THE PHARMACIST’S ROLE IN PMDD
Premenstrual dysphoric disorder is a fairly recent discovery in women’s health; yet, it currently costs the nation millions of dollars a year in direct and indirect costs.Most costs associated with PMDD patients are related to days missed from work or reduced work performance due to symptoms. Premenstrual dysphoric disorder symptoms result in a huge economic and health burden for our nation. To reduce the incidence of PMDD, it is crucial to understand the criteria and many different treatment options available.
When counseling a patient who may be suffering from PMDD, it is important to seek information. Table 6 provides a list of useful questions for the pharmacist to ask. The patient’s complete medical and personal history should be carefully reviewed and assessed. It is important for the pharmacist to then make a decision to triage the patient to a physician or begin to work with the patient to institute an effective self-care program.
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If the self-care path is selected, nonpharmacological treatment should be considered first before medication. Pharmacists play a key role in counseling patients on the nonpharmacological and pharmacological treatments available. Understanding the patient helps the pharmacist to individualize patient therapy. A pharmacist should be well educated on the symptoms, treatment approaches, and strategies. Therefore, the patient should be encouraged to chart and identify target symptoms for at least two consecutive menstrual cycles. A healthy, well-balanced diet including sufficient vitamins, calcium, and minerals should be recommended. The patient should be informed of the negative association between increased caffeine, alcohol, nicotine, and drugs of abuse as triggers for specific premenstrual dysphoric disorder symptoms. Supportive therapy should also be discussed. In addition to nonpharmacological therapies, pharmacists should always discuss indications, side effects, and common concerns regarding medications to reduce symptoms of PMDD. The pharmacist should remember that premenstrual dysphoric disorder is an emotionally, socially, mentally, and physically debilitating condition. Respecting the concerns and confidentiality of the patient is significant for optimizing patient care. Patients need to aware of the wide spectrum of symptoms experienced in PMDD. Furthermore, because premenstrual dysphoric disorder affects the patient both emotionally and physically, it often interferes with family and relationships. The pharmacist should be sympathetic to all individuals involved in the care of the PMDD patient.
SUMMARY AND CONCLUSION
The most important point to remember when selecting the appropriate course of treatment for premenstrual dysphoric disorder is that therapy must be tailored to the individual patient’s needs and responses. Studies recommend nonpharmacological adjustments prior to initiating drug therapy. First-line pharmacological therapy includes SSRIs; second-line agents are anxiolytic agents. Finally, ovulation suppressors, oral contraceptives, or oophorectomy could all be considered after nonpharmacological and pharmacological agents (i.e., first- and second-line agents) fail. However, before changing classes of drugs or considering alternatives such as ovulation suppressors, it is important to note that the timeline to alleviation of symptoms may differ among patients. While many patients may notice relief of symptoms within three to five days of starting therapy during the luteal phase, many other patients may need to continue therapy for several cycles before noticing improvement. Although no data are currently available as to how long therapy should be continued, at least nine to 12 months of treatment is recommended. Once again, the pharmacist plays a crucial role in the care of the PMDD patient with regard to symptoms and treatment options.
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