ICD-10 code: F32.81
Premenstrual dysphoric disorder (PMDD) is part of a cluster of diagnoses called the depressive disorders. Depressive disorders are a group of psychiatric conditions that include:
The depressive disorders are characterized primarily by mood disturbance (sad, empty, or irritable mood). Individuals with depressive disorders often experience significant somatic changes, such as disruptions in sleep (insomnia or hypersomnia), eating (overeating or loss of appetite), or energy level. Changes in cognition, such as difficulty concentrating, indecisiveness, and morbid ideation (such as thoughts of death) are also common.
Individuals with major depressive disorder experience pervasive sadness or anhedonia (loss of interest) along with significant changes in somatic and/or cognitive functioning. To be diagnosed, these problems must be present nearly every day for at least two weeks. Individuals with persistent depressive disorder (dysthymia) experience similar symptoms, including sad mood and problems with somatic and/or cognitive functioning that occur most days for at least two years. Individuals with premenstrual dysphoric disorder experience marked changes in mood and interpersonal functioning that begin sometime following ovulation and remit within a few days of the onset of menses. Disruptive mood dysregulation disorder is diagnosed in children under 12 years old who experience persistent irritability and extreme behavioral dyscontrol.
PMDD is a psychiatric disorder that will affect approximately 1-8% of menstruating women at some point in their lives. An individual with PMDD experiencesa variety of mood-related symptoms that emerge in the final week before the onset of menses, improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.
To be diagnosed with PMDD, a person must experience at least five diagnostic symptoms. These five symptoms must include at least one symptom from the following list:
The five symptoms must also include at least one symptom from the following list:
PMDD should not be diagnosed if the symptoms are solely an exacerbation of another disorder, such as major depressive disorder.
PMDD symptoms may be subject to memory biases. For example, a person may misremember when symptoms occur, attributing them to the menstrual cycle when in fact there is no association. Therefore, PMDD diagnoses should be confirmed through the use of prospective daily symptom ratings for at least two menstrual cycles. Prior to confirmation, the diagnosis should be listed as provisional.
PMDD severity can range from mild to severe. In severe cases, PMDD may lead to impaired ability to fulfill responsibilities at work, school, or home while symptoms are present. PMDD may also cause problems in interpersonal relationships, for example if irritability and rejection sensitivity are pronounced. Many people with PMDD also have other psychiatric conditions, most commonly a history of a major depressive episode.
Currently, little is known about the precise biological factors that contribute to PMDD. However, increased sensitivity or other abnormalities in neuroendocrine-modulated neurotransmitters such as serotonin and the hypothalamic-pituitary-gonadal axis have been proposed as candidate mechanisms. Neurobiological abnormalities include abnormal activation in the amygdala, which is involved in emotion generation, and the orbitofrontal cortex, which is involved in emotion regulation. The disorder appears to be heritable, although having a genetic predisposition to PMDD does not necessarily mean that someone will develop PMDD.
PMDD is treatable. Published treatment guidelines for PMDD include those from theAssociation of Reproductive Health Professionals, the Journal of Women's Health, and the American Academy of Family Physicians.
Currently, clinical research suggests that antidepressant medications, which work by altering the amount of serotonin in the brain, are effective for treating PMDD. Specific medications that have shown efficacy for the treatment of PMDD include:
Additionally, the following treatments have shown some promise in treating PMDD:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.