PMDD Antihistamines: Why They May Help — and Why Histamine Isn't the Whole Story

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It sure seems like everyone in their mother is talking about antihistamines like Allegra and even Pepsid for PMDD right now, and I asked you what you wanted to know and your questions were very clear. So here are the questions I'm going to be answering in this episode. Can you explain the whole PMDD, could be a histamine response thing? What are your thoughts on the Allegra Pepsid thing that's been circulating? Is there any natural relief, and how do I tell if I have PMDD and not PMI? So today on the Doctor Brighton Show, and hi, by the way, this is your host, Dr. Dr. Dr. Drillian. Right now, we're going to get into all of this. But before we do, I want to make sure that you don't miss out on this because if you're struggling with PMDD, I don't want you stuck guessing. I am a PMDD girly myself and it's no coincidence that I also have endometriosis ADHD and autism. Now, for a limited time, when you pre-order my book, ADHD and women, you're going to get access to my live PMDD workshop that's happening June 10th. In that training, I'm going to help you identify your PMDD pattern, understand how ADHD, histamine, and hormones are interacting in your body, and we're going to map out what to do in each phase of your cycle. But I'm also going to walk you through supplement strategies, what to talk to your doctor about, using dosages, and I'll be answering your questions live. Now, if that sounds good to you, go to Dr. Brighton.com/PMDD, grab a copy of ADHD and women, where I have an entire chapter on PMDD just for you, and then you'll also get access to the June 10th workshop. Okay, so I'm actually going to start with the question I've been asking, and that is, if PMDD affects millions of women, why in the hell are there only nine active NIH funded studies going on right now? Now PMDD, pre-menstrual dysphoric disorder, that's anticipated to affect anywhere from three to eight percent of menstruating women. Some research says it is highest 10 percent, and since medicine is absolutely awful, and not gaslighting women and believing them, that 10 percent may even be an underestimate. And while someone will definitely comment 3 percent, that's not a lot of women, no, that's millions of women. That's actually a lot of women. And so despite that, we've got limited research, limited treatment options, and a lot of women are being dismissed. So what happens when medicine doesn't give clear answers? Women start experimenting, because PMDD, and we're going to talk about the symptoms in this episode, we're going to talk about how to tell if it's PMS or PMDD, but I want you to understand that PMDD is so severe, the self-harm rate is so high that women are literally doing anything they can to remain on this planet with us. And I think anyone out there looking at you mainstream media, judging women, and saying, oh, they're using anti-histamine, these dumb women just following a TikTok trend. Like you should slow your roll, because what we're not talking about is why the hell don't we have more research studies going on, why is it so underfunded, and why do we act like women's lives are so expendable? Women are literally doing anything they can to stay with us, and I think we need to pause and we need to listen. Now, the anti-histamine conversation is not new, hi, I have endometriosis, PMDD, we've been talking about this for years now, and I think the first time I saw people on social media it was like five years ago. Women started trying it, it started working, and that's exactly how something like anti-histamine suddenly became a trend, but here's the thing, trends don't come out of nowhere. If it wasn't working, no one would be talking about it. So there's a biological reason, this works for some people, and that now brings me to your question, which is, can you explain the whole PMDD could be a histamine response thing? Okay, so here's the truth, yes, histamine can be involved in PMDD, I write about histamine all throughout ADHD and women because it is acting as a neurotransmitter, but histamine alone is not the whole story. Now, if histamine had nothing to do with PMDD, antihistamines wouldn't help anyone, and we're going to talk about antihistamines and the Pepsid H2 blocker in this episode as well, so stick around for that. Now, histamine is part of your immune system, but it's also playing role in inflammation in the brain, neuroinflammation, brain signaling, our mood, it can disrupt our sleep at night, and estrogen increases histamine release. So during certain times of your cycle, especially when your brain is already more sensitive, histamine can be amplifying your anxiety, your irritability, we see the perimenopause rage that can come with that, and even perimenopause sleep disorders, insomnia, brain fog, that can be part of the PMDD picture. Now, in your cyclical years, this is hitting you like 7, 10, maybe 14 days out of every month, put it in a perspective, y'all, that is six months out of every year, and we got nine research studies active right now, actively being funded by the NIH. I don't think so. That is lame. If you are in perimenopause and you have PMDD, this can become a lot more unstable and unpredictable, and the rage can be amplified. Now you add on top of that, having ADHD or autism, which is commonly associated with emotional dysregulation, and ADHD and autistic brains have a propensity towards throwing histamine, having histamine issues, we see a lot of MCAS being involved in this, which is my cell activation syndrome, we see histamine intolerance, but there is also this underlying neuroinflammation that is already happening when you have a neurodevelopmental condition. And when you have a neurodevelopmental condition, you are also more hormonally sensitive. And so the same shifts that another brain experiences, the normal hormone shifts throughout our cycle, you know, as it turns out in the research, it's actually not that bad if you're neuro-typical, but if you are neurodivergent, in that camp, things swing wildly. And we see that roughly around 50% of those with ADHD in one survey, they reported having concomitant PMDD, and over 90% of those who are autistic report having concomitant ADHD. So there is something going on here, and it is very much related to the full body experience, which is being a neurodevelopmental condition. And that I know is a reframe for a lot of people because ADHD is always like, that's a brain condition, that's a psychiatric condition, hate to break it to you. It's a full body condition, which is why in my book I was like, we gotta go through all the systems here. Now, the other thing I will mention is endometriosis. So endometriosis, those lesions tend to be rich in my cells, and I like to joke that if you like, look at them wrong, they just degranulate and they dump histamine. And so we see women with endometriosis reporting more symptoms of PMDD. We do not have research at this time to say, oh, endometriosis PMDD, they go to big gather like besties or anything like that. But we do understand, if you just listen to women, that women with endometriosis experience more PMDD-like symptoms. And all of this, the ADHD, the PMDD, the endometriosis comes down to inflammation, immune signaling, and definitely those histamine pathways. So when someone takes anti-histamine, and then they fill better, that is because histamine is involved. But it's not the full picture of PMDD, and I want you to understand that. We're also gonna go through some warnings here of why that is not a good idea as a long-term treatment. Now, another question you asked me was, what are my thoughts on the Allegra pepsid thing that's been circulating? So Allegra, that is an anti-histamine. Pepsid is an H2 blocker. The anti-histamines working on the H1 system, I'm gonna break that down a little bit more. But what I wanna share with you is that when I was going through infertility treatments, it was my fertility doctor who recommended doing a combination of H1 and H2 blockers. And the reason why they recommended that is because of the history of adenomyosis and endometriosis. There can be higher levels of histamine. This mean is inflammatory, it can affect how implantation happens, and what I noticed with that is that yes, my symptoms of endometriosis, they did mildly improve. It wasn't a complete game changer for me, but it was also something as well that when I went through my miscarriage, which was a secondary miscarriage about a year ago, and I went through grief as one does, I was in a really dark place. But then months later, cyclically, what started to move in was that dark cloud that I remember of PMDD. And I realized my old friend was back. And I was man, I had managed PMDD very well through my life, and then following the The pregnancy loss, this is a very inflammatory state to be in, not to mention where my mood, my mental health was, and I was like, I got to get relief ASAP, and I used the combination, I used Claretin and H2 blocker Pepsid. And taking both of those gave me relief, but I didn't stay with that long term. I am not on antihistamines now, and we're going to be talking, there's going to be a two-part episode, but we're going to be talking about more layers. And in the workshop, I'm going to take you through things of ways to approach PMDDs that you're not beholden to antihistamines. Antihistamines are not a root cause approach, but they can be a life-saving approach for some people. But I got a lot more to say on this. So firstly, a lot of people will get relief with just using the antihistamine, the H1 blocker. So histamine is like a signal that your immune system sends, but your body has different receptors for that signal, and H1 receptors are what most people think of with allergies. So that's what most people think of when they think about histamine. They think about the itching, the hives, maybe the stuffy nose, the watery eyes, the swelling that can happen. If you're really histamine sensitive, maybe you drink wine, you have flushing, and for some people, they have a more wired and reactive feeling. So that's the H1 receptor. The H2 receptors are found heavily in your stomach, and they are responsible for your stomach acid production. Already, if you understand that, you understand why this is not going to be a long-term solution, and if you don't, don't worry. We're going to get there. But the H2, it also exists in immune cells and blood vessels. So a legra that's going to block the H1 receptors. Do you remember the itchy, the swelling, the watery eyes, pepsid blocks the H2, which is involved in digestion, but also some of the immune cells as well. And that means using both can reduce histamine signaling by affecting multiple pathways, not just one. And that's why some people try an antihistamine, and they're like, "That's not enough. I have to add pepsid," because they have to hit both pathways. But here is something so key that I need you to understand. And that is blocking histamine receptors is not the same as fixing why your body is releasing histamine in the first place or not clearing it. So antihistamines, those are symptom control. They're not real cause. It's like putting on noise-canceling headphones while a fire alarm is going off. But maybe that's not even a fair analogy, because in a lot of ways, it does help. You do feel better, right? So if I put on noise-canceling headphones and there's an alarm, I feel better. But the alarm is still there. So we can always use things to help you get symptom relief while we work on the root cause of things. But I don't want anyone hearing this and being like, "Anahistamines for life." Now, before you go and grab whatever you have at home, I want to talk to you about something really important, because not all antihistamines are created equal. And if you are reaching for benedral, that's a first-generation antihistamine, and I never recommend this. Because benedral crosses into the brain, and it has anti-colonurgic effects. That means it interferes with acetylcholine. Acetylcholine is a neurotransmitter that's involved in your memory and your cognition. My perimenopausal women, my ADHD women, I need you to listen up. You have acetylcholine problems. You don't want to compound that by adding in benedral. To long-term frequent use of medications like benedral, those have been associated with an increased risk of cognitive decline and even dementia. So benedral, we're in reach for that, you want to talk to your doctor about alternatives to that. Now, I just want to be clear, because I just said this, that doesn't mean if you one time took benedral, that it's dangerous, or that an occasional use, like you're like, "I got stung by a bee, I needed it." That doesn't seal the deal that you're going to get dementia. It is regular, consistent, and how are women with PMDD using it? Cycle after cycle after cycle, sometimes for two weeks out of time. That's six months out of the year. That is not something that any doctor who understands the research would recommend. Now, second generation antihistamines, Allegra, Zartek, Claretin. Those have a different profile, but even those, we still need to zoom out and we need to look at the bigger picture, because the reality is there is no study for PMDD and antihistamines. We need that research, there's clearly a mechanism here, but we don't know the long-term impact if you are using that three to six months out of the year. Now the other question, I think, is really important and goes along with this, is there any natural relief? Yes, but it also has to be targeted. So if histamine is part of your PMDD story, then vitamin C, that can support histamine breakdown, D-A-O enzyme. That's the enzyme that exists to break down your histamine. That can also help, but I also want to talk about saffron here, and specifically affron. Now, if you know the radiant mind story of this formulation I created, it's because of my struggles with PMDD and when I knew what was coming down the pipeline for me in menopause, I did lupron and I got a little preview, like a movie clip role of how hellish that was going to be for me. And I was like, "Ah, absolutely not." So that's why I designed this formulation. Now why this particular form of saffron matters is that it has been studied in PMDD. There was a randomized control trial where PMDD women, they were assigned to saffron, aloxetine, or placebo, and during the luteal phase for two menstrual cycles, that's what they took. These are the moments that make Nordstrom, Nordstrom, bigger or small, we're here for all of it, celebrating 125 years with new moments still ahead, discover it all in Nordstrom stores and at Nordstrom.com. Fall never arrives all at once, verse the air, then the light, and slowly the things you love begin to find each other. A jacket meets a dress, a hoodie slips beneath a blazer, an old cap finds a new scarf, because you don't simply step into the season, you create it, layer by layer, until it finally feels like fall, find fall your way at Ross. Saffron group used 15 milligrams twice daily, so it's 30 milligrams in a day, both saffron and aloxetine reduced PMDD symptoms compared to placebo. So when I mention radiant mind, which you all know I take, it's not just take something for mood, I'm saying there is evidence that saffron may support mood, irritability, emotional symptoms, it helps with libido, it helps with sleep, it helps with hot flashes, but that doesn't mean that saffron is a replacement for medications, okay, supplements are designed to support your natural physiology, they're not designed to treat disease. And I think that's just a really important caveat, because I would never want someone to be like SSRIs are saving my life, but Dr. Brighton talked about saffron, so I'm going to jump off that and use saffron and said, that's a conversation to have with your prescriber. Now, there's a lot of things that can help with PMDD, and I'm going to go through them in the workshop with dosages, because I know you can ask clarifying questions, and I feel like that's a more responsible way to do it, so I can help you have a productive conversation with your provider, but the reality is, is throwing the kitchen sink at PMDD and just hoping for the best, that doesn't always work. And so we have to talk about like the exact things, and this is a two-part episode. In part two, I'm going to also talk a lot more about SSRIs and birth control, but in this episode, I wanted to make it more in the theme of histamine, since that is what's circulating and I've gotten so many questions about it. Now to answer the question, like, is it PMDD or is it PMS? Like, how do I tell if I have PMDD and not PMS? So if you don't know which one you're dealing with, you certainly can't treat it correctly, because in PMS, we often need more progesterone in PMDD, the level of progesterone, that's not necessarily going to get as positive effect as it does with PMS. Now PMDD is defined by a very specific pattern, those symptoms show up in the loodial phase that is after ovulation, and then within starting your period, they go away. So they improve shortly after starting your period, pre-menstrual exacerbation, that is when you have depression that is consistent, but then it gets worse before your period. That's different from PMDD. PMDD is very loodial phase specific, as is PMS. But with PMDD, you also need at least five symptoms, and at least one must be mood-related. So that's going to be things like irritability, anxiety, depression, so a lot of mood symptoms are going on with PMDD. You can also have really severe mood swings, like one minute you're so happy, and the next minute you're crying. But the biggest distinction between PMS and PMDD is that PMDD impairs your ability to function. It's not just filling off, it's not just filling like, "I'm a little bit sad, a little but we be when that one commercial comes on. PMDD is a, I don't recognize myself. I can't function the way I normally do. A dark cloud has moved in. The way I have always described it feels like to me, is I can see how great my life is on the other side, but there is a window between me and my life, and I cannot reach through. I cannot touch it. I cannot fill it. I cannot be grateful for it or get to it. I'm stuck. I'm stuck on this other side and it sucks. It's the worst. So in addition to the mood symptoms, we also see lack of concentration. That can be difficult when you have concomitant ADHD going on to differentiate it, but you have these severe, severe, impeding your life level of mood symptoms. There's can also be physical symptoms. So joint pain, muscle aches, you may have fatigue. You may have increased cravings. You may have symptoms that look a lot like disordered eating. You can have severe fatigue despite sleeping and then also wanting to sleep all the time. So track your symptoms because there's a lot of symptoms that fit into PMDD's umbrella. Track your symptoms and then make sure that you're following them throughout your cycle for at least two months to take them to your doctor. So that brings me to the question of, how do I get a doctor to listen? Now, I will say there is no test to confirm PMDD date. There's no blood work, there's no hormone test, there's nothing like that. And most women aren't getting dismissed because their symptoms aren't real. They're getting dismissed because the pattern isn't clear and it hasn't signal to the doctor that like this is a pattern or your doctor may not believe in PMDD. That's real, okay? I wrote all about it in my book about how PMDD was pharma initiated. So that pharma could sell us one particular drug for this and get it FDA approved. That's all real. But because of that, that's made some doctors believe that PMDD is not real. Although it's someone who lived it and experienced it before it was even recognized before it was even a diagnosis before it was an ICD-10 code or DSM criteria condition, like I had it, it's real. So I want you to know just because like pharma was like, hey, we can make some money off of this condition. Doesn't mean the condition is not real. So the biggest advice I would give you is that if you need to get diagnosed with PMDD, you're like, I have this, I need to get a diagnosis, I need to get help. You gotta track your symptoms and you do it alongside your cycle. And you have to do it for at least two cycles and you're tracking everything. What's your mood doing? Has it impacting work? Has it impacting your relationships? Has it impacting school? How is it impacting your physical capacity? Can you even work out? Are you sleeping 12 hours a day? When you bring that pattern, that should change the conversation. And if it doesn't, then that provider there weren't really ever going to help you anyways. And that sucks. And I hate to say that. And sometimes it's like, oh, I can say, like goes to another provider, but is it really that easy? Is it really that easy on women's medicine? It's not. So how do you find a provider? Start getting into forums. Start getting into chat groups. Like they have them on Reddit. Ask in the comments. Certainly on my Instagram post on this YouTube video, if you have a provider who's great, drop their name and their location. You never know whose life you're going to save, but just by sharing like this doctor will listen to you. Now, when it comes to antihistamines and pepsid, women are typically using these for half of the month or five days before they expect their symptoms to hit. So they are tracking their symptoms and then they're like, okay, five days before I'm going to start the antihistamines and put honestly the pepsid. Now, I talked about some of the problems with antihistamines, but what I want to note about pepsid is that it is very real that if we are lowering your stomach acid, that can affect your digestion. That can affect gut motility. So that could set you up possibly for infections. Your stomach acid is a barrier for things that are coming in and it can also lead to nutrient deficiencies. You're not able to liberate minerals. You're not able to liberate B12 as easily. And so being on pepsid, long term, isn't an answer for PMDD. And that may be frustrating to you because you're like, but this is actually working. You gotta talk to your doctor. So I'm a doctor, I'm not your doctor. You can't listen to this episode or women on social media and then be like, okay, I'm just going to take antihistamines and pepsid for the rest of my life. That is playing with fire. We just don't have the data to say that is safe. And like I said, histamine is only one part of the picture. In episode two, we're gonna go even deeper on this. But what I want you to understand is that these medications, while they can be helpful, they're not without side effects. So while women are following just the standard dose on the package because these are over the counter and they're using those and they're reporting success. And I believe these women, I have also experienced it with these antihistamines. We've gotta ask the question, why? Why are you struggling with all this histamine? Did we miss endometriosis or adnomyosis? Could that be going on? Do you have gut dysbiosis? So the gut, we're gonna talk about in episode two, can be playing a role here. Is it a situation where your muscles are really unstable? What we need to stabilize them? Is it a situation where you're not clearing estrogen effectively and estrogen is stimulating those muscles to release histamine and then histamine is stimulating your ovaries to make more estrogen? We have to go deeper and ask why? Because while the compensation with an antihistamine may work in the short term, I have had people come to me who were like, I started the antihistamine thing and I was on it for years and then it stopped working and things got worse. Well, we were using a band-aid approach rather than getting to the root cause and I am not against a band-aid approach, okay? I am a big fan. Like, right, if we are thinking about self-harm, if we may injure ourselves, like I don't think it's a bad idea, whether that is an antihistamine, the go-to, which is SSRI, maybe birth control actually works for you. We're gonna talk about the details on that in episode two, but I'm not against that because I think short term acute care has a place but we wanna long term be thinking about how do we effectively address the root of what is going on for you? Now, if you want help in doing that, that's exactly what we're gonna do in the live PMDD workshop that's happening on June 10th. When you pre-order ADHD and women, you're gonna get access to that workshop, complimentary to you. You go to doctorbrayton.com/PMDD and I'm gonna walk you through PMDD, ADHD connection and we're gonna go through your phases of your cycle and what to be doing because we wanna be addressing PMDD issues before we arrive to the loodial phase because once we're there, it's very hard to do the self-care that is necessary when you're experiencing PMDD. We'll also talk about exact supplement strategies, how to talk to your doctor about different prescriptions that might help you. Now, make sure you're subscribed to the Dr. Brighton Show. There's a second episode coming on PMDD. We're gonna talk about why treatments fail. So if you're someone who's like SSRI didn't work for me, birth control didn't work for me, like what is going on? I'm gonna go into that deeper. I'm gonna go over the research with you and definitely come prepared to take notes because this is gonna help you advocate a little bit more with your doctor. Now, as always, share, like, comment, subscribe, show this podcast some love so that we can get this information out to more women, help empower them to take charge of their health and also hopefully change medicine for the better. And thank you so much for spending your time with me. I, as always, love your questions. You guys guide the conversation. So please drop me a comment, let me know what you'd like to hear more of or what was helpful in this episode. I will see you next time. Fall never arrives all at once. Verse the air, then the light. And slowly the things you love begin to find each other. A jacket meets a dress, a hoodie slips beneath a blazer. An old cap finds a new scarf because you don't simply step into the season. Find fall your way at Ross. Hank joined BJ's wholesale club the day he became a father of 30. I coach football. 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