Amanda - posted on 11/22/2008 ( 8 moms have responded )
Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome affecting 3-8% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance. The most common symptom is irritability; however, many women also report depressed mood, anxiety, or mood swings. These symptoms emerge one to two weeks preceding menstruating and resolve completely with the onset of menstruating. By definition, this mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning.
PMDD is a psychiatric diagnosis and is considered to be one of the affective disorders, classified in the DSM-IV-TR as “depressive disorder not otherwise specified.” Typically PMDD emerges in women in their 20’s and may worsen over time; it has been observed that some women may experience worsening premenstrual symptoms as they enter into the menopause. Less commonly, PMDD may begin during adolescence, and case reports suggest that treatments effective for adult women can also be helpful to adolescents with PMDD.
Non-Pharmacologic Treatment for PMS and PMDD
Lifestyle changes can help to ameliorate the symptoms of PMS and PMDD. For women with mild symptoms, and these interventions should be tried before pharmacological treatment. Although solid evidence is lacking, clinicians generally recommend that patients with PMS or PMDD decrease or eliminate the intake of caffeine, sugar, and sodium. Other helpful lifestyle modifications include decreasing alcohol and nicotine use and ensuring adequate sleep. Also, regular aerobic exercise has been demonstrated to have beneficial effects on both the emotional and physical symptoms of PMS/PMDD.
Pharmacologic Treatment for PMS and PMDD
Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological agents for the treatment of premenstrual mood symptoms. A significant body of evidence, including numerous double-blind, randomized studies, supports the effectiveness of SSRIs in reducing both the emotional, as well as physical symptoms, of PMS and PMDD. In general, women respond to low doses of SSRIs, and this treatment response usually occurs rapidly, often within several days.
SSRIs may be prescribed continuously throughout the menstrual cycle, or may be given in intermittent fashion during the luteal phase of the cycle. Studies have also begun to examine whether beginning medication at the onset of symptoms may be effective for some women. Also, other antidepressants which inhibit serotonin reuptake, including clomipramine (a tricyclic antidepressant), and venlafaxine (Effexor) have evidence to endorse their use in the treatment of premenstrual symptoms. Duloxetine (Cymbalta) has also been reported to be helpful. (read this blog post on treatment approaches incorporating SSRIs)
Among other psychotropic medications used in the treatment of PMS and PMDD, benzodiazepine alprazolam (Xanax) has been shown to have benefit in reducing premenstrual symptomatology, in particular premenstrual anxiety. However, this medication should be prescribed cautiously, given its potential for addiction.
For women who are ultimately diagnosed with a premenstrual exacerbation of a mood disorder, there are several treatment options. These women require treatment throughout the menstrual cycle and typically do not respond well to intermittent dosing. It may also be helpful to raise the dose of antidepressant in the luteal phase and return to a lower level at the onset of menses. In addition, a recent study also found that adding oral contraceptives to the antidepressant regimen in these women can improve residual mood symptoms that occur prior to menstruation.