From the Research
The five criteria for diagnosing Premenstrual Dysphoric Disorder (PMDD) include: timing of symptoms occurring during the luteal phase of the menstrual cycle with resolution shortly after menses begins; presence of at least five symptoms including at least one mood symptom (such as mood swings, irritability, depression, or anxiety); significant functional impairment in daily activities; symptoms not attributable to another medical condition or mental disorder; and prospective daily symptom tracking for at least two consecutive menstrual cycles to confirm the diagnosis. For proper diagnosis, patients should track their symptoms daily using a calendar or mobile app for at least two months, noting the relationship between symptoms and their menstrual cycle. The mood symptoms are particularly important for distinguishing PMDD from premenstrual syndrome (PMS), as PMDD represents a more severe condition with significant psychological distress. Treatment options include SSRIs (like fluoxetine 20mg daily or sertraline 50-150mg daily), hormonal contraceptives, lifestyle modifications, and cognitive behavioral therapy. PMDD affects approximately 3-8% of women of reproductive age and is thought to be caused by abnormal sensitivity to normal hormonal fluctuations rather than hormone imbalances themselves 1.
Some key points to consider when diagnosing and treating PMDD include:
- The importance of prospective daily symptom tracking to confirm the diagnosis
- The use of SSRIs as a first-line treatment option
- The potential for adverse effects with SSRI use, such as nausea, insomnia, and sexual dysfunction
- The importance of considering lifestyle modifications and cognitive behavioral therapy as additional treatment options
- The need for further research on the optimal treatment regimens and duration of treatment for PMDD 1.
In terms of treatment, SSRIs are probably more effective when taken continuously compared to luteal phase administration 1. The most common adverse effects associated with SSRI use in PMDD include nausea, asthenia, and somnolence 1. Overall, the diagnosis and treatment of PMDD should be individualized to each patient's specific needs and symptoms, and should involve a comprehensive approach that includes medical, lifestyle, and psychological interventions 1.
Key considerations for healthcare providers include:
- Ensuring accurate diagnosis through prospective daily symptom tracking
- Providing education on treatment options and potential adverse effects
- Encouraging lifestyle modifications and cognitive behavioral therapy as additional treatment options
- Monitoring patients for adverse effects and adjusting treatment regimens as needed
- Staying up-to-date with the latest research and guidelines on PMDD diagnosis and treatment 1.