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CHAPTER 10 - IMAGES OF PMS
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Is It Real? You Bet!
Over the past years we have scanned many women with PMS just before the onset period,
during the worst time of their cycle, and then again a week after the onset of their
period, during the best time. Most often when PMS is present we see dramatic differences
between the scans. When a woman feels good, her deep limbic system is calm and cool and
she has good activity in her temporal lobes and prefrontal cortex. Right before her period
when she feels the worst her deep limbic system is often overactive and she has poor
activity in her temporal lobes and prefrontal cortex!
I have seen two PMS patterns, clinically and on SPECT, that respond to different
treatments. One pattern is focal increased deep limbic activity often accompanied by
temporal lobe hypoperfusion that correlates with cyclic mood changes. When the limbic
system is more active on the left side it is often associated with anger, irritability and
expressed negative emotion. When it is more active on the right side it is often
associated with sadness, emotional withdrawal, anxiety and repressed negative emotion.
Left-sided abnormalities are more a problem for other people (outwardly directed anger and
irritability), while right-sided overactivity is more an internal problem. Focal deep
limbic and temporal lobe findings, worse during the premenstrual period, often respond
best to lithium or anticonvulsant medications, such as Depakote, Neurontin, Lamictal or
Tegretol. These medications tend to even out moods, calm inner tension, decrease
irritability and help people feel more comfortable in their own skin.
The second PMS pattern that I have noted is increased deep limbic activity in conjunction
with increased cingulate gyrus activity. The cingulate, as we will see, is the part of the
brain associated with shifting attention. Women with this pattern often complain of
increased sadness, worrying, repetitive negative thoughts and verbalizations (nagging) and
cognitive inflexibility. This pattern usually responds much better to medications which
enhance serotonin availability in the brain, such as Zoloft, Paxil or Prozac. Here are
several examples.
Case Studies
Haley
Andrea
Michelle
J.J.
Chris
Danielle
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