What is the diagnosis and treatment for Premenstrual Dysphoric Disorder (PMDD)?

From the Guidelines

Premenstrual dysphoric disorder (PMDD) treatment should prioritize selective serotonin reuptake inhibitors (SSRIs) as first-line medication options, such as fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily), due to their efficacy in managing symptoms. These medications can be taken either continuously or only during the luteal phase (14 days before menses) 1. Hormonal treatments like combined oral contraceptives, particularly those containing drospirenone like Yaz, can also be effective 1. For symptom management, NSAIDs like ibuprofen (400-600mg every 6 hours) can help with physical symptoms, while calcium (1200mg daily) and vitamin B6 (50-100mg daily) supplements may provide modest benefits 1. Lifestyle modifications including regular exercise, stress reduction techniques, adequate sleep, and dietary changes (reducing caffeine, salt, and alcohol) are important complementary approaches 1.

Key considerations in treating PMDD include:

• The use of SSRIs as a first-line treatment due to their established efficacy in reducing symptoms of PMDD 1.
• The potential benefits of hormonal treatments, such as combined oral contraceptives, in managing PMDD symptoms 1.
• The importance of lifestyle modifications, including regular exercise and stress reduction techniques, in complementing medication treatment 1.
• The need for individualized treatment based on symptom severity and patient preferences, taking into account the latest evidence from clinical guidelines and studies 1.

In making treatment decisions for PMDD, it is essential to consider the most recent and highest-quality evidence available, prioritizing studies that directly address the treatment of PMDD and its symptoms 1. By doing so, clinicians can provide the most effective and personalized care for patients with PMDD.

From the FDA Drug Label

The effectiveness of sertraline for the treatment of PMDD was established in two double-blind, parallel group, placebo-controlled flexible dose trials (Studies 1 and 2) conducted over 3 menstrual cycles Patients in Study 1 met DSM-III-R criteria for Late Luteal Phase Dysphoric Disorder (LLPDD), the clinical entity now referred to as Premenstrual Dysphoric Disorder (PMDD) in DSM-IV. Efficacy was assessed with the Daily Record of Severity of Problems (DRSP), a patient-rated instrument that mirrors the diagnostic criteria for PMDD as identified in the DSM-IV, and includes assessments for mood, physical symptoms, and other symptoms

Sertraline is effective for the treatment of Premenstrual Dysphoric Disorder (PMDD).

• The recommended initial dose is 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle.
• Dose increases can be made at the onset of each new menstrual cycle, up to a maximum of 150 mg/day when dosing daily throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle 2.

From the Research

Definition and Symptoms of PMDD

• 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 3.
• Symptoms of PMDD occur during the last week of the luteal phase of the menstrual cycle and usually abate at the onset of menses 4.
• About 3-8% of all menstruating women experience PMDD, which can lead to significant functional impairment 4.

Treatment Options for PMDD

• Selective serotonin reuptake inhibitors (SSRIs) have been established as the first-line treatment for PMDD 3, 5, 4, 6.
• SSRIs can be taken either in the luteal phase or continuously, and are probably more effective when taken continuously compared to luteal phase administration 5, 6.
• Other treatment options include psychiatric medications such as venlafaxine, duloxetine, alprazolam, and buspirone, as well as anovulatory-related treatments and supplements like calcium 3.
• A selective progesterone receptor modulator (SPRM) has also shown promise in reducing the severity of mental symptoms of PMDD with negligible side effects 7.

Efficacy and Safety of SSRIs

• SSRIs have been found to significantly improve symptoms of PMDD, particularly psychological or behavioral symptoms, during the luteal phase 5, 4, 6.
• The most common adverse effects associated with SSRIs include nausea, asthenia, somnolence, fatigue, decreased libido, and sweating 5, 6.
• The overall quality of the evidence for the efficacy and safety of SSRIs is moderate, with the main weakness being poor reporting of study methodology 5, 6.