PMDD: Debilitating but Treatable

Up to 75 to 85 percent of women experience some degree of premenstrual syndrome (PMS), the emotional and physical symptoms tied to their monthly period.

PMS symptoms typically occur in the week leading up to a woman's menstrual period. They usually end a few days after the period begins.

A few women have the most severe form of PMS, called premenstrual dysphoric disorder (PMDD). PMDD affects 3 to 8 percent of American women. It is a debilitating condition marked by a depressed mood, increased anxiety, and difficulty with interpersonal relationships.

Treatment success

Some women are very sensitive to hormonal changes in their bodies and their lives can be severely affected. As severe as it is, though, PMDD can be successfully treated if it's diagnosed properly.

PMDD versus PMS

Most people who describe themselves as having PMS have a lot of physical symptoms, and maybe some mild emotional symptoms. The physical symptoms the PMDD sufferer encounters are not the primary source of her discomfort.

People who have PMDD primarily have emotional symptoms, especially difficulty in relationships.

Who's at risk?

Any woman can develop PMDD, but some are definitely at a higher risk than others. Women who experience PMDD are also at risk for postpartum depression and perimenopausal depression.

As a group, these women may be more sensitive to changing estrogen and progesterone levels in their brains, which alter sensitivity to brain neurotransmitters.

Doctors and medical researchers have identified certain traits that make a woman more likely to experience PMDD. Three of the biggest indicators are family history of severe PMS, personal history of depression or other mood disorders, and age. 

Using a diary for diagnosis

To help doctors make an accurate diagnosis of PMDD, you should keep a diary of how you are feeling throughout the month. Write in the diary every day, not just when you experience premenstrual symptoms.

If you suspect you have PMDD, call your health care provider before your scheduled visit and let him or her know you're keeping a diary. You also can ask your health care provider to provide a pamphlet in a diary format.

Generally, women who have symptoms that get worse premenstrually, need treatment throughout the whole month. Women who have symptoms only premenstrually can be treated only premenstrually.

Treatment

It is important to get an accurate diagnosis of PMDD, because the disorder is treatable. Researchers have found that lifestyle changes and selective serotonin reuptake inhibitors (SSRIs), a widely used class of antidepressants, are the most effective treatment for PMDD. Serotonin is a neurotransmitter in the brain that experts think is responsible for PMDD, as well as depression.

SSRIs don't help everyone who suffers from PMDD, but they do help 65 to 70 percent of the patients who take them.

The most significant difference between using SSRIs to treat depression and using them to treat PMDD is duration of treatment. To effectively treat depression, an SSRI must be in your system for four to six weeks. To treat PMDD, taking an SSRI for only a few days per month may raise your serotonin levels enough for you to feel better.