What is Premenstrual Dysphoric Disorder (PMDD)?

From the Guidelines

Premenstrual Dysphoric Disorder (PMDD) should be treated with selective serotonin reuptake inhibitors (SSRIs) as the first-line medication, given their efficacy in managing mood symptoms, as evidenced by the characterization of PMDD in the ICD-11 updates 1. The diagnosis of PMDD is characterized by a pattern of mood symptoms, somatic symptoms, or cognitive symptoms that begin several days before the onset of menses, start to improve within a few days after the onset of menses, and then become minimal or absent within 1 week following the onset of menses, as outlined in the changes from ICD-10 to ICD-11 1. Key features of PMDD include:

• Mood symptoms such as depressed mood
• Somatic symptoms like overeating
• Cognitive symptoms including forgetfulness These symptoms must be severe enough to interfere with daily functioning and must be confirmed by at least two menstrual cycles of symptom tracking. Treatment options for PMDD, based on the most recent understanding of the disorder, include:
• SSRIs such as fluoxetine, sertraline, or escitalopram, which can be taken continuously or just during the luteal phase
• Hormonal treatments like combined oral contraceptives, particularly those containing drospirenone
• Lifestyle modifications including regular exercise, stress reduction techniques, adequate sleep, and dietary changes
• Symptom management with NSAIDs for physical symptoms and supplements like calcium and vitamin B6 for modest benefits The choice of treatment should be individualized, considering the severity of symptoms, patient preferences, and potential side effects, with the goal of improving quality of life and reducing morbidity and mortality associated with untreated PMDD 1.

From the Research

Definition and Symptoms of PMDD

• Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects 3-8% of menstruating women, causing significant functional impairment 2.
• Symptoms of PMDD occur during the last week of the luteal phase of the menstrual cycle and usually abate at the onset of menses 2.
• Common symptoms of PMDD include psychological or behavioral symptoms, such as irritability, anxiety, and depression, as well as physical symptoms like headache, fatigue, and breast tenderness 2, 3.

Treatment of PMDD

• Selective serotonin reuptake inhibitors (SSRIs) are a highly effective treatment for PMDD, reducing overall symptomatology and improving quality of life 4, 2, 5, 3.
• SSRIs can be administered continuously or in the luteal phase only, with continuous administration being more effective in some studies 4, 2.
• Common adverse effects of SSRIs in PMDD treatment include nausea, insomnia, sexual dysfunction, and fatigue 4, 2, 3.
• Other treatment options for PMDD include combined oral contraceptives, gonadotropin-releasing hormone agonists, and surgical interventions, although the evidence for these treatments is less robust than for SSRIs 6.

Efficacy of SSRIs in PMDD Treatment

• Studies have consistently shown that SSRIs are effective in reducing premenstrual symptoms in women with PMDD, with a significant improvement in overall symptomatology and quality of life 4, 2, 5, 3.
• The efficacy of SSRIs in PMDD treatment is thought to be due to their ability to enhance serotonergic action, which improves premenstrual irritability and dysphoria with a rapid onset of action 3.
• Different SSRIs, such as fluoxetine, sertraline, paroxetine, and citalopram, have been shown to be effective in PMDD treatment, although the evidence is most extensive for fluoxetine and sertraline 2, 3.