Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 5-10% of all women. It is an mood disorder associated with the luteal phase of the menstrual cycle. 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. It 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. It has been proposed as a disorder requiring further study by the American Psychiatric Association in the DSM-IV-TR. PMDD is accepted as 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. Though some suggest that PMDD has been "marketed" by pharmaceutical companies in order to increase the demand for treatments, significant evidence of a neurological foundation appears in Swedish studies. 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).

The cause of PMDD has not been definitively established, but several theories exist. One 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).

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. Notably, fluoxetine (also known as Prozac), has been repackaged as a PMDD therapy under the trade named Sarafem. Among the SSRIs tested, Sertraline has been shown in the largest number of studies to effectively reduce mood symptoms of premenstrual dysphoric disorder (PMID 10471170).