Question. I have developed a panic disorder. My first attack occurred on the day of my menstrual period. It went away over the month, but then it came back with a vengeance when I had PMS the following month. I had my worst attack ever a few hours before I started my period for the third time. I am taking Serzone and my doctor recently put me on Klonopin, which does relieve some anxiety. Are we simply treating a symptom of PMS or is this a symptom of a hormonal imbalance?
Answer. You are raising a complex and intriguing question. The short answer is, your panic attacks are probably not simply a symptom of PMS, though they may be related to hormonal factors. Most women with PMS (or the more severe version, called premenstrual dysphoric disorder) do not have panic attacks, either premenstrually or the rest of the month. However, anxiety disorders are more common in women with PMS or PMDD than in healthy controls. Moreover, premenstrual worsening of ongoing anxiety has been reported in some studies.
One of the hormones that fluctuates during the menstrual cycle is progesterone. This hormone may actually have antianxiety effects. During the final days of the menstrual cycle (e.g., days of 25-28 of a 28-day cycle), progesterone levels fall, which may account for increased anxiety or panic symptoms in some women. However, this does not necessarily point to progesterone as the best treatment for PMS. In one study, Xanax outperformed oral progesterone. Other medications, such as Prozac and Zoloft appear to be effective for both PMS/PMDD and panic attacks. Serzone also looks promising for both disorders, but there are still few studies available. Although there are other options, it sounds like you are on a reasonable combination of medications.
You may also benefit from a form of treatment called cognitive-behavioral therapy, if these attacks continue. This should be provided only by someone experienced in CBT, such as a behavioral psychologist.