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Premenstrual Dysphoric Disorder

Currently, there is no consensus on the cause of PMDD. Biologic, psychologic, environmental and social factors all seem to play a part. Genetic factors are also pertinent: 70 percent of women whose mothers have been affected by PMS have PMS themselves, compared with 37 percent of women whose mothers have not been affected.

Features of PMDD and depressive disorders—specifically atypical depression—overlap considerably. Symptoms of atypical depression (i.e., depressed mood, interpersonal rejection hypersensitivity, carbohydrate craving, and hypersomnia) are similar to those of PMDD. Thirty to 76 percent of women diagnosed with PMDD have a lifetime history of depression, compared with 15 percent of women of a similar age without PMDD. A family history of depression is common in women diagnosed with moderate to severe PMS. There is significant comorbidity between depression and PMDD. Despite this relationship, many patients with PMDD do not have depressive symptoms; therefore, PMDD should not be considered as simply a variant of depressive disorder.

Lifestyle changes

  • Discuss with your medical doctor
  • Regular, frequent, small balanced meals rich in complex carbohydrates and low in salt, fat, and caffeine
  • Regular exercise
  • Smoking cessation
  • Alcohol restriction
  • Regular sleep
  • Caffeine reduction to abate anxiety
  • Sodium reduction to abate eema and bloating

Nutritional supplements

  • Vitamin B6, up to 100 mg per day
  • Vitamin E, up to 600 IU per day
  • Calcium carbonate, 1,200 to 1,600 mg per day
  • Magnesium, up to 500 mg per day
  • Tryptophan, up to 6 g per day

Nonpharmacologic treatments

  • Stress reduction and management
  • Anger management
  • Self-help support group
  • Individual and couples therapy
  • Cognitive-behavioral therapy
  • Patient education about the cause, diagnosis, and treatment of PMS/PMDD
  • Light therapy20 with 10,000 Lx cool-white fluorescent light

Herbals (NOTE: these are not FDA approved and research has variable conclusions)

  • Evening primrose oil, 500 mg per day to 1,000 mg three times per day, Days 17 through 28 of menstrual cycle
  • Chaste tree berry, 30 to 40 mg per day, Days 17 through 28 of menstrual cycle

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