Premenstrual Dysphoric Disorder

Recently, I have had a number of patients and friends as well come to me to talk about a strikingly similar set of symptoms. Their complaints ranged from mild irritability to intense feelings of despair and lethargy. They often experienced periods of tearfulness and found themselves unable to work or care for their children. One said it was like "PMS on crack." When asked how often these symptoms occur for them, they characterize them as occurring only at certain times of the months usually right before their period.

The diagnosis of Premenstrual Dysphoric Disorder (PMDD) is relatively new (only 8 years old) and is considered a more severe or intense version of the more common Premenstrual Syndrome (PMS). The American Psychological Association's (APA) website provides some sound information about the diagnosis of PMDD as well as documents arguments against the existence of PMDD. The list of symptoms  are basically the same as Markedly Depressed Mood (aka depression), with the exception that the symptoms of PMDD resolve with the onset of ones period.

* Markedly depressed mood. A symptom of MDD is depressed mood most of the day, nearly every day.
* Decreased interest in usual activities. One criterion for MDD is markedly diminished interest or pleasure in all activities.
* Lethargy, fatigability or lack of energy. Similarly, patients with MDD have fatigue or loss of energy.
* Hypersomnia or insomnia--also symptoms of MDD.

The APA article questions whether the diagnosis is "good for women?," pondering whether a diagnosis of PMDD will stigmatize women in today's society implying that the hormonal changes experienced during the cycle is a disordered process. However, when these symptoms are debilitating to women to a point where they are unable to function normally for 3 to 4 days out of the month, my opinion is that some sort of diagnosis and treatment is warranted.