Premenstrual Dysphoric Disorder (PMDD)

Amanda - posted on 11/22/2008 ( 8 moms have responded )

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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
Psychotropic Medications

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.

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Deena - posted on 07/20/2010

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I'm teary eyed reading all of this, cause it's so nice that i can put initials to what's going on!!! I have been realllly bad the past couple of years... My period is really irregular, but I get PMS every month! I have a 4 year old son, and it's definitely gotten worse since I had him.. The feelings of self loathing I get during that time, is totally enhanced by my irritability and quick temper. My son and husband seem to kind of understand, and still seem to love me afterwards.. Hubby knows what's going on, that it's pms,and that frankly, there's nothing I can do about it!! (other to give fair warning, and say sorry afterwards!) plus, I don't think I'm so bad the rest of the time!! ;)
I'm reallly glad to have found this place on COM's.. I'll be coming back!!

Melodee - posted on 03/27/2009

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Quoting Sheila:

Me too for sure! Besides just being so irritable that I could literally bite your head off and crying so much that I have actually been low that I thought about just leaving my family--I actually get very sick to my stomach almost like morning sickness for at least one day maybe two each month before my period. OBGYN says nothing he can do it about except for go on birthcontrol for three straight months-but I don't need to be on bc anymore, hubby is "fixed. I tried it for awhile on the pills but for some reason I was an axious mess more so than what I really am. So now, when I am so sick to my stomach that nothing helps I look at the calendar and know that my period will be here soon. My hubby notices too and can actually track when my period is coming better than me!



ohhhh me too i am that bad of late! Seems to me that mine gets worse after every baby.. And i too have gotten to the stage where i just want to leave my family. My husband knows this and knows why i say it and feel it.. but i must say i am glad to hear that i am not the only one! I now understand my mother, i just thought she was a mega bitch growing up, but recently i told her i now knew how she felt and how we made her feel! As soon as my period begins with the first 24hr i can breathe.. i dont feel anxious! Not stressed and can actually talk to my kids and not scream at them! I feel so bad for them

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Nicolette - posted on 06/06/2010

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wow i found this very helpful thank you i am currently taking effexor xr and i also do toher things to help with my moodiness and terrible mood swings my family was getting whiplash from my mood swings

Melodee - posted on 03/27/2009

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hahahahah no that is me! I have a great dr too who has now helped me and hopefully prescribed the pills to enable my house not to fall apart for 10-12 days of the month hehe! Will see how they work im coming up to it within the next week to where my pms usually starts. He has prescribed prozac for me for only those days of the month! Its now got to a point where i get depressed and teary which is just not like me. I am prone to depression anyway but now it comes and goes with my pms. Will let you all know how it works for me! I hope it does cause it just keeps getting worse and worse, and something has got to change :)

Laura - posted on 03/18/2009

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My PMDD has gotten much worse since the birth of my first child. I really seem to lose all control for 3-5 days. It is scary. I am about to start taking YAZ, I have never taken birth control before but I need some help.

[deleted account]

Me too for sure! Besides just being so irritable that I could literally bite your head off and crying so much that I have actually been low that I thought about just leaving my family--I actually get very sick to my stomach almost like morning sickness for at least one day maybe two each month before my period. OBGYN says nothing he can do it about except for go on birthcontrol for three straight months-but I don't need to be on bc anymore, hubby is "fixed. I tried it for awhile on the pills but for some reason I was an axious mess more so than what I really am. So now, when I am so sick to my stomach that nothing helps I look at the calendar and know that my period will be here soon. My hubby notices too and can actually track when my period is coming better than me!

Amanda - posted on 01/27/2009

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I totally understand, my family has a hard time dealing with me as well. It can be quit upsetting.

Tracey - posted on 01/22/2009

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Hey that's me lol! No really it is. Finally found a good doctor who was stunned when I told him that's me and then read up on it. He was like wow that is you! We are trying stuff out now. Better late than never if you ask me. It is soo hard on my husband and daughter.

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