Understanding Sarafem: Memorial's Experts Weigh In on the Value of this Exciting and Controversial New Drug.
May 2001 — You may have seen the commercial:
Several women friends are chatting it up at a restaurant, and when the conversation turns to PMS, they empty the contents of their handbags onto the table and display their favorite over-the-counter medications with astonishing zeal. The show-and-tell session comes to a halt when one woman triumphantly produces a single bottle of pills that claims to alleviate every major symptom - something that the other brands won't do.
In the stunned silence that follows, every woman at that table is sold on that brand. Presumably, so are you.
A New Treatment Option
Premenstrual syndrome afflicts women all over the world in varying degrees and with varying symptoms. While home remedies and over-the-counter meds work well for most of them, a small percentage of women have a harder time finding relief and may experiment eagerly with different products, as do the women in the commercial above.
Ask anyone whose personal experience with PMS has been especially trying, and you'll realize that the only thing harder than finding a safe, reliable cure is finding people who take you and your symptoms seriously.
Recently, doctors have recognized a form of PMS so severe that it warrants a separate name: premenstrual dysphoric disorder (PMDD). Affecting three to five percent of menstruating women, this condition can be treated with psychiatric medications known as selective serotonin reuptake inhibitors (SSRI).
Now, amid all the usual products on the market, another contender joins the pharmaceutical fray. Eli Lilly and Company, the makers of Prozac, recently introduced Sarafem, the first FDA-approved drug to treat PMDD. What may surprise you is that Sarafem isn't really new. Its active ingredient is identical to that of Prozac.
Buyer Beware
Marketing the world's most famous SSRI under a new name allows for a more distinct brand identity, which is advantageous both for the manufacturer and the consumer. Since Prozac is already approved by the FDA for the treatment of depression, bulimia, and obsessive-compulsive disorder, adding yet another indication to that list would confuse the general public. By calling the drug something else, not only would Eli Lilly carve out a distinct niche in the competitive pharmaceutical arena, it would allow for a targeted marketing campaign that would encourage women to take the drug without having to worry about the stigma associated with being on Prozac.
"Sarafem's marketing has been tremendous," says Dr. Peysaf Worthalter, a psychiatrist on the medical staff of Memorial Regional Hospital. "It's got a feminine-sounding name, and the pill is pink. Prozac is yellow and green."
However, just because both drugs have been proven to alleviate PMDD, it doesn't mean that women should "borrow" these pills from people who have them. Despite their apparent safety, Prozac and Sarafem are still powerful drugs and should not be taken without a prescription.
"There is no single specific treatment for PMS," says Dr. Robert Siudmak, Chief of Obstetrics and Gynecology at Memorial Regional Hospital. "Sarafem is a very good drug, but it's not right for everyone. Different things work for different people."
Women who suffer from PMS should explore all other avenues before considering prescription medicines, he adds. "I make sure patients follow an appropriate diet, take vitamins, exercise regularly, and eliminate smoking, alcohol, caffeine, and other toxins first."
When should women inquire about Sarafem or other SSRI drugs?
"Women should consider these drugs in conjunction with the above recommendations or when nothing else seems to work," he says.
Women who talk to their doctors and pharmacists about these drugs should be prepared to discuss all other drugs or herbal supplements they are taking, so as to avoid the dangers of drug interaction, according to Dr. Worthalter.
"Women who take two or more SSRI products at the same time can have side effects such as agitation, dizziness, stomach pain, or lack of sleep," he says. Another class of drugs called monoamine oxidase inhibitors (MAOI) can even be fatal when used in combination with Sarafem or Prozac.
Feminist Considerations
Pharmacology aside, the advent of Sarafem resurrects the age-old feminist issues surrounding the meaning of premenstrual syndrome.
"Throughout history, women in patriarchal societies were prevented from expressing certain emotions, including aggression, and economic disadvantages contributed to that suppression. Because these women had a limited sense of control over their environment, they were more likely to express their frustration through physical outlets," says Memorial Healthcare System psychologist Rosa Maria Rigol, Ph.D.
In other words, while PMS is no doubt a real set of physical and psychological symptoms, a woman may be more likely to believe her symptoms are severe if she or her culture accepts PMS but rejects other forms of feminine expression.
The danger of this mindset is that these women may emphasize their symptoms and consequently underestimate other factors in their lives. They run the risk of not being able to "recognize and assume ownership of some feelings. They may say, 'It's not me, it's the PMS,' when in fact there may also be some other problem," says Dr. Rigol.
Because of all the recent hoopla over Sarafem, some women with mild or moderate PMS may end up asking for the drug when less drastic treatments are more appropriate.
"PMS has been pathologized, and in my opinion, that vilifies the reproductive cycle. I fear that marketing this drug only reinforces that," she says.
To avoid overestimating the impact of PMS, Dr. Rigol says that in addition to considering medications and other physical remedies, women should learn psychological skills to acknowledge and deal with their emotions, no matter what time of month it is.
"The more control women have over their bodies and their environment, and the more choices they have over their treatment, the less likely they are to see medication as the only option," she says.