Premenstrual dysphoric disorder

Menstrual Cycle

Premenstrual Dysphoric Disorder (PMDD) is an advanced and severe form of premenstrual syndrome (PMS) that affects an estimated 5-10% of women. Predominantly characterized by profound mood disturbances, PMDD's prominent features are rooted in its cyclical nature, mainly occurring during the luteal phase of the menstrual cycle.

Clinical Presentation

The hallmark symptom of PMDD is intense irritability which emerges between ovulation and menstruation. This symptom typically dissipates within the initial days of bleeding (PMID 11571794). In addition to irritability, affected individuals may also experience heightened anxiety, pronounced anger, and episodes of depression. The severity of these symptoms distinguishes PMDD from standard PMS. Such is its impact that it significantly disrupts daily activities and interpersonal relationships, necessitating therapeutic interventions.

Classification and Perception

While the American Psychiatric Association has identified PMDD for further exploration in the DSM-IV-TR, the World Health Organization's International Classification of Diseases has not yet incorporated it as an independent disorder. Nonetheless, the Food and Drug Administration (FDA) has acknowledged PMDD as a genuine medical condition. Controversies arise with some opining that PMDD has been "marketed" to boost pharmaceutical demands. However, Swedish investigations have showcased substantial evidence pointing to its neurological underpinnings. Notably, PET (Positron emission tomography) scans revealed a profound correlation between mood symptoms and a decline in brain serotonin activity in women diagnosed with PMDD (PMID 16515859).

Etiology

The exact pathogenesis of PMDD remains elusive, but several hypotheses have emerged. A prevalent theory associates it with serotonin deficiency, a vital neurotransmitter, influenced by variations in sex hormone levels - including progesterone, estrogen, and testosterone - during the menstrual cycle's luteal phase (PMID 16515859).

Treatment

The pivotal role of serotonin in PMDD's manifestation is underscored by the efficacy of selective serotonin reuptake inhibitors (SSRIs) in addressing its mood-centric symptoms. Clinical trials have demonstrated the potency of SSRIs, especially when administered during PMDD's dysphoric phase. A case in point is fluoxetine, popularly recognized as Prozac, which has been reintroduced specifically for PMDD therapy under the brand name Sarafem. Of the myriad SSRIs scrutinized, sertraline has consistently exhibited the most significant reduction in PMDD's mood-related symptoms (PMID 10471170).

Conclusion

PMDD, though a subject of ongoing research and debate, has been acknowledged as a debilitating condition that profoundly affects the quality of life of those afflicted. While its exact cause remains a topic of exploration, current treatments, particularly SSRIs, have provided a respite to many, underscoring the importance of continuous research in this domain.

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