09/29/2002

BY LAURA MEADE KIRK

Journal Staff Writer

At first, Lorie Johnson thought she had PMS.

About 10 days before her monthly period, she'd start feeling tired and irritable. But as the days progressed, she'd become withdrawn, depressed and filled with an uncontrollable rage -- she'd scream at her husband and three children and throw everything from shoes to pots and pans across the room.

"I was psycho mom," says Johnson, 39, of Pawtucket. Even after her period started, she'd have several more "bad days" where she'd curl up in her bed, unable to cope with life at home or at work.

"I thought I was going crazy," she recalled. So did her husband, Ron.

Then one day, she heard an ad on the radio recruiting volunteers for a study testing medications for women with severe premenstrual symptoms.

By the end of the six-month study, Johnson was diagnosed with premenstrual dysphoric disorder, or PMDD. Finally, she understood what was wrong with her -- and she was able to get medication to get her life back on track.

Now, she says, "I'm normal again."

PMS, OR PREMENSTRUAL SYNDROME,
was for years the blanket diagnosis for more than 100 types of physical and mental symptoms women would complain of in the days preceding their monthly menstrual cycle, explained Dr. Nada Stotland, a professor at Rush Medical Center in Chicago who's one of the nation's top experts on the topic, according to the American Psychiatric Association.

Up to 90 percent of all women of childbearing age experience some symptom of PMS, from mild irritation and moodiness to cramps, bloating or breast tenderness.

But 3 to 5 percent of all women suffer from the far more debilitating PMDD, a mental disorder identified in 1987 and given this name in 1994. It has a handful of specific symptoms that interfere with all aspects of a woman's daily life for a few weeks each month.

"The criteria for making something a disorder, rather than just a feeling you have, is that it interferes with your life," Stotland explained. "It has to interfere with your relationships, or your work, or your mood."

It's like a "mini-depression," she said. And it's only within the past few years that the FDA has approved medications that can be used to treat PMDD, including the anti-depressants fluoxetine and sertraline, marketed under the names Sarafem (or Prozac) and Zoloft.

Studies show these medications can be effective whether they're taken daily or for the two weeks before a woman's period, Stotland said.

Johnson, like many, finds it easier to take the drugs every day. She's just grateful that she's found something that helps.

JOHNSON DIDN'T EXPERIENCE
even the mildest form of PMS until about six years ago, she said, after the birth of her third child, Brandon, now 7.

That's when she began to notice she was increasingly fatigued and irritable, especially in the days before her period. "As the days progressed, so did the severity of the symptoms," Johnson said.

Her condition worsened over the coming months and years, to the point where she'd regularly lash out at her husband, Ron, and her older kids, Chancelee, now 18, and Nicole, now 15. One time it was so bad that when her son didn't take out the trash, she could barely prevent herself from dumping the garbage all over his room, she said.

When she wasn't angry, she was totally withdrawn, refusing to talk to family or friends, unwilling to cook dinner or handle daily chores. She'd simply curl up in bed. "There were times I could not, emotionally or physically, function," she said.

At first Johnson thought she must have been suffering from PMS, like some of her friends. "But what I was experiencing was on a different scale," so severe that she feared she was losing her mind. Her husband and kids began to avoid her, not knowing when she was going to explode.

"I was a bad mother, a bad wife. I couldn't cope," she said. "I realized what I was doing was damaging [her relationships] but I couldn't stop myself. . . . Nobody wanted to be around me."

A few days after getting her period, she'd be back to normal for a week or so -- and she'd spend that time apologizing for everything she'd done wrong and all the people she'd hurt. But eventually, her apologies and excuses fell on deaf ears.

"Finally, my husband said, 'We don't care what it is. You need help.'

"My husband is very old school," Johnson explained. "As far as he was concerned, there was no such thing as PMS. It's something you made up so you didn't have to clean and cook."

But Johnson knew differently. So she began seeing a counselor, in hopes of find out what was wrong.

DURING COUNSELING, JOHNSON
began tracking her "good days" and "bad days" and confirmed that her symptoms were linked to her menstrual cycle. "I'd write tired, cranky, then RAGE would be slapped across the page in big red letters."

She tried some of the standard remedies for PMS symptoms -- watching her diet, increasing her exercise and getting more sleep. She also tried the herbal supplement St. John's Wort.

None of these has been clinically proven to help relieve the symptoms of PMS, Stotland noted. They didn't help Johnson either.

"What I was trying to do was to manage the symptoms, and they were unmanageable," Johnson said. ". . . I was trying with every fiber of my being to remain in control [of myself]. It was exhausting."

And it wasn't working.

Johnson, who'd been a stay-home mom, even took on a job as a customer service administrator for a local safe company. She thought maybe she needed to pursue outside interests and find a life outside her home.

But that didn't help. In fact, when she was at her worst, she couldn't even deal with going to the office.

But it was while she was at work one day, about three years ago, when she heard a radio ad seeking women who suffered from severe PMS symptoms to be involved in a research project.

As Johnson listened to the description of the type of volunteer being sought, she remembers thinking: "That's me."

THE FIRST STAGE
of the six-month study was to determine whether the volunteers were suffering from PMDD or something else, explained Dr. Teri Pearlstein, who headed the study here in Providence. The diagnosis can't be made until patients track their emotions for at least two months, to see whether their symptoms are linked to their menstrual cycles and are disruptive enough to impact their daily lives, she said.

"These women feel that they are not coping, that they get much more overwhelmed with pressure the two weeks before [their period]," Pearlstein said. "They may be aware that they're overreacting, and that they're lashing out." But they can't seem to control themselves, she said.

Many women who seek treatment for what they believe to be severe PMS, or even PMDD, actually suffer from other types of mood and anxiety problems, including depression, explained Pearlstein, a professor at Brown University School of Medicine and director of the Women's Behavioral Health Program at Women & Infants Hospital. She's been studying PMS and other mood disorders for 17 years.

But many women don't want acknowledge their depression, or they don't want to seek treatment because of the stigma attached to the disease. So it's easier to dismiss their irritability or mood swings as PMS, Stotland said.

Though PMDD can strike at any time, and usually starts to affect women in their mid-20s, most women don't seek help until their mid-30s, when the symptoms affect their relationships and family lives, Stotland said.

In some cases, the treatment for PMDD is the same as the treatment for other problems, Pearlstein said. But an accurate diagnosis is critical to determine the best overall course, which can also include counseling.

The good news is that more women are seeking treatment -- regardless of their ailment -- thanks in large part to the marketing efforts of drug companies that produce Sarafem and Zoloft, Pearlstein said. Women at least know there's help.

JOHNSON KNEW, IN HER HEART,
that she wasn't depressed. After she tracked her emotions in an electronic diary for several months, the study's doctors confirmed that Johnson was suffering from PMDD.

Indeed, Johnson said the doctors told her she had a "classic clinical case study" of PMDD. So she went on to the second stage of the study, in which some participants were given Zoloft to treat their symptoms and the others were given a placebo.

Because it was a blind study, neither the researchers nor volunteers were told who was given the drug. But Johnson said she knew she was taking the placebo, simply because it had absolutely no effect.

"I was still crazy and off the charts," she said.

But she stuck with the program, knowing that at the end, Pearlstein would take her on as a patient. When the study ended, Pearlstein prescribed Zoloft for Johnson. She noticed the difference almost immediately, she said, and within two months, she was back in control.

"I STILL GET PMS SYMPTOMS,"
Johnson said. "I still feel fatigued, and get a little irritable, but they're controllable now."

She recently separated from her husband after nearly 20 years of marriage, but she said that's because of reasons other than her PMDD. Meanwhile, she enrolled in school, at the University of Rhode Island, trying to start her life over in so many ways. She quips that she's a freshman, studying in Providence, while her eldest son is a freshman at URI in Kingston.

"I'm normal now," she said. "My relationship with my children is 110 percent better. I can be a wife. I can be a mother. I can have a relationship."

"My life is on track," Johnson said. "I won't say it's good because there are good days and bad days (given other issues in her life). But I'm definitely on track."