On July 6, 2000 Eli Lilly announced the FDA approval of Sarafem for the treatment of premenstrual dysphoric disorder (PMDD), a severe form of PMS. At this time, it is the first and only prescription medication indicated for the treatment of this condition.
Sarafem, however, is not a new drug. It is actually a new brand name for the antidepressant Prozac (fluoxetine hydrochloride), which has had some very serious allegations leveled against it. Opponents of the drug claim that it is a trigger for violent and / or suicidal behavior in certain susceptible individuals.Because the true degree of risk remains to be seen, many women are opting to use natural cures for PMS, such as herbal products as well as lifestyle changes, to treat their condition. While "natural" does not by any means equate with "safe", it is helpful to know that treatment alternatives, some of them geared towards treating the root cause (hormonal imbalance) rather than just the symptoms (moodiness, bloating and pain), do exist.
St. John's Wort
St John's Wort is the common name for the herb Hypericum perforatum. It has been used for quite awhile in Germany as an antidepressant, and its use in the United States for both women and men has increased substantially during the past few years.1
Hypericin is the primary active constituent of St John's Wort and is thought to inhibit both monoamine oxidase and serotonin reuptake, and perhaps to effect numerous other central nervous system activities. Another active constituent, hyperforin, may also inhibit serotonin reuptake. Although St John's Wort seems to affect monoamine oxidase, its inhibitory effect is considerably less than that of monoamine oxidase inhibitors. It appears that monoamine oxidase inhibitor-related drug interactions and dietary restrictions should not be an issue with St John's Wort.1,2
St John's Wort has been widely evaluated for its use in depression. A recent review of eight randomized controlled trials concluded that, when compared with placebo, the herb demonstrated significantly better performance than placebo for common markers for depression. In the four studies in which St John's Wort was compared with tricyclic antidepressants, there was no significant difference in the antidepressant effects of any drugs studied vs. the herb.2
A preliminary study conducted at The University of Exeter in England indicates that St. John's Wort may also be an effective treatment for the moods associated with PMS. For two menstrual cycles, each woman took one 300 milligram tablet of St. John's Wort daily and maintained a diary in which she rated her symptoms on a scale of zero to four. Of the 19 women who completed the study, symptom ratings improved by about 50%. Scores on tests of anxiety and depression also dropped significantly after the first month on St. John's Wort.3