pmdd

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I got that from Dust Bunnys documentation.

OK, went back a few pages and got caught up.

From a medical standpoint, the Salon article is full of shit. Flouxetine is flouxetine is flouxetine. You can prescribe it for pmdd under any name (trade or generic). Branding it as Sarafem is simply a marketing ploy for prescribers that don't like to think.

From :http://emedicine.medscape.com/article/293257-overview#a4

Major theories developed to explain the pathophysiology of PMDD include the following[5] :

• Ovarian hormone hypothesis
  
• Serotonin hypothesis
  
• Psychosocial hypothesis
  
• Cognitive and social learning theory
  
• Sociocultural theory
  

The ovarian hormone hypothesis suggests that PMDD is caused by an imbalance in the estrogen-to-progesterone ratio, with a relative progesterone deficiency. Accordingly, in the 1960s, PMS patients were treated with progesterone suppositories. However, later studies of estrogen and progesterone levels in women with PMS were inconclusive because of methodologic difficulties. The current consensus seems to be that normal hormonal fluctuations trigger central biochemical events related to PMDD symptoms in some predisposed women.

The serotonin theory hypothesizes that normal ovarian hormone function (rather than hormone imbalance) is the cyclical trigger for PMDD-related biochemical events within the central nervous system (CNS) and other target tissues.[6]

PMDD shares many of the phenomenologic features of depression and anxiety states that have been linked to serotonergic dysregulation. A growing body of evidence suggests that serotonin (5-hydroxytryptamine [5-HT]) also may be important in the etiology of PMDD. Decreased serotonergic activity in women with PMDD has also been implied by the observation of reduced platelet uptake of serotonin and serotonin levels in peripheral blood.

In women with PMDD, sensitivity to perturbations of the central serotonin system is altered premenstrually. The administration of the serotonin agonist m -chlorophenylpiperazine may induce mood elevation.[7] Agents that transiently diminish serotonin activity have been associated with behavioral changes, including irritability and social withdrawal.

The psychosocial theory hypothesizes that PMDD or PMS is a conscious manifestation of a woman’s unconscious conflict about femininity and motherhood. Psychoanalysts proposed that premenstrual physical changes reminded the woman that she was not pregnant and therefore was not fulfilling her traditional feminine role. Obviously, proving this theory through scientific evidence is quite difficult.

The cognitive and social learning theory hypothesizes that the onset of menses is an aversive psychological event for women susceptible to PMDD. Moreover, these women might have had negative and extreme thoughts that further reinforce the aversiveness of premenstrual symptoms.

Consequently, these women develop maladaptive coping strategies (eg, lability of mood, absence from school or work, and overeating) in an attempt to reduce the immediate stress. The immediate reduction of stress acts as a reinforcement, leading to the regular recurrence of symptoms during the premenstrual period.

Finally, the sociocultural theory hypothesizes that PMDD is a manifestation of the conflict between the dual roles society expects women to fill simultaneously—namely, productive workers and child-rearing mothers. PMDD is postulated to be a cultural expression of women’s discontent with the traditional role of women in the society.

Of these 5 theories, the serotonin theory is perhaps the most popular at present. Although genetic predisposition and societal expectations may play a role, the strongest scientific data implicate serotonin as the primary neurotransmitter whose levels are affected by ovarian steroid levels. Other neurotransmitter systems that have been implicated include the opioid, adrenergic, and gamma-aminobutyric acid (GABA) systems.[8]
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So, the most popular theory is a problem with neurotransmitter(s) in the brain, which makes it fall into a mental treatment category, not mental diagnosis category. The diagnosis category (according to icd 9) is 624.5. This puts it in the same category as other female genital disorders (http://www.icd9data.com/2012/Volume1/580...7-629/625/).

DB, get over the term, get on with addressing the problem. If you don't want pharmacologic treatment and you want a bilateral salpingo-oophorectomy, find a surgeon who will give you one.