What is PMDD? Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of Premenstrual syndrome (PMS), afflicting 3% to 8% of women. It is a diagnosis associated with the luteal phase of the menstrual cycle.

Symptoms

PMDD is premenstrual syndrome (PMS) that is so severe it can be debilitating due to either physical, mental or emotional symptoms.

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains.

Treatment is recommended because PMDD interferes with the sufferer's ability to function in her social or occupational life. The cardinal symptom—surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding—is irritability. Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include:

feelings of deep sadness or despair, possible suicide ideation
feelings of tension or anxiety
increased sensitivity to rejection or criticism
panic attacks
mood swings, crying
lasting irritability or anger, increased interpersonal conflicts. Typically sufferers are unaware of the impact they have on those close to them
apathy or disinterest in daily activities and relationships
difficulty concentrating
fatigue
food cravings or binge eating
insomnia or hypersomnia; sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep
feeling overwhelmed or "out of control"
increase or decrease in sex drive
increased need for emotional closeness
physical symptoms: bloating, heart palpitations, breast tenderness, headaches, joint or muscle pain, swollen face and nose

Other symptoms that are common and more specific to PMDD include: physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain.
an altered view of one's body - a sensation of 'bloating', feeling fat or actual weight gain.

Five or more of these symptoms may indicate PMDD. Symptoms occur during the 2 weeks before the menstrual cycle and disappear within a few days after the onset of the bleeding.

In a recent study published in the journal Biological Psychology and led by Susan Girdler, Ph.D., professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine, demonstrated that PMDD women had greater sensitivity and respond to stress and pain.

Treatment

Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. There is some evidence that vitamin B6 in doses up to 100 mg can alleviate symptoms. Certain SSRIs provide relief as well. The U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of PMDD: Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. Sertraline (Zoloft) was approved in 2002, Paroxetine HCI (Paxil) and also Escitalopram oxalate (Lexapro) has also been approved by the FDA. The patent for Fluoxetine expired in 2001, but Eli Lilly was able to extend patent protection until 2007 for its use in the treatment of PMDD, and thereafter marketed it heavily for this use under the trade name Sarafem. Fluoxetine is available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem. L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose of (six grams) per day.

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