Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. The disorder consists of a variety of affective, behavioral and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle. PMDD affects women from their early teens up until menopause, excluding those with hypothalamic amenorrhea or during pregnancy and breastfeeding. Those with PMDD are at higher risk of suicide, with rates of suicidal thoughts 2.8 times higher, history of suicidal planning 4.15 times, and suicide attempts 3.3 times.
The emotional effects of premenstrual dysphoric disorder are theorized to be the result of severe gonadal steroid fluctuations, as they cause dysregulation of serotonin uptake and transmission, and potentially calcium regulation, circadian rhythm, BDNF, the HPA-axis and immune function as well.
In 2017, researchers at the National Institutes of Health discovered that women with PMDD have genetic changes that make their cells overreact to estrogen and progesterone. They believe this overreaction may be responsible for PMDD symptoms.
Some studies have suggested that those with PMDD are more at risk of developing postpartum depression after pregnancy, but other evidence has been found to suggest against that notion. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. It has 11 main symptoms, and a woman has to exhibit at least five to qualify for PMDD. Roughly 20% of women have some symptoms of PMDD, but either have less than five or do not have functional impairment.
Treatment is often with antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or hormone treatment (ovulation suppression) using birth control pills and GnRH analogues. SSRIs are the most common treatment, as they tend to improve both the physical and emotional symptoms as well as the general behavior and functionality of the woman, however the clinician must determine the best treatment based on the subjects criteria markers, only given that the subject doesn’t display markers outside the luteal phase or menses.
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