PMDD: Debilitating but Treatable

Up to 70 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 5 percent of American women. It is a debilitating condition marked by a depressed mood, increased anxiety, and difficulty with interpersonal relationships.

Treatment success

As severe as it is, though, PMDD can be successfully treated if it's diagnosed properly.

"We have to think of this whole thing as a spectrum of disorders. There are people who have mild or moderate PMS, and there are people who have severe PMS. Those women with the severe cases are the ones who have PMDD," says Diana Dell, M.D., an OB/GYN and psychiatrist in Durham, N.C.

A woman's premenstrual period is a biologically vulnerable time, according Dr. Dell. Some women are sensitive to the changes that occur during this time. These are the women who suffer from PMS or PMDD.

"To complicate this time even more, whatever condition you have may get worse premenstrually if you are one of these sensitive women," says Dr. Dell. "Women can experience premenstrual exacerbation of anything, from asthma to diabetes to schizophrenia."

PMDD versus PMS

"Most people who describe themselves as having PMS have a lot of physical symptoms, and maybe some mild emotional symptoms," Dr. Dell says. 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," she says.

Who's at risk?

Any woman can develop PMDD, but some are definitely at a higher risk than others. Doctors know that 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," Dr. Dell says.

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. "This is a disorder that starts becoming a problem for women who are in their late 20s and early 30s," says Dr. Dell.

Using a diary for diagnosis

To help physicians make an accurate diagnosis of PMDD, patients should keep a diary of how they are feeling throughout the month. Write in the diary every day, advises Dr. Dell. Not just when you are experiencing premenstrual symptoms.

If you suspect you have PMDD, Dr. Dell advises that you call your health care provider before your scheduled visit and let him or her know you're keeping a diary. You can also ask your doctor for a diary format.

"Physicians have to use a diary to make this diagnosis," says Dr. Dell. "The patient and the physician need to be able to look at the diary and see if this is something that gets worse before the premenstrual period or if it only occurs then. In my practice, that affects how the patient is treated."

Women who have symptoms that get worse premenstrually need treatment throughout the whole month, and women who have symptoms only premenstrually can be treated only premenstrually. "But the most important thing you should know about keeping a diary," says Dr Dell, "is that you've got to do it every day."

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 is thought to be 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. That's also the same response rate for patients who try SSRIs for depression, says Dr. Dell. "People who don't respond to one drug may respond to another SSRI, though," she explains.

But Dr. Dell points out that any SSRI can be used to treat PMDD. "Physicians have been using them for that purpose for several years," she says.

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 the patient's system for four to six weeks. With the treatment of PMDD, taking an SSRI for only a few days per month may raise serotonin levels enough for the patient to feel better.