PMDD

Symptoms of PMDD include:

• Lasting irritability or anger that may affect other people

• Feelings of sadness or despair, or even thoughts of suicide

• Feelings of tension or anxiety

• Panic attacks

• Mood swings or crying often

• Lack of interest in daily activities and relationships

• Trouble thinking or focusing

• Tiredness or low energy

• Food cravings or binge eating

• Trouble sleeping

• Feeling out of control

• Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

Currently, PMDD is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a separate entity under Depressive disorders, with the criteria for diagnosis as follows:

Criterion A - At least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) should be present:

1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”

3. Marked affective lability

4. Persistent and marked anger or irritability o increased interpersonal conflicts

5. Decreased interest in usual activities (i.e. work, school, friends, and hobbies)

6. Subjective sense of difficulty in concentrating

7. Lethargy, easy fatigability, or marked lack of energy

8. Marked change in appetite, overeating, or specific food cravings

9. Hypersomnia or insomnia

10. A subjective sense of being overwhelmed or out of control

11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.

Criterion B - symptoms severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.

Criterion C - symptoms discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of these disorders).

Criterion D - criteria A, B, and C are confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.

Women with moderate-to-severe PMS or PMDD experience more quality-of-life detriments and work-productivity losses and incur greater healthcare costs than women with no or only mild symptoms

Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A brain chemical called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes.

Andrea will talk to you about your overall physical and mental health and make recommendations.  It may be recommended to see an OBGYN for a physical to ensure there are no other medical issues contributing.   Your PCP can also try you on birth control pills to see if that will manage your symptoms.  You will need to keep a calendar or diary of your symptoms to help your provider diagnose PMDD.

You must have five or more of the PMDD symptoms above, including one mood-related symptom, to be diagnosed with PMDD

Treatments for PMDD include:

• Antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs change serotonin levels in the brain. The Food and Drug Administration (FDA) approved three SSRIs to treat PMDD:

  • Sertraline

  • Fluoxetine

  • Paroxetine HCI

• Birth control pills. The FDA has approved a birth control pill containing Drospirenone and ethinyl estradiol, to treat PMDD. Talk with your PCP or your OBGYN about these options.

• Over-the-counter pain relievers may help relieve physical symptoms, such as cramps, joint pain, headaches, backaches, and breast tenderness. These include:

  • Ibuprofen

  • Naproxen

  • Aspirin

• Stress management, such as relaxation techniques and spending time on activities you enjoy

• Making healthy changes, such as eating a healthy combination of foods across the food groups, cutting back on salty and sugary foods, and getting more physical activity, may also help relieve some PMDD symptoms.

• Psychopharmacological genetic testing (PGT) can be order and is covered by some insurance carriers to determine how you metabolize certain medications. This can be helpful if you have failed or had serious side effects on medications in the past. If you have questions, or want to order this test, ask Andrea for more details.