Adequate levels of serotonin help the body regulate sleep, appetite, and mood. When levels of serotonin decrease at synapses, the body craves more. Major depression, insomnia, and eating disorders can directly result from a body's craving for serotonin. Different women respond differently to the decrease in the level of serotonin. Diagnosis of PMS is therefore a very difficult and subjective process.
Patients record their daily symptoms on a chart to aid in diagnosis.
Dr. Endicott noted that antidepressants are highly recommended for this small percentage of women. There are women, however, who do not qualify for PMDD despite having some symptoms that are very intense. Antidepressants prescribed to them may be beneficial as well. Most doctors prescribe antidepressants to patients whose depressive symptoms do not improve after they make serious changes in diet, exercise, and other health habits. Instead of prescribing antidepressants, doctors may also prescribe hormonal therapy, which consists of taking oral contraceptives and estradiol for estrogen.