Brief Answer:
Probably SSRI is better option for your condition

Detailed Answer:
Dear XXXXXXX
Thanks for using healthcaremagic.

I read your query and understand your concerns.

After going through all the problems encountered by you, I would prefer to use SSRI group of medication (e.g. Fluoxetine) instead of Mirtazapine as an antidepressant. The reason for my preference is better efficacy of Fluoxetine in both anxiety and PTSD symptoms. It is also has better evidence of effectiveness in premenstrual depression. The another thing I like to add is beta blockers group of medication such as propranolol for control of symptoms due to over active thyroid for a short period, provided there is no contraindication.

I like to emphasize here that short duration of your menstrual cycle could be related to over active thyroid. Once the thyroid is controlled there will be resting of menstrual cycle as earlier.
Having said this it will be better if you can get other hormone profile along with T3, T4, TSH. The recommended hormone testing in your case is LH, FSH and serum prolactin.

I hope this answers your question at this stage. You can talk to your doctor about some change of medication as described above and laboratory request for hormonal testing.

If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
Thanks and regards
Dr Ashok Kumar

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Brief Answer:
fluoxetine has evidence in premenstrual depression

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me with encouraging feedback.

As per available data at this moment Fluoxetine has the best evidence in management of premenstrual depression. Other than the pharmacotherapy understanding your symptoms and managing stress is of paramount importance in that period. Discuss these things with your psychologist can give you a great relief.

Regarding stress management I am writing down few of the strategies that will help you in management of stress leading to reduction of your symptoms.

1. Diet: Ensure intake of adequate quantity of fiber. 2 servings of vegetable salad and 2 servings of fruits( One preferable citrus fruit).

2. Ensure adequate water intake: Follow rule of 1 which i usually advise. 1 glass of water 1 hour before and 1 glass of water 1 hour after every meals will ensure adequate consumption of water .

3. Early morning Exercise: Brisk walking for 30 minutes at a stretch preferably in garden will be very helpful. Walking is the best exercise, it also promotes release of Endorphins( naturally occuring pain killers released in brain) which causes mood elevation and generalized feeling of well being.

4. Avoid tea/coffee/ nicotine and alcoholic beverages: If at all you want to drink something, drink fresh lime water.

5. Start your day with a glass of Lemon water with 2 spoons of honey added.
have a good breakfast

6. Don't take work so seriously: We all have the feeling to excel in our respective fields and don't spend adequate time with our own self trying to understand our own needs. Spend time with your family and friends.

7. While working take frequent regular breaks: Taking regular breaks will not waste the time, but it will definitely increase the productivity, concentration and reasoning. Take break for 5 minutes every 30 minutes.

8. Avoid late night socialization

9. Avoid starring for longer time at the computer screen or TV for longer time

10. Steam inhalation before going to sleep will be very refreshing.

11. Multivitamin and Calcium supplement.

I am sure that many things that what I written above is followed by you but intensifying them and adding few more strategies is going to help you.

Adding one or two medication is ok when absolutely necessary but we are not supposed to prescribe a pill for every ill.

I hope this clarifies the situation.

If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health.

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