PMDD stands for Premenstrual Dysphoric Disorder. It's a
severe form of PMS (Premenstrual Syndrome). Like PMS, PMDD
occurs the week before the onset of menstruation and disappears
a few days after. PMDD is characterized by severe monthly
mood swings and physical symptoms that interfere with everyday
life, especially a woman's relationships with her family
and friends. PMDD symptoms go far beyond what are considered
manageable or normal premenstrual symptoms.
PMDD
is a combination of symptoms that may include irritability,
depressed mood, anxiety, sleep disturbance, difficulty concentrating,
angry outbursts, breast tenderness and bloating. The diagnostic
criteria emphasize symptoms of depressed mood, anxiety,
mood swings or irritability. The condition affects up to
one in 20 American women who have regular menstrual periods.
Among
500 women recently surveyed, eight out of ten did not know
that severe premenstrual problems have been officially classified
as PMDD, nor did they know that such problems can be diagnosed
and treated. Even more disturbing is that the one in four
respondents who described their premenstrual symptoms as
strong or severe were among those unaware of PMDD
Twenty
to fifty percent of women between the ages of 30 to 40 with
regular menstrual cycles experience
premenstrual syndrome (PMS) as a regular
physiological occurrence every month. In more severe cases,
affecting three to five percent of menstruating women, this
syndrome is labeled as premenstrual dysphoric disorder (PMDD)
. Patients with severe PMDD may be at risk for developing
postpartum depression. Furthermore, women successfully treated
with antidepressants often show breakthrough symptoms of
depression in the premenstrual phase of their menstrual
cycle. All that is needed is a small increase in the dosage
of the antidepressant premenstrually.
PMDD
Symptoms
Women with PMDD complain of irritability, anger, tension,
marked depressed mood, and mood liability (crying spells
for no reason), verbal outbursts, to such a severity that
quality of life is seriously compromised. In addition to
these symptoms, some women complain of exhaustion, fatigue,
sleep disturbance, limited concentration and a host of physical
symptoms such as breast tenderness, headaches, joint and
muscle pain, bloating and weight gain.
The
primary symptoms that distinguish premenstrual dysphoric
disorder from other mood disorders (i.e., major depression)
or menstrual conditions is the onset and duration of PMDD
symptoms -- with symptoms appearing during the week or so
before and disappearing within a few days after the onset
of menses -- and the level by which these symptoms disrupt
daily living tasks. (This diminished level of functioning
is generally in great contrast with the same woman's interactions
and abilities at other times during the month.)
The
symptoms of PMDD may resemble other conditions or medical
problems, such as a thyroid condition, depression, or an
anxiety disorder. Consult a physician for diagnosis.
What
Causes PMDD?
Although
the exact cause of PMDD is not known, several theories exist.
No one knows for sure, but it may be related to the neurotransmitter
in the brain called serotonin (sair – uh – toe
– nin). The symptoms of PMDD may occur when serotonin
and other neurotransmitters are out of balance. In PMDD,
this imbalance may be related to your monthly changes in
hormones.
One
theory states that women who experience PMDD may have abnormal
reactions to normal hormone changes that occur with each
menstrual cycle. This may include the fluctuation of estrogen
and progesterone levels that normally occur with menstruation
causing a serotonin deficiency, in some women (Serotonin
is a substance found naturally in the brain and intestines
that acts as a vessel-narrowing substance, or vasoconstrictor).
Additional research is necessary.
How
is Premenstrual Dysphoric Disorder Diagnosed?
Aside from a complete medical history and physical and pelvic
examination, diagnostic procedures for PMDD are currently
very limited. Your physician may consider recommending a
psychiatric evaluation to, more or less, provide a differential
diagnosis (to rule out other possible conditions). In addition,
he/she may ask that you keep a journal or diary of your
symptoms for several months, to better assess the timing,
severity, onset, and duration of symptoms. In general, in
order for a PMDD diagnosis to be made, the following symptoms
must be present:
Over the course of a year, during most menstrual cycles,
five or more of the following symptoms must be present:
* depressed mood
* anger or irritability
* difficulty in concentrating
* lack of interest in activities once enjoyed
* moodiness
* increased appetite
* insomnia or hypersomnia
* feeling overwhelmed or out of control
* symptoms that disturb social, occupational, or physical
functioning
* symptoms that are not related to, or exaggerated by, another
medical condition.
What
is the Difference Between PMS and PMDD?
The physical symptom list is identical for PMS and PMDD;
while the emotional symptoms are similar, they are significantly
more serious with PMDD. In PMDD, the criteria focus on the
mood rather than the physical symptoms. With PMS, sadness
or mild depression is not uncommon. With PMDD, however,
significant depression and hopelessness may occur.
In extreme
cases, women may feel like killing themselves or others.
These feelings must be taken as seriously as they are in
anyone else and should be brought promptly to the attention
of a mental health professional.
Women
who have a history of depression
are at increased risk for PMDD. Similarly, women who have
had PMDD are at increased risk for depression after menopause.
In simplest terms, the difference between PMS and PMDD can
be likened to the difference between a mild headache and
a migraine.
PMDD Treatment
Treatment for PMS depends on the severity of the symptoms.
For mild cases, treatment recommendations include diet modifications
such as high carbohydrate meals and reducing salt, caffeine
and alcohol, as well as a variety of methods for stress
reduction and relaxation such as exercise, counseling and
stress/behavior management strategies.
For severe PMDD, treatment is more aggressive, often requiring
pharmacological intervention in addition to nonpharmacological
treatments. The selective serotonin reuptake inhibitor class
of antidepressants are effective in the treatment of PMDD.
Fluoxetine (Prozac - Serafem) has been widely studied and
found to be effective in reducing symptoms of tension, irritability
and dysphoria. These results have been replicated with sertraline
(Zoloft) and paroxetine (Paxil). Use of the SSRIs is positive
as well in that side effects, such as nausea, diarrhea,
headache, and insomnia, to name a few, are minimal and reportedly
tolerable by the majority of women.
For some women, even more drastic measures must be taken
to ameliorate the symptoms of PMDD. For these women, hormonal
therapies are necessary that work by suppressing the menstrual
cycle. For some women, the severity of symptoms increase
over time and last until menopause (when menses ceases).
For this reason, a woman may require treatment for an extended
period of time, and may require several re-evaluations to
adjust medication dosages throughout the course of treatment.
Women, however, do face barriers to diagnosis and treatment.
There is often a stigma attached to any condition that is
associated with the menstrual cycle. Many women who do not
seek treatment for the mood and physical symptoms of PMDD
accept their symptoms as an inevitable consequence of the
menstrual cycle which cannot be addressed.
Some women view seeking treatment for PMDD as a sign of
weakness. Additionally, physicians aren't traditionally
trained to recognize the signs and symptoms of PMDD symptoms
are often dismissed as just a "part of being a woman."
This attitude often keeps women from getting the help they
need.
If you think you have PMDD find a doctor is familiar with
PMDD or get a second opinion from another OB/GYN or psychiatrist.
If
Your Doctor Prescribes Medication For Your PMDD
Or if your doctor prescribe an antidepressant for PMDD,
they should inform you that antidepressants increased the
risk of suicidal thinking and behavior in children and
teenagers with depression and other psychiatric disorders.
Patients starting therapy should be observed closely for
worsening depression symptoms, suicidal thoughts or behavior,
or unusual changes in behavior.
People on antidepressants and their families should watch
for worsening depression symptoms, unusual changes in behavior,
and thoughts of suicide. Patients should call their doctor
if they have thoughts of suicide or if any of these symptoms
are severe or occur suddenly. Be especially observant at
the beginning of treatment or whenever there is a change
in dose.
Most
medications will give you side effects. Some women may experience
side effects such as headache, upset stomach, tiredness,
insomnia, nervousness, dizziness and difficulty concentrating.
Side effects are usually mild and tend to go away within
a few weeks.
* If
you develop a rash or hives while taking any medication,
call your doctor right away because this can be a sign of
a serious medical condition.
Be sure to tell your doctor about other prescription or
nonprescription medications you may be taking, including
antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs),
aspirin, vitamins and herbal remedies.
For info on Postpartum
Depression, click
here.
See the Mental Health Center
for more on mental health news and articles.
