Combination of SSRI and chromium for PMS (PMDD)

Q: My sister suffers from the extreme form of PMS a.k.a. PMDD and has tried various antidepressants to treat it with varying but always minimal success (and lots of side effects). Most recently her Dr. prescribed birth control pills to artificially "force" her hormones in line and hopefully relieve some of her PMDD, it's early with this treatment though and carries its own side effects like headache and nausea. When I read about chromium and your case studies with the women who had depression and severe PMS I immediately thought of my sister. I have been searching for something, anything to help ease her symptoms. I have also noticed that my own PMS is continuing to worsen every year, although not to the extreme (yet) that she has it. I am very excited to try chromium for myself and suggest it to my sister.

May I ask, would chromium be taken every day in the case of PMS/PMDD or just at the time of cycle when the symptoms are ocurring?

A: Thank you for your question. Unfortunately, your sister's experience is usual. Large-scale, well-designed studies have demonstrated that a class of antidepressant medications - known as selective serotonin reuptake inhibitors or SSRIs for short - is more effective than placebo for relief of symptoms of severe PMS. But, as is the case with your sister, these medications usually causes annoying side effects with the result that many women stop taking them.
In an excellent study of Prozac (fluoxetine) for PMS, 4 out of 10 women dropped out of the study, presumably due to undesirable side effect. In a study of Zoloft for PMS, 2 in 10 women dropped out of the study, again probably due to medication side effects. Dr. Thwe T Htay has written an excellent review article on PMDD.

In my practice, I have given dozens of women combination chromium picolinate and an antidepressant medication. Often they have reported complete and dramatic absence of symptoms of PMS. I have found that regular dosing throughout the month is better than half-cycle dosing.

Dr. Anna L. Stout (Director of Women's Behavioral Health at Duke University Medical Center) and I decided to test my theory under rigorous scientific conditions. We conducted a small, placebo-controlled, double-blind study in which we administered the combination of 400 micrograms of chromium picolinate per day and 50 mg of Zoloft per day for one month. The next month, we administered Zoloft and a placebo. The results of the study supported my theory that chromium boosts the efficacy of Zoloft and and reduces side effects. We are presently writing up this clinical study.

The Duke study was a pilot study and was too small for calculation of statistical significance. More data is needed.

Please take my general advice to your healthcare professional for further guidance. If you decide to try an SSRI and chromium for sever PMS, please let me know the results. I hope other women will report their experience of combination of chromium and an SSRI for PMS. Perhaps I can use your story and that of other women to support a large study. Thank you.