Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 8% of all women. It is a mood disorder associated with the luteal phase of the menstrual cycle. Premenstrual syndrome (PMS) (also called PMT or Premenstrual Tension) is a collection of physical, psychological, and emotional symptoms related to a womans menstrual cycle. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of several mammals, including human beings and apes. ...

Symptoms

PMDD is similar to premenstrual syndrome (PMS), but differs from it in severity and in that it requires treatment, because it interferes with the sufferer's ability to function in her environment. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability (PMID 11571794). Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include^[1] PMS redirects here. ...

 – feelings of sadness or despair, or possibly suicidal thoughts – feelings of tension or anxiety – panic attacks – mood swings, crying – lasting irritability or anger that affects other people – disinterest in daily activities and relationships – trouble thinking or focusing – tiredness or low energy – food cravings or binge eating – having trouble sleeping – feeling out of control – physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain 

You must have five or more of these symptoms to be diagnosed with PMDD. Symptoms occur during the week before your period and go away after bleeding starts.

Background and controversy

Originally called late luteal phase dysphoric disorder (LLPDD), the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. PMDD was moved from a position in the appendix of the manual to a "disorder requiring further study."^[2][3] While few would prefer to leave disabling and treatable symptoms untreated, some groups of psychiatrists and women's groups object to the labeling of a severe form of PMS as a psychiatric disorder. Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ...

PMDD is accepted as illness by the Food and Drug Administration (FDA) but has not as been listed as a separate disorder in the World Health Organization's International Classification of Diseases. In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe.^[4] The committee found that hi “FDA” redirects here. ... The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... “CHMP” redirects here. ...

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.^[5]

PMDD is not listed on the Australian Pharmaceutical Benefits Scheme. ^[6] The Pharmaceutical Benefits Scheme or PBS is a programme of the Australian Government that provides heavily subsidised prescription drugs to residents of Australia. ...

Some commentators suggest that PMDD (along with social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments.(PMID 16597181). Of course the marketing of a cure is no proof that the underlying condition does not exist, or that the distress of the sufferers is not real. Social anxiety, sometimes known as social phobia or social anxiety disorder (SAD), is a common form of anxiety disorder that causes sufferers to experience intense anxiety in some or all of the social interactions and public events of everyday life. ... Wittmaack-Ekbom or restless legs syndrome is a disorder of the nervous system that affects sensation and movement in the legs and causes the limbs to feel uncomfortable. ...

There is, in fact, significant evidence of a neurological foundation. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be strongly correlated with the concomitant worsening of their brain serotonin function measured objectively by Positron emission tomography (PET) (PMID 16515859). Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ...

While the cause of PMDD has not been definitively established, a leading theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle (PMID 16515859). Serotonin (pronounced ) (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Estriol. ... Testosterone is a steroid hormone from the androgen group. ...

Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been proven in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase. Serotonin (pronounced ) (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... SSRI redirects here; for other uses, see SSRI (disambiguation). ...

Treatment

Lifestyle changes may ameliorate some of the effects of PMDD, and certain SSRIs provide relief as well.^[7] The U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of PMDD: Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. Sertraline (Zoloft) was approved in 2002, and Paroxetine HCI (Paxil) has also been approved by the FDA. The patent for Fluoxetine has expired, but Eli Lilly was able to obtain a new patent for its use in the treatment of PMDD, which has since marketed heavily under the trade name Sarafem.^[8] However Fluoxetine is now available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem. SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... Fluoxetine pills. ... Zoloft bottles, with blue and green tablets Sertraline hydrochloride (also sold under brand names Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Fluoxetine pills. ... Eli Lilly and Company (NYSE: LLY) is a global pharmaceutical company and one of the worlds largest corporations. ... Fluoxetine pills. ...

References

1. ^ http://www.4women.gov/FAQ/pms.htm "Premenstrual Syndrome" // Includes concise discussion re: "What is Premenstrual Dysphoric Disorder (PMDD?"
2. ^ Laurence, Leslie. "Psychiatric group scruitinzes categorizing form of PMS", Chicago Tribune, 1993-05-16. 
3. ^ Lehman, Betsy. "A little revision is creating a big furor", Boston Globe, 1993-05-10. 
4. ^ Ray Moynihan (2004-02-14). "Controversial disease dropped from Prozac product information". BMJ 328. 
5. ^ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products (2003-06-13). Summary Information...for Prozac and associated names.
6. ^ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
7. ^ http://www.4women.gov/FAQ/pms.htm
8. ^ Jennifer Daw (2002-10-09). "Is PMDD real?" 33. 

See also

• Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) (also called PMT or Premenstrual Tension) is a collection of physical, psychological, and emotional symptoms related to a womans menstrual cycle. ...

External links

• eMedicine on PMDD
• Madison Institute of Medicine (a non-profit organization) on PMDD
• A Disease for Every Pill, an article in The Nation questioning the reality of PMDD