Premenstrual dysphoric disorder is a severe form of premenstrual syndrome in which mood symptoms like depression, anger and irritability are prominent. It frequently disrupts work and damages relationships.

Premenstrual dysphoric disorder is classified in the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision) under the category of Depressive Disorder Not Otherwise Specified. It is defined as the presence of symptoms like markedly depressed mood, anxiety, affective lability and decreased interest in activities, which occur regularly during the last week of the menstrual cycle, in most cycles during the past year. The symptoms remit within a few days of the onset of menses and must be severe enough to markedly interfere with work, school or usual activities. The symptoms must be entirely absent for at least 1 week postmenses. Some women complain of strong cravings for certain foods, problems with concentration and sleep, fatigue and physical symptoms such as breast tenderness, headache, joint and muscle pain, sweating and bloating.

The cause of premenstrual dysphoric disorder is not clear, but current theories suggest that normal ovarian function may trigger changes in brain chemistry in predisposed women. Genetics may play a role. Premenstrual dysphoric disorder occurs in 3% to 8% of menstruating women, and it has been suggested that stressful life events and a family history of premenstrual syndrome or premenstrual dysphoric disorder may increase the chances of getting it.

Treatment is directed at preventing or minimizing symptoms. The antidepressant medications known as SSRIs (selective serotonin reuptake inhibitors) effectively reduce mood symptoms and are well tolerated. Scheduled administration of SSRIs either throughout the cycle (all month) or only during the luteal phase (the 2-week period between ovulation and menstruation) is equally effective for this purpose. Medications that suppress ovulation and the production of ovarian hormones have also been used to treat premenstrual dysphoric disorder. Regular exercise, eating a healthy diet and cutting back caffeine and alcohol intake are recommended as well in order to reduce the symptomatology of premenstrual dysphoric disorder.

 Ana C Posada-Diaz, MD

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