What is PMDD?
Premenstrual dysphoric disorder (PMDD)is a significant disabling condition. It is the only form of premenstrual disorder currently classified in DSM V. Fourto Eight percent of women suffer from PMDD, far fewer women than from Premenstrual Syndrome (PMS).
PMDD often involves significant depression, anxiety, mood swings, and a host of other symptoms that begin 7-14 days before menstruation and usually resolve with its onset. PMDD symptoms interfere significantly with women's functioning. Click here to learn more about PMDD symptoms.
Where does PMDD come from?
Although there have been many theories about PMDD, we currently believe that women who suffer from PMDD are sensitive to estrogen and progesterone's normal hormonal fluctuations in their bodies. How we treat PMDD is based on how we understand it.
The first step in how to treat PMDD is to get an accurate diagnosis. That isn't an easy feat. You and your health care provider should be working on this together, or you may want to begin the process of gathering data yourself so you can get a head start.
PMDD is diagnosed with the assistance of charting. Charting is a recording tool that can help the clinician both gather data and visually inspect a pattern to determine when women's symptoms occur and how severe women's symptoms are.
Charting should occur for at least two months, but preferably more due to the often dramatic variation in a women's pattern of symptoms over her menstrual cycles. It should then continue through treatment to determine if the chosen course is effective.
PMDD can easily be confused with other disorders or minimized by your health care providers. Clarification can be important and finding a tool that accurately captures your symptoms and their severity is also important.
Recommended tools for charting include the Calendar of Premenstrual Experiences (COPE), the Prospective Record of the Severity of Menstruation (PRISM) and the Daily Record of Severity of Problems DRSP.
Studies have shown women who believe they have PMDD often have another more continuous diagnosis exacerbated during their menstrual cycle. PMDD is cyclical, and the mood is only present during the luteal phase of the menstrual cycle.
If your health care provider sees you have symptoms every day after looking at your chart, but more on the days leading up to your period, he or she is likely to consider you as having premenstrual exacerbation (PME). PME is a worsening of another diagnosis like bipolar disorder or depression. This does not mean you should not get treatment.
Your health care provider is likely to consider you as having PMS if you don't have severe enough symptoms, include enough mood instability, or meet enough criteria. That does not mean you shouldn't get treatment.
Your doctor will help you decide, based on your other medical conditions and medications, the best course. But SSRIs are often considered one of the best choices for medications. At a recent workshop I attended on PMDD at Massachusettes General Hospital series given by Laura Fagioli Petrillo, M.D., I learned fluoxetine, sertraline, and controlled release paroxetine are FDA approved for PMDD. These SSRIs are considered the best treatment that we have for PMDD. However, Dr Patrillo states, all SSRIs can be useful. They work at a low dose and have a rapid response. Also, SNRI's can be effective. They are: clomipramine, venlafaxine, duloxetine. She states they have a 60 to 90 percent response rate.
How are the medications for PMDD given?
You and your doctor might decide for you to take a daily dose of your antidepressent at the same time every day.
You and your doctor might decide to take your medicine in the luteal phase only with no other medication through the rest of the month. This choice for dosing is only likely if you have a very predictable period. Some women think that this might minimize the side effects of your antidepressant, but this is not necessarily true. Additionally, taking a pill only certain times a month, rather than daily, can make it challenging to remember.
Some doctors, in certain circumstances, will prescribe a bump-up of meds during the luteal phase. This is likely if you have another condition (for example, anxiety) being exacerbated during your luteal phase.
It's important to note that PMDD is chronic. Most women will relapse within one to two cycles after discontinuing their meds. Medication is not curative.
Evidence from double-blind, randomized, placebo-controlled trials supports the use of some oral contraceptives to treat PMDD. Some research suggests drospirenone based pills are more effective. Pills can be prescribed continuously or with a seven-day placebo break. Doctor Patrillo warns that there are risks with birth control pills that must be weighed with this option; that is not the first choice. One of the severe risks includes increased suicide.
Gonadotropin-Releasing Hormone Agonists ( GnRH agonists)
GnRH agonists prevent the production of hormones and induce medical menopause. This condition is reversible. This is an option in very severe cases but not a first choice. It is administered by nasal spray and subcutaneously. If it is effective and it is reversed when the hormones are added back the symptoms of PMDD reappear.
Mood charting can be an effective treatment because it helps you practice awareness and acceptance of your symptoms. It also allows you to predict when your symptoms will be exacerbated. This will help you plan for less stress.
These supplements have been recommended to women who have PMS; although not explicitly shown to alleviate PMDD symptoms, they will likely assist in the more underlying somatic symptoms that plague women with PMDD.
How to Treat PMDD: Vitex agnus-castus (VAC) Chasteberry
Chasteberry can be taken in pill or liquid form. It may be more desirable for women who have side effects that are undesirable or unwilling to take antidepressants or birth control to try alternative treatment methods. A recent literature review suggests that chaste berry has effectiveness when taken a week before menstruation in alleviating somatic symptoms of PMDD. However, some studies suggest it may interact with hormones, cause side effects of nausea or headache, and affect how antipsychotic medications work.
Cerqueira, R., Frey, B., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of Women's Mental Health, 20(6), 713-719.
Petrillo F. L.Psychiatric Disorders in Women: Diagnostic and Treatment Considerations Across the Female Lifespan (February 2020) PMDD https://mghcme.org/
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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.