Drug Marketing Campaign Prompts Patient Requests

After Eli Lilly launched its advertising campaign for Sarafem as “the first and only prescription medication for PMDD,” psychiatrists began fielding frequent requests for the drug from patients.

“Doctors will tell you that the marketing of pharmaceuticals is a mixed blessing,” said Wendy Hookman, a psychiatrist who directs the women’s mood disorders program at Georgetown University Hospital. Although it helps educate patients to seek treatment, “it can be difficult when a patient gets their mind set that a particular medicine is best for them.”

Clinicians such as David Rubinow, clinical director at the National Institute of Mental Health, say that concerns over the disorder are about politics, not science. If a woman were in distress and an effective treatment were available, common sense would dictate that she should get help. Several large studies have shown that medicines such as Sarafem are effective in reducing the symptoms of premenstrual syndrome, or PMS, and premenstrual dysphoric disorder, or PMDD. Women typically take Sarafem every day, but it may also be effective when used briefly before periods.

“Abuse is much more likely to derive from the failure of treating clinicians to confirm the diagnosis of what they are treating,” Rubinow said. “There is a very high degree of false-positive self-assessments--people assume they are suffering from PMS or PMDD when, in fact, they are not.”

The American Psychiatric Assn.’s manual recommends that doctors ask women to keep daily journals about their mood states through two menstrual cycles before making a diagnosis. But “we are not a patient society,” said Nada Stotland, a psychiatrist at Rush Medical College in Chicago who was designated by the association to speak about premenstrual dysphoric disorder. “People feel they know what they have, and we don’t want to step on a woman’s authority to say what’s going on in her own body.”

As a practical matter, asking patients to wait two months may not be realistic, some doctors say.

When Kerry Burke, a 26-year-old management consultant in Alexandria, Va., found herself breaking down and crying before her period--behavior that she found disruptive to both her job and personal life--she went to see Hookman. After an hourlong evaluation, Hookman put her on a medication similar to Sarafem and, in a few weeks, Burke reported her symptoms much reduced.

“If a patient is not functioning, if she is saying she is staying home from work because she’s afraid she is snapping at her boss and she is going to lose her job, you are not going to keep her out of work for three months before you help her,” Hookman said.