What is PMDD? (Premenstrual Dysphoric Disorder)

Premenstrual dysphoric disorder (PMDD) is a major depressive disorder and is defined in the latest version of the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR). Premenstrual dysphoric disorder is a mental illness that describes mood changes occurring exclusively during the two weeks before menses. While 80% of women experience some physical and emotional problems during this time, only 3% - 8% meet the definition of PMDD. Premenstrual dysphoric syndrome is most commonly found in women in their late-30s to mid-40s.¹

Premenstrual Dysphoric Disorder (PMDD) Symptoms

Premenstrual dysphoric disorder symptoms are similar to those in major depression with the most common symptom being irritability. Physical PMDD symptoms of breast pain and bloating, as well as its timing, differentiate PMDD from standard depression with PMS. PMDD is associated with an increased risk of suicide when the patient is symptomatic.

Other symptoms of PMDD include:

• Depressed mood, feelings of hopelessness or self-deprecating thoughts (read more about: Depression Symptoms)
• Anxiety, tension, feelings of being "keyed up" or "on edge"
• Frequently changing, wide-ranging emotions (eg, feeling suddenly sad or tearful or increased sensitivity to rejection)
• Anger or increased conflicts with others
• Decreased interest in usual activities
• Difficulty concentrating
• Lack of energy, tired
• Change in appetite, overeating or specific food cravings
• Sleeping too much or too little
• Feelings of being overwhelmed or out of control
• Other physical symptoms, such as headaches, joint or muscle pain or weight gain

In addition to the above PMDD symptoms, to be diagnosed with PMDD these symptoms must occur only during the two weeks before menses for at least two consecutive cycles. Other diagnostic criteria for PMDD include:

• The symptoms of PMDD must be severe enough as to interfere with day-to-day functioning (for example, avoiding friends or decreased productivity at work).
• The symptoms must not be an exacerbation of another illness.

Premenstrual Dysphoric Disorder (PMDD) Treatment

There are several treatments available for premenstrual dysphoric disorder. Both pharmacological and lifestyle changes are options for PMDD treatment. Dietary changes such as abstaining from caffeine, reducing sodium and avoiding alcohol may be helpful. Exercise is also helpful in treating the symptoms of PMDD.

Other non-pharmacological treatments for PMDD include:

• Relaxation therapy – reduces blood pressure, heart rate, rate of breathing and slows brain waves. Therapy may be specific to PMDD or general as in yoga or meditation. Studies show conflicting results on efficacy.
• Light therapy – usage of natural, full-spectrum lighting. Clinical efficacy of bright light therapy is uncertain.
• Sleep deprivation – as in major depressive disorder, those with PMDD seem to respond to sleep deprivation treatment. Depressive symptoms of PMDD were reduced after a night of recovery sleep following a night of sleep deprivation.
• Cognitive behavioral therapy (CBT) – focuses on anger control as well as emotion and thought restructuring. Although clinical evidence suffers from poor study design, CBT is thought to be effective. (more information on: Therapy for Depression)

Medication treatment is also available for PMDD. Antidepressants, anxiolytics (anti-anxiety) and mood stabilizers are all commonly used. Other pharmacological PMDD treatments with supporting clinical evidence include:

• Vitamins and minerals such as calcium supplements and magnesium
• Hormone medications like drospirenone and ethinyl estradiol (Yaz), an estradiol transdermal patch (Esclim) or danazol
• Diuretics
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like mefenamic acid (Ponstel) or naproxen sodium (Naprelan)
• Beta-blockers like atenolol (Tenormin) or propranolol (Inderal)

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