Is it real? Well, recently a charge of first degree murder was reduced to manslaughter based on P.M.S. (Premenstrual Syndrome) as the reason for diminished responsibility. I believe it is real.

The syndrome occurs in about 40% of women and 10% of these women have severe symptoms. The incidence PMS peaks in the mid-thirties, but the symptoms tend to be the worst in the fourth decade.

The symptoms usually occur 2-3 days before the onset of the menses and end with its occurrence. It can be present a week before starting and rarely may be a problem the whole second half of the cycle. If the symptoms are present more than 2 weeks out of the month, or if they continue past the menses, the diagnosis is in doubt and another problem may be the culprit.

The symptoms are two fold:

Theories on cause include: abnormal ratio of estrogen and progesterone, the release of the body's natural pain relievers, increase prolactin level (the hormone of milk production), a vitamin B-6 deficiency and this all may be intensified by the psychodynamics of the thirties and forties. As in many diseases that had multiple treatments, none worked very well or all the time. It was and is hard to scientifically study PMS because of the subjective nature of the symptoms.

There are several treatments that are effective in some women. Counseling is key to any treatment, the fact that PMS exists and they aren't crazy is enough for some women. A symptom diary can also give the problem some predictability and be a forum for discussion of therapy. Medication is addressed to the individual patient and problematic symptoms. Birth control pills, progesterone, diuretics, vitamin B-6, sleep medications and bromocriptine (anti-prolactin medicine. Symptomatic treatment, if any, is tailored to the individual symptoms.

Currently, serotonin re-uptake inhibitors are a global treatment that covers many symptoms with one treatment. These are now the standard proven treatment for bad PMS. These are also used as anti-depressants: Prozac, Zoloft and Paxil. These are very familiar meds in the North Dallas area and they are especially good for the emotional upheavals of PMS. The dose for PMS is generally less than that for depression. These meds have changed the lives of many women who suffer with severe PMS. The down side is you must take them every day month in and month out.