Premenstrual dysphoric disorder
|Premenstrual dysphoric disorder|
|Classification and external resources|
|ICD-9||Controversial. Either 311, 625.4, or none|
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome affecting 3–8% of women. It is a diagnosis associated primarily with the luteal phase of the menstrual cycle, comprising a "cluster of affective, behavioral and somatic symptoms".
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like 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. On average, the symptoms last six days, with the most intense symptoms happening in the two days before through the day of the start of menstrual blood flow.
Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant. Substantial disruption to personal relationships is typical for women with PMDD. Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include:[medical citation needed]
- Feelings of sadness or despair, or even thoughts of suicide
- Feelings of tension or anxiety
- Panic attacks
- Mood swings or frequent crying
- Lasting irritability or anger that affects other people
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
The symptoms occur during the week before menstruation, and go away once it starts. A diagnosis of PMDD requires the presence of at least five of these symptoms.[medical citation needed]
A demonstrable hormonal imbalance in women with PMDD has not been identified. It is hypothesized that normal ovarian function produces biochemical events in the nervous system that cause the premenstrual symptoms in women who have a predisposition to the disorder.
PMDD is listed in the DSM-IV, and was originally included as late luteal phase dysphoric disorder LLPDD in the DSM-III. In many parts of the world, PMDD is not recognized as a disease and it is not listed as a separate disorder in the World Health Organization's International Classification of Diseases (ICD).
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. Reflecting the approach of the ICD-10, 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.
Selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. Unlike treatments for other depressive disorders, SSRIs do not need to be taken daily but instead can be taken only in the luteal phase or for the duration of PMDD symptoms. The U.S. Food and Drug Administration (FDA) has approved four SSRIs for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil) and escitalopram oxalate (Lexapro).[medical citation needed]
From three to eight percent of women of reproductive age meet the PMDD criteria.
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