Dysphoric Disorder, PMDD, Extreme Premenstrual Syndrome

Dysphoric disorder has been described as extreme PMS. Millions of American women experience disturbing emotional and physical symptoms before your monthly menstrual periods? Do these symptoms disrupt your life and interfere with your usual activities and your relationships with others? Do the symptoms go away when your flow begins or shortly thereafter, only to return before your next period?

If this description sounds like you, you may have a condition known as premenstrual dysphoric disorder or PMDD. To find out more about PMDD -- what it is, what it is not, how common it is, how it is diagnosed, what may cause it, and how it can be treated successfully -- please read on. We know a lot about PMDD and you should find the information here quite helpful to you or someone you know.

Here are the symptoms that make up the diagnosis of PMDD. At least 5 are required to make the diagnosis, including at least one of the first four.

• Very depressed mood, feeling hopeless
• Marked anxiety, tension, edginess
• Sudden mood shifts (crying easily, extreme sensitivity)
• Persistent, marked irritability, anger, increased conflicts
• Loss of interest in usual activities (work, school, socializing, etc.)
• Difficulty concentrating and staying focused
• Fatigue, tiredness, loss of energy
• Marked appetite change, overeating, food cravings
• Insomnia (difficulty sleeping) or sleeping too much
• Feeling out of control or overwhelmed
• Physical symptoms such as weight gain, bloating, breast tenderness or swelling, headache, and muscle or joint aches and pains

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder or PMDD is a condition associated with severe emotional and physical problems that are linked closely to the menstrual cycle. Symptoms occur regularly in the second half of the cycle and end when menstruation begins or shortly thereafter.

PMDD is not just a new name for premenstrual syndrome (PMS), a condition that affects as many as 75% of menstruating women. It is, however, considered to be a very severe form of PMS that affects about 5% of menstruating women.

PMDD and PMS share symptoms

• depression,
• anxiety,
• tension,
• irritability and
• moodiness.

What sets PMDD apart is its severity. Women with PMDD find that it has a very disruptive effect on their lives.

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 5-10% of all women. It is a mood disorder associated with the luteal phase of the menstrual cycle. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability (PMID 11571794). Anxiety, anger, and depression may also occur. It is similar to premenstrual syndrome (PMS), but differs from it in severity and in that it requires treatment, because it interferes with the sufferer's ability to function in her environment.

PMDD TREATMENT

Treatment for PMS depends on the severity of the symptoms. For mild cases, treatment recommendations include diet modifications, like high carbohydrate meals and reducing salt, caffeine and alcohol. A variety of methods for stress reduction and relaxation such as exercise, counseling and stress/behavior management strategies may also help. For severe PMDD, treatment is more aggressive and often requires antidepressants.

The cause of PMDD has not been definitively established, but several theories exist. One theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle (PMID 16515859).

PMDD Therapy Sarafem

Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been proven in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase. Notably, fluoxetine (also known as Prozac), has been repackaged as a PMDD therapy under the trade named Sarafem. Among the SSRIs tested, Sertraline has been shown in the largest number of studies to effectively reduce mood symptoms of premenstrual dysphoric disorder (PMID 10471170).

PMS PMDD