This subgroup of PMS is the least prevalent and is relatively rare in its pure form. Its key symptom is depression.
This depression is usually associated with low levels of biogenic amines in the synaptic vesicles of the Central Nervous System. In PMS-D patients this is most likely due to increased type A-MAO levels as a result of decreased peripheral estrogen. This is in contrast to PMS-A which has elevated levels. The decreased ovarian estrogen output in the luteal phase has been attributed to a stress-induced increase in adrenal androgens and/or progesterone.
Lead blocks the binding of estrogen to receptor sites and but has no effect on progesterone. A chronic magnesium deficiency may be a contributing factor as it results in increased lead absorption and retention, while decreasing resistance to stress. Hair mineral analysis has shown that, in general, PMS patients have higher heavy metal levels and lower magnesium levels than non-PMS controls. Menstrual cramps, irritability, fatigue, depression and water retention have been lessened with magnesium, usually given along with calcium and often with vitamin B6. Magnesium is often at its lowest level during menstruation. Supplementing magnesium in the same amount (or more) as calcium (about 500-1,000mg daily) is currently recommended for premenstrual problems.
In one study, women received 50mg per day of vitamin B6 or a placebo for 3 months. Symptoms amongst these women included depression, irritability, tiredness, headache, breast tenderness and swollen abdomen/hands. At this dose depression, irritability and tiredness were the only symptoms to respond and they were reduced by 50%. [Gynecol Obstet Invest 1997;43(2): 120-124]
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