| Premenstrual dysphoric disorder | |
|---|---|
| Classification and external resources | |
| ICD-9 | Controversial. Either 311,[1] 625.4, or none[2] |
| eMedicine | article/293257 |
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome,[3] afflicting 3% to 8% of women.[4] It is a diagnosis associated primarily with the luteal phase of the menstrual cycle. Up to one-third of women diagnosed with PMDD report residual symptoms into the first 2 or 3 days of the follicular phase.[5]
Contents |
PMDD is a severe form of premenstrual syndrome (PMS).
PMDD is a severe forms of PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.[6]
Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant.[6] Substantial disruption to personal relationships is typical for women with PMDD.[6] Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[7]
Common physical symptoms include:
Five or more of these symptoms may indicate PMDD.
In 2007, the first significant genetic finding in premenstrual dysphoric disorder was reported.[8][9] Variants in the estrogen receptor alpha gene that are associated with PMDD. Women with these genetic variants were more likely to suffer from PMDD. They also discovered that this association is seen only in women with a variant form of another gene, Catechol-O-methyl transferase also known as COMT, which is involved in regulating the function of the prefrontal cortex, a critical regulator of mood.
Previously, research showed that women with PMDD have an abnormal response to normal hormone levels, and, thus, are differentially sensitive to their own natural hormone changes.
There is objective correlational evidence of a neurological connection for PMDD distress. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be significantly correlated with the concomitant worsening of their brain serotonin precursors, measured by positron emission tomography (PET).[10]
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.[10]
Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been shown in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase.
Women with PMDD but have never experienced major depressive disorder (MDD) have lower sensitivity and response to stress and pain than people with MDD.[11] This suggests that PMDD is a separate disease from MDD.
Unipolar depression, anxiety disorders, and other Axis I disorders are more common in women with premenstrual dysphoric disorder (PMDD) than in women without PMDD.[12]
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. It is not recognized as a disorder in the DSM-IV. PMDD was moved from a position the DSM-IV in the appendix of the manual to a "disorder requiring further study."[13][14]
PMDD is accepted as an illness by the Food and Drug Administration (FDA) but has not as yet 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.[15] The committee found that
...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.[16]
In Australia, although PMDD is recognized by the Therapeutic Goods Administration, SSRIs are not reimbursed for it under the Pharmaceutical Benefits Scheme.[17]
Some commentators suggest that PMDD (along with heart disease, borderline high blood pressure, mild hypercholesterolemia, social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments.[18] Some psychiatrists and women's groups say that labeling this severe form of PMS as a psychiatric disorder, rather than a physical disorder, is stigmatizing. Psychologist Peggy Kleinplatz has criticized the diagnosis as part of a trend in medicalization of normal human behavior.[19]
The primary goal of treatment is to reduce the woman's suffering and the disruption to her social relationships.
Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. There is some evidence that vitamin B6 can alleviate symptoms.[20]
Certain SSRIs provide relief as well.[21] The U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil) and escitalopram oxalate (Lexapro).
L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose.[22]
|
|||||||||||||||||||||||||||||||||||||