How Severe PMS Became PMDD And Prozac Became Sarafem

by Dr. Daniel J. Heller October 11, 2011

There’s a very good chance that you’ve never met anyone who was diagnosed with PMDD—premenstrual dysphoric disorder—before 2001. That’s because PMDD was almost unheard of before August 2001, when Prozac (Fluoxetine) went off patent. The Eli Lilly drug company responded by rebranding (a fancy drug company word for renaming) their bestselling antidepressant as Sarafem. They then began promoting Sarafem, and the very concept of PMDD, to consumers, gynecologists, psychiatrists, and general practitioners. This is a common strategy in the pharmaceutical industry: when a drug is about to go off patent, it is repackaged into a different color and shape of pill, usually, and promoted for a related but previously underutilized purpose.

Some have accused Eli Lilly of “inventing” PMDD, which is certainly untrue: there are research papers on PMDD going back as far as 1987. Although this is the year the FDA approved the marketing and sales of Prozac, there’s no reason to think that that research was related to the release of the drug. Shortly after it hit the market, doctors from many disciplines were thrilled with the effectiveness of Fluoxetine, and were exploring its use for many conditions. It’s quite logical that it was tested for severe PMS, because previous generations of anxiolytics and antidepressants had been prescribed for PMS before that.

Still, if not for Eli Lilly’s interest in extending their Fluoxetine franchise, there can be little doubt that PMDD would not be anywhere as recognizable as it is today.

At PMS Comfort, we are all for greater recognition of PMS, especially severe PMS, and PMDD. However, a mistaken belief has taken hold across the medical universe, among researchers, doctors, and patients that PMDD and PMS are completely separate conditions. They’re not. The main difference between them is that PMDD received a very clear medical definition in the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), while PMS received a weak definition in 2000 that has never been updated. Since medical doctors understandably embrace clear diagnostic criteria, and because there are now drugs approved for the treatment of PMDD, it has an imprint of legitimacy that PMS does not seem to have. 

But you only need to just scratch the surface to see that there is major overlap between their possible symptoms, and to realize that both PMDD and moderate to severe PMS, by definition, interfere with life and living. This is a source of confusion: while mild PMS is a mere annoyance, moderate to severe PMS interferes with women’s lives to a similar degree as PMDD. In fact, they're really not separate conditions. We wish more medical professionals were aware of this fact, because it might help women understand it also.

We are at the forefront of those trying to get PMS and PMDD the recognition, understanding, and compassion they deserve: unfortunately, too much of the wrong kind of attention gets focused on them. And we are pleased that more and more women are realizing that drugs aren’t the only answer for premenstrual symptoms. Natural and holistic treatments are safe, effective, and were never patented in the first place.

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About The PMS Comfort Blog

The PMS Comfort Blog is our informal way of keeping you up to date on women’s health issues that we think are important; timely; underappreciated; useful; or just interesting. And, we’ll admit, sometimes we can’t resist poking some good-natured fun at the way the mainstream media portrays health, natural health, and women’s health issues. As always, we’d love to hear from you and are interested in knowing what you think and feel about these or other topics. Leave a comment for us, we’ll always respond. And, if there’s a women’s health topic that’s of interest to you, or that you find confusing, let us know! We want this blog to be helpful to you.


Dr. Daniel Heller is the primary author of this blog, the developer of our PMS Natural Relief Programs, and the founder of He is a holistic naturopathic doctor in Northern California with over 16 years experience helping thousands of women recover from PMS, PMDD, as well as helping women, children, and families find natural answers to all manner of health challenges.


PMS Comfort is here to support you with detailed, practical knowledge presented in a balanced manner you can trust. We are committed to educating, informing, and empowering womenregarding PMS, PMDD, and women’s health, and to providing natural relief for premenstrual symptoms.



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