Sarafem: The Pimping of Prozac for PMS

By Alicia Rebensdorf, AlterNet. Posted June 12, 2001.

Most of the time it's discussed, it's passed off as a joke. An office comment about cranky female staffers. A stand-up's punch line about his emotionally-unstable wife. The stereotypical, hyper-sensitive, chocolate-seeking bitch: PMS is cliché.

But for many women, it's also a lot more. From extreme irratibility to emotional breakdowns, premenstrual symptoms aren't always so funny. I would know. Pre-period, I will weep over a parking place. I snap in a Safeway line. Everything can provoke me: traffic, a broken dish, an unenthusiastic hello. There are times when I have hidden in employee bathrooms, humiliated by my inability to control myself. Once I get my period, I feel fine, but during those days I wonder if the mental illness in my family gene pool has finally claimed me.

When I first saw an ad for a pill to treat something called Premenstrual Dysphoric Disorder, or PMDD, I felt validated. Having a new clinical acronym to name my monthly mood swings made me feel less responsible, more normal. The commercial's snappy, bloated, irritated women reminded me of the bitch I don't want to be. The pill, spiraling across the screen like the bone in Kubrick's 2001: The Space Odyssey, looked like the next major evolution for woman-kind. I thought: At last our symptoms were considered seriously! At last, like the other great pill of the '60s, we could be liberated from the biological drawbacks of our sex!

That was my introduction to Sarafem, a new FDA-approved prescription treatment from the pharmaceutical mega-company Eli Lilly. With the active ingredient fluoxetine hydrochloride, Sarafem promises to make you "more like the woman you are." Such a lovely gesture. But it also turns out Eli Lilly wants to treat the women we aren't. Much more than a drug to relieve monthly moodiness, Sarafem is a wolf in sheep's clothing.

Snuggly Sarafem

And what a soft wool they've weaved. Intrigued by Sarafem's ad and interested in ways to rectify my monthly Jekyl and Hide complex, I visited Sarafem's heavily promoted website. Images of women seemingly plucked from Oprah's audience flashed across the screen, while nebulous phrases like "bloating" and "mood swings" flickered to and fro. Even in my entirely composed post-menstrual state, the site provoked the high levels of irritability Sarafem purports to solve. Yet after the annoying intro, the site's information was as fuzzy as their soft-lit television spots.

It says PMDD is "a distinctive medical condition" that is not "yet fully understood," but does little to distinguish it from most women's normal premenstrual syndromes. According to Eli Lilly, a woman must experience at least five of the following 11 symptoms for a diagnosis to be made: mood swings, irritability, tension, depressed mood, decreased interest in usual activities, difficulty concentrating, lack of energy, marked change in appetite, insomnia/ hypersomnia, feeling overwhelmed and bloating and breast tenderness. Eli Lilly goes on to claim that only 3 to 5 percent of women experience PMDD, but based on this vague diagnosis, almost every woman I know suffers from this mental disorder.

Eli Lilly qualifies its diagnosis by explaining PMDD's symptoms must occur about a week before one's period, remit on its onset and "interfere with daily life." But what "interfere" means is never explained. What's more, the company contradicts its own diagnosis by including a testimonial from a woman who "felt (her)self only one week of the month" before taking Sarafem.

Perhaps the only viable service the website offers is "Serene Screens" (pictures of flowers and natural scenes), "Soothing Sounds" (of crickets, cicadas and croaking toads) and "Inspirations." They'll even email you a "Daily Affirmation" that special time of the month. All in all, such ploys were good for a laugh -- a treatment I've always found to be an excellent antidote to PMS -- but I'm not sure this was Eli Lilly's intent. What they've actually adopted is a "Remembering Your Spirit" version of therapy, as if spinning sunflowers and babbling brooks are really going to calm those times when the computer looks like the enemy.

The Dubious Diagnosis of PMDD

So the site is annoying. But it's also alarming, if you pay attention. There's a bit hid deep in the website (and slipped in at the end of the TV ad) that reads: "Sarafem contains the same active ingredient as Prozac." When I first heard this statement, sitting in my living room wiping the tears away after some sappy-ass mini-series, it didn't sound so bad. I figured Sarafem must be diluted with a milder medicine, made in a lesser dose and/or taken less frequently. Certainly they wouldn't prescribe Prozac for PMS.

But it turns out that's exactly what Eli Lilly has done. The company changed the color of the pill from green to girly pink and turned the depression-stigmatized lable Prozac to the oh-so-feminine name Sarafem. Yet Sarafem/Prozac both require daily 20 mg. doses of fluoxetine hydrochloride. You don't take Sarafem any less often. You don't take it any smaller doses.

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