Does the combination of an SSRI and chromium help PMS?

Does the combination of an SSRI and chromium help PMS?

QUESTION:

Hi Dr. McLeod,
I was taking 10 mg. of Prozac for approximately 4 1/2 years for what I thought was difficult PMS. Even with this small dose, I benefited quit a bit and even experienced benefits in areas that surprised me (overall confidence increased dramatically) I went off in January because I started an In Vitro Fertilization (IVF) cycle. IVF ended in April and I hit rock bottom. It has taken the last three months to allow the hormones from the IVF to leave my system, and I have to say I feel much better. However, I am still somewhat irritable, blue and am experiencing chronic insecurity. I’ve come to the conclusion that perhaps I do in fact have low serotonin and perhaps always have. I went back on 10 mg. of Prozac this week.
Here are my questions:
1. Over the long term I gained 10-15 lbs on the Prozac. That was my only side effect but it is a big one and I am very concerned this will happen again. I bought Solgar brand Chromium Picolinate (500 mcg) after reading that it can help with this side effect of an SSRI. Is it safe to take long term along side the Prozac?
2. Are there any other supplements that should be avoided? I also take Asacol for mild ulcerative colitis, is this okay to take with the Chromium Picolinate?
I look forward to reading your answer on the blog.
Sincerely,
R. K.

ANSWER:

Dear Ms. K,

Thank you for contacting me with your interesting and important questions.

Not only is it safe to add chromium, the combination of chromium and Prozac (and other SSRIs) seems to work better than SSRIs alone for PMS and atypical depression. I do not know of any long term ill effects. Some of my patients have taken chromium along with an SSRIs for over a decade with great benefit and no side effects. In some cases, they have NEVER had another difficult period.

There are no reported interactions among chromium, Asacol and Prozac.

In case you don’t already know, women with severe PMS tend to relapse after discontinuing treatment with antidepressant medications, according to a recent study published in the May issue of the Archives of General Psychiatry.

Dr. Dr. Ellen W. Freeman and colleagues at the University of Pennsylvania School of Medicine in Philadelphia studied 174 women with severe PMS, known as premenstrual dysphoric disorder (PMDD). Some of the women took the antidepressant medication, sertraline, for 4 months and were then switched to a placebo or dummy pill. Other women took sertraline for 12 months and were then switched to placebo. (Sertraline and Prozac are both selective serotonin reuptake inhibitors.)

Although 72 percent of the 174 women improved while taking sertraline, symptoms returned in roughly half of the women after discontinuation of sertraline.

This study suggests that the more severe your symptoms are before treatment, the greater your likelihood of relapse (return of symptoms) after discontinuation of treatment.

If you decide to add chromium, please let me know if it helps or not. Again, thank you for contacting me.

Malcolm McLeod, MD