What is the management for a 30-year-old female with premenstrual irritability and cry episodes?

From the Guidelines

Management for a 30-year-old female with premenstrual irritability and cry episodes should prioritize lifestyle modifications and consider medication if symptoms are severe, focusing on selective serotonin reuptake inhibitors (SSRIs) as a first-line pharmacological option. When considering the management of premenstrual irritability and cry episodes, it's essential to differentiate between various depressive disorders, including premenstrual dysphoric disorder, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1. Given the context of premenstrual symptoms, the following interventions can be considered:

• Lifestyle modifications: Regular exercise, stress reduction techniques, and dietary changes can help alleviate symptoms.
• Supplements: Calcium and vitamin B6 may reduce symptoms, although specific dosages and efficacy can vary.
• Pharmacological options: SSRIs, such as fluoxetine, sertraline, or escitalopram, are effective in managing severe symptoms and can be taken continuously or during the luteal phase.
• Hormonal contraceptives: Particularly those containing drospirenone, may help stabilize hormone fluctuations and reduce symptoms. It's crucial to individualize treatment based on symptom severity, patient preferences, and response to therapy, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem®, fluoxetine hydrochloride).

The management for a 30-year-old female with premenstrual irritability and cry episodes may include fluoxetine (2), as it is marketed for the treatment of premenstrual dysphoric disorder.

• The drug is available in various formulations, including capsules and oral solution.
• The dosage and administration of fluoxetine for premenstrual dysphoric disorder should be determined by a healthcare professional.

From the Research

Management of Premenstrual Irritability and Cry Episodes

The management of premenstrual irritability and cry episodes in a 30-year-old female can be approached through various treatments, including medicinal and psychotherapeutic options.

• Medicinal Treatments:

  • Antidepressants, specifically Selective Serotonin Reuptake Inhibitors (SSRIs), have been identified as effective treatments for Premenstrual Dysphoric Disorder (PMDD) 3.
  • Oral contraceptives, including drospirenone, have also shown effectiveness in managing PMDD symptoms 3.
  • Calcium has been reported to reduce emotional, behavioral, and physical premenstrual symptoms in some studies 4.

• Psychotherapeutic Treatments:

  • Cognitive Behavioral Therapy (CBT) has shown positive results in reducing the functional impact of PMDD, including symptoms such as depressed mood, anxiety, and irritability 3.
  • CBT could potentially become a first-line treatment with more evidence of its effectiveness 3.

Considerations for Treatment

When managing premenstrual irritability and cry episodes, it's essential to:

• Distinguish between Premenstrual Syndrome (PMS) and PMDD, as they have different symptoms and severity 3.
• Consider the patient's symptoms, severity, history, plans for procreation, contraindications, and preferences when choosing a treatment 3.
• Be aware of the overlap between reported PMS symptoms and underlying mood or anxiety disorders, and have a low threshold for ruling out these disorders 5.

Lifestyle and Dietary Changes

While the provided evidence focuses on medicinal and psychotherapeutic treatments, other studies suggest that lifestyle and dietary changes, such as exercise, relaxation, and diet recommendations, may also be beneficial in managing premenstrual symptoms 6, 4. However, more research is needed to fully understand the effectiveness of these approaches.