Ketamine for PMS or PMDD?

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are challenging conditions that affect 50-80% of women. Furthermore, up to 8% of women may experience severe symptoms of PMDD. Learn how IV Ketamine can significantly help women struggling with PMS and PMDD.

What is PMS?

Premenstrual syndrome (PMS) is combination of physical and psychological symptoms that occur in the second half of the menstrual cycle (the luteal phase). This occurs after ovulation and before menses, when cumulative estrogen and progesterone concentrations peak. These symptoms can significantly impair functioning and include:

• Mood symptoms: depression, irritability, and anxiety
• Physical symptoms: breast pain, bloating and swelling
• Pain: headaches and heightened pain sensitivity

Symptoms must be absent outside of the luteal phase, meaning women must be symptom-free during the follicular phase. If a woman experiences symptoms in the follicular phase, a diagnosis of dysthymic disorder or major depressive disorder. These other conditions may worsen during the luteal phase but can have different treatment options.

PMDD is the Most Severe Form of PMS

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS where symptoms of anger, irritability, and internal tension are prominent, affecting 3-8% of women. Up to 15% of women who experience PMDD report at least one suicide attempt in their life. Additional symptoms may include:

• Mood swings, sudden sadness, increased sensitivity to rejection
• Sense of hopelessness, depressed mood, self-critical thoughts
• Tension, anxiety, feeling on edge
• Difficulty focusing and concentrating
• Change in appetite, food cravings, overeating
• Less interest in usual activities
• Easy fatigability and feeling less energy
• Feeling overwhelmed or out of control
• Sleeping too much or not sleeping enough

What Causes PMS and PMDD?

While we don't know for certain, PMS and PMDD appear related to changes in estrogen and progesterone that impact our brain and nervous system:

• Progesterone acts as a "downer" by decreasing serotonin levels, increasing monoamine oxidase (MAO) activity, and stimulating GABA receptors
• Progesterone metabolizes into allopregnanolone, a powerful neurosteroid that activates and sensitizes GABA-A receptors, producing an anti-anxiety effect
• Women with PMS have less allopregnanolone than women without PMS. In addition, women with PMS produce less progesterone and allopregnanolone when stimulated with gonadotropin-releasing hormone (GnRH) during the luteal phase (compared to women without PMS).
  • This means less anti-anxiety support in women with PMS than in women without PMS.
• Women with PMS also have lower serotonin levels in the luteal phase. Women with PMDD also have dysregulated serotonin levels.
• Glutamate levels appear imbalanced in women with PMDD in mood-related brain regions. These areas are the anterior cingulate cortex (ACC) and medial prefrontal cortex (PFC).

Ketamine is unique among prescription medications in its ability to target modulate glutamate levels,  activate estrogen receptors and shares some overlapping characteristics with the neurosteroid allopregnanolone.

Traditional PMS Treatment Options

When considering Ketamine therapy for PMS or PMDD, you should discuss traditional treatment options, as well. Conventional PMS and PMDD treatment options include combinations of different approaches:

1. Antidepressants, such as SSRIs during the luteal phase
2. Ovulation suppressors: estrogen-progestin oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists
3. Anti-anxiety medications: alprazolam (Xanax)
4. Calcium (1200mg/day)
5. Acupuncture
6. Pyridoxine (vitamin B6)
7. Exercise
8. Myo-inositol (2gm of powder)
9. Vitex agnus castus
10. Surgery to remove the ovaries (surgical menopause, used as a "last resort")

About 60-70% of patients find relief from PMS symptoms with prescription medications. Notably, there is a considerably high placebo response, as well. This is important, because many of these prescription medications carry side effects.

Ketamine for PMS and PMDD

Rapid-acting antidepressants are believed to provide relief to PMS and PMDD, such as with allopregnanolone and ketamine. Ketamine has numerous possible beneficial aspects compared to traditional prescription medications:

• Temporary estrogen receptor activation, instead of continuous use hormonal contraceptives
• Rapid acting effects, believed to be through glutamate modulation
• Global improvements in mood outside the luteal phase
• Pain relief from cramping
• Minimal side effects
• Possible neurocognitive improvements throughout the cycle

IV Ketamine is the fastest acting form of ketamine therapy, allowing the safest and most effective option for women struggling with mood disorders, especially PMS and PMDD.

Are you a Candidate for Ketamine Therapy?

The decision to pursue IV Ketamine therapy depends on many factors, including the holistic benefits of treating your mental health. You deserve to learn your treatment options for safe and rapid results. You should always speak with your doctors to learn about the risks and benefits of IV Ketamine therapy so you can make an informed decision. Learn more about the options for your depression by contacting Clarus Health today.