Is hormonal contraception an option for you. Stablising your pre-menstrual symptoms by managing your hormone levels would give you the breathing space to work through some of the other issues. If not, you could try evening primrose oil, at therapeutic doses it can really alleviate PMS, and even if it just takes the edge of things it might be enough to keep you out of the psych ward. Have you tried Prozac, at 20mg it didn't do much for my depression but it helped my PMT and I have low blood pressure and Prozac wasn't a problem for me.