Disruptive changes in mood and low energy level are among the most
common reasons women consult a physician. Usually no clear
physiological explantation for these changes can be found.
Many physicians feel uncomfortable dealing with patients with
these complaints. The purpose of this paper is to discuss a
practical approach to helping women with such conditions.
A variety of terms have been utilized to refer to the situation
in which a female patient has decreased energy or labile mood.
Premenstrual Syndrome (PMS) and chronic fatigue syndrome (CFS)
are currently popular terms. An association of low mood with
menstrual cycle phase is undoubted, with the late luteal-early
premenstrual phase most commonly associated with depression
and irritability. It seems likely that women with PMS and
those without it do not differ in circulating hormone levels
during their cycles but rather in the brain response to these.
Estrogen and progesterone receptors exist in the brain and
change during the cycle.
Elaborate diagnostic efforts are rarely rewarding in managing mood
and energy disorders. Of more value is a careful history particularly
concerned with the pattern of mood changes and with life stresses,
accompanied by a thorough physical examination and laboratory
tests. In most cases, changes in mood and energy are a variant
of clinical depression. Changes in energy and sleep may be
more evident than low affect. Treatment with an appropriate
antidepressant, usually a selective serotonin re-uptake
inhibitor (SSRI), benefits most of these patients. Allowing
the patient to express concerns about stressful life
situations is often of great value.