Mental health professionals need to know about Premenstrual Dysphoric Disorder (PMDD) which, according to DSM-5, is a type of Depressive Disorder. Often, women who have PMDD go undiagnosed and others are wrongly diagnosed as having PMDD. So let’s get clear on what is and is not PMDD. Also, since SSRIs are the first line treatment for PMDD, I think that mental health clinicians can and should be among the primary persons treating this disorder, only referring the patient to a gynecologist if initial treatments fail.
How to diagnose Premenstrual Dysphoric Disorder (PMDD)
Four things are needed for the diagnosis of PMDD:
1. Time course
As the name suggests, the symptoms must be premenstrual.
a) The symptoms must be present in the week prior to the onset of menstruation, i.e., the last week of the menstrual cycle.
b) The symptoms must begin to improve after menstruation starts.
c) The symptoms must be minimal or absent in the week after menstruation ends.
2. Mood symptoms
It is a “dysphoric” disorder, so at least one mood symptom must be present. But the mood symptom does not have to be depression. It can be mood lability, irritability/anger/interpersonal conflict, depression, or anxiety/tension.
3. Other symptoms
Just as in major depressive disorder the person has depressed mood (or anhedonia) along with other symptoms, the woman with PMDD has at least one mood symptom and along with that has other symptoms. The other symptoms may symptoms of depression (decreased interest in activities, change in appetite, change in sleep, fatigue, decreased concentration), feeling overwhelmed or out of control, or they may be physical symptoms (breast tenderness or swelling, joint or muscle pain, sense of bloating or weight gain).
4. Prospective daily rating
Many women may think that they report symptoms suggestive of PMDD, but when prospective charting of symptoms is done, it becomes apparent that the symptoms are not really premenstrual. Therefore, it is now a requirement of for a definite diagnosis of premenstrual dysphoric disorder that symptoms be charted prospectively for at least two menstrual cycles during which symptoms are present.
How should this prospective daily rating be done? The form that I recommend is called the Daily Record of Severity of Problems.
What causes PMDD?
While the exact pathophysiology of PMDD is not known, it is believed to be related to the marked drop in progesterone level towards the end of menstrual cycle (see figure below).
Management of PMDD
Related Pages
Management of PMDD
A Deeper Understanding of the DSM-5 Criteria for Major Depressive Disorder (Free)
Grief versus Major Depression (Free)
Seasonal Affective Disorder (Free)
Antidepressants: Main Page (Index and Links)
“Depression”: Main Page (Index and Links)
References
Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2006 Jan;9(1):41-9. PubMed PMID: 16172836.
Copyright 2016, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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