Premenstrual Dysphoric Disorder

What Causes Premenstrual Dysphoric Disorder?

The cause of PMDD is not yet known. Some scientists think it may be an extreme reaction to a natural drop in the level of the hormones estrogen and progesterone after a woman ovulates. It may also be related to levels of a neurotransmitter called serotonin, which plays a role in mood regulation.

Some factors seem to put a person at increased risk for PMDD. Possible risk factors include:

• A family history of PMS or PMDD
• A personal history of PMS
• A personal history of anxiety or depression

Is Premenstrual Dysphoric Disorder Hereditary?

Researchers have not identified a direct genetic link to PMDD, but many scientists suspect that there is a genetic component to risk for the disorders. Women with a family history of PMDD or PMS are more likely to have PMDD themselves. This suggests that genetics plays a role in the development of PMDD, although other factors likely contribute to the disorder.

How Is Premenstrual Dysphoric Disorder Detected?

Many of the symptoms of PMDD overlap with those of PMS, making it challenging to identify if the symptoms have crossed the line to the more severe condition. In general, PMDD produces more extreme mood-related symptoms that interfere with a woman’s ability to function normally and may become life-threatening.

Some possible warning signs of PMDD include:

• Depression that manifests as extreme sadness or hopeless
• Persistent anxiety that includes feeling “on edge”
• Extreme mood swings or feeling out of control
• Suicidal thoughts

How Is Premenstrual Dysphoric Disorder Diagnosed?

Diagnosis of PMDD begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that PMDD is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for PMDD. These criteria include:

• At least five symptoms are present during most menstrual cycles over the course of a year.
• The symptoms cause significant distress or impairment of daily functioning.
• The symptoms aren’t caused by another medical condition.

 PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Premenstrual Dysphoric Disorder Treated?

PMDD has no known reliable cure, but a combination of medications and lifestyle changes is often effective at reducing the severity of symptoms for many women.

Common treatment approaches include:

• Selective serotonin reuptake inhibitors (SSRIs). These drugs work by increasing the levels of serotonin, a neurotransmitter chemical in the brain. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Hormonal birth control pills. Birth control pills help regulate hormonal levels during the menstrual cycle and may help relieve symptoms of PMDD and PMS.
• Dietary supplements. Calcium, vitamin B-6, magnesium, and L-tryptophan may help control symptoms in some women. Consult your doctor before taking any supplements.
• Over-the-counter pain medications. These medications may help with physical symptoms such as cramps or headaches.
• Avoidance of caffeine, nicotine, and alcohol
• Improving sleep quality
• Practicing relaxation techniques such as yoga or meditation
• Getting regular exercise

How Does Premenstrual Dysphoric Disorder Progress?

PMDD is a serious disorder that can cause severe complications if left untreated. Potential long-term consequences of PMDD include:

• Relationship problems
• Problems at work or school
• Risk of developing major depression
• Substance abuse
• Suicidal thoughts, suicide attempts, or suicide

How Is Premenstrual Dysphoric Disorder Prevented?

There is no way to prevent PMDD, but prompt diagnosis and an effective treatment plan can help to manage symptoms. Some scientists believe that PMDD is related to depression and that hormonal changes during the menstrual cycle may worsen symptoms of pre-existing depression. If this is the case, treatment of the underlying depression may help lessen the symptoms of PMDD.

It’s important for those diagnosed with PMDD to seek treatment from healthcare providers and stick to any prescribed medication plan.

Premenstrual Dysphoric Disorder Caregiver Tips

Caregivers for someone with PMDD should consider some of the following self-care tips:

• Learn as much as possible about the disorder.
• Make time for yourself away from the condition.
• Take care of your own physical and mental health. Unfortunately, it is not uncommon for caregivers to experience depression or let their own healthy lifestyle suffer because of stress.

Many people with PMDD also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the conditions commonly associated with PMDD:

• People with PMDD may also suffer from anxiety.
• PMDD is often associated with depression.

Premenstrual Dysphoric Disorder Brain Science

Although PMDD is clearly linked to the hormonal changes during a woman’s menstrual cycle, research has shown there is no difference in hormone levels between women with PMDD and those without the disorder. This has led some scientists to believe that the difference lies in how the brains of women with PMDD respond even to typical hormone levels.

Imaging studies have found that some women with PMDD show increased activity in specific parts of their brains, including the dorsal anterior cingulate cortex (dACC) and the dorsolateral prefrontal cortex (DLPFC). The DLPFC is involved in mood regulation and conflict management, among many other cognitive functions. The role of the dACC is far less clear to neuroscientists, but it may be involved in functions such as self-control and learning.

Premenstrual Dysphoric Disorder Research

Title: Oral Contraceptives for Treating Premenstrual Dysphoric Disorder in Bipolar Disorder

Stage: Not Yet Recruiting

Principal investigator: Benicio N. Frey, MD, MSc,PhD

St. Joseph’s Healthcare Hamilton

Hamilton, Ontario

This study is being conducted in the hope of finding a safe and effective treatment for individuals who experience both bipolar disorder and severe premenstrual symptoms. As part of this clinical trial, participants will receive either a combined oral contraceptive (i.e., oral birth control pills) as a treatment for severe premenstrual symptoms or a placebo. People enrolled in this study will either receive the treatment or the placebo for 90 days. During this time, people participating in the study will fill out questionnaires, and their mental and physical health will be monitored by the study physicians.

One of the goals of this study is to understand whether it is feasible (practical) to do a larger clinical trial using this treatment in this group of people.

Title: Emotional Processing and Oxytocin Mechanisms in Premenstrual Dysphoric Disorder: A Pilot Study

Stage: Completed

Principal investigator: Susan Girdler, PhD

University of North Carolina

Chapel Hill, NC

This research study will examine brain and symptom differences among women with severe premenstrual mood symptoms. One goal of this study is to look at the effects of taking a nasal spray containing oxytocin (a hormone made in the brain) on brain areas involved in emotion regulation while viewing pictures during a neuroimaging (fMRI) session. The investigators will also look at whether oxytocin improves premenstrual mood symptoms.

The primary objective of this pilot study is to use functional neuroimaging techniques to begin to identify the central brain networks that may contribute to impairment in emotion regulation, interpersonal relationships, and marital and family function in women with premenstrual dysphoric disorder (PMDD), particularly for those women who also have a history of early life abuse (ELA).

Based on the evidence that the mammalian neuropeptide oxytocin (OT), best known for its role in lactation and parturition, plays a seminal role in social affiliation, emotion regulation, attachment, maternal behavior, trust, and protection against stress; and because OT neural pathways and receptors are prominently expressed in brain regions involved in emotion regulation and maternal/affiliative behavior; the study will: 1) use intranasal OT administration as a probe to assess whether it modifies activation of brain regions involved in emotion regulation in response to an emotional processing task; and 2) whether daily intranasal OT administration during the premenstrual phase improves symptoms in women with PMDD with or without a history of ELA.

Title: Alternative Treatments for Premenstrual Dysphoric Disorder

Stage: Completed

Principal investigator: Barbara L. Parry, MD

University of California, San Diego

San Diego, CA

The primary aim of this study is to examine the effects of co-administered wake therapy followed by light treatment on mood and secondarily on circadian rhythms, to test the hypothesis that critically-timed chronotherapy improves mood by correcting phase disturbances in melatonin and sleep in women with Premenstrual Dysphoric Disorder.

The design is a randomized cross-over contrasting Late Wake Therapy plus morning bright light (LWT+Am BWL)vs. Early Wake Therapy plus evening bright light (EWT+PM BWL) administered in the luteal phase of two separate menstrual cycles and preceded by two evaluation months. To lessen the patient’s burden, the 1-night EWT or LWT and the following 7-day BWL interventions will be conducted at home, given at a fixed point in each menstrual cycle, from day 1 to 7 after the mid-cycle luteinizing hormone(LH) surge (ovulation). We anticipate that LWT+7 days of AM BWL (vs. EWT+PM BWL) will produce much greater mood benefits, and more significant physiological responses, than the one-time light pulses used in our earlier phase-shift studies.