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 treatment, given their efficacy in reducing symptoms of depression, anxiety, and mood swings, as characterized in the ICD-11 classification 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 study 1. Some key points to consider in the management of PMDD include:

• The use of SSRIs such as fluoxetine, sertraline, or escitalopram, which can be taken either continuously or only during the luteal phase (2 weeks before menses) 1.
• Hormonal contraceptives, particularly those containing drospirenone, are also effective in reducing symptoms of PMDD 1.
• Lifestyle modifications, including regular exercise, stress reduction techniques, adequate sleep, and dietary changes, are important for symptom management 1.
• Calcium and vitamin B6 supplements may help reduce symptoms, although the evidence for this is not as strong as for SSRIs and hormonal contraceptives 1.
• Cognitive behavioral therapy can address negative thought patterns associated with PMDD, and patients should track symptoms for at least two menstrual cycles to confirm the diagnosis and evaluate treatment effectiveness 1.

From the Research

Definition and Symptoms of Premenstrual Dysphoric Disorder

• Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that involves a combination of emotional and physical symptoms, resulting in 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 3.
• The symptoms of PMDD can affect personal, social, family, and professional life 4.

Treatment Options for Premenstrual Dysphoric Disorder

• Selective serotonin reuptake inhibitors (SSRIs) have been established as the first-line treatment for PMDD 5, 2, 3.
• SSRIs can be taken either in the luteal phase or continuously, and they have been found to significantly improve symptoms, particularly psychological or behavioral symptoms, during the luteal phase in women with PMDD 5, 6, 3.
• Other treatment options for PMDD include cognitive behavioral therapy (CBT), oral contraceptives, and other psychiatric medications 4, 2.
• CBT has been found to be effective in reducing the functional impact of PMDD, and it may become a first-line treatment if more evidence of its effectiveness is found 4.

Efficacy and Safety of Selective Serotonin Reuptake Inhibitors

• SSRIs have been found to reduce overall self-rated symptoms significantly more effectively than placebo in women with PMDD 5, 6.
• The most common side effects associated with SSRIs are nausea, asthenia, somnolence, fatigue, decreased libido, and sweating 5, 6, 3.
• Adverse effects are dose-dependent, and intermittent SSRI therapy may be a recommended treatment option to minimize side effects 3.

Comparison of Treatment Regimens

• Continuous SSRI treatment has been found to be more effective than luteal phase treatment in reducing premenstrual symptoms 5.
• However, more research is needed to compare the efficacies and differential symptom response of continuous, semi-intermittent, luteal phase, and symptoms-onset dosing 2.