Premenstrual Dysphoric Disorder

Imagine that each month you experience a week of depression, lack of energy, increased interpersonal conflicts, persistent anger, headaches and a bloated feeling.

In addition, imagine that these symptoms are serious enough to interfere with your occupational and social functioning and cause increasing damage to your relationships.

For approximately five per cent of women, this type of scenario is a reality. These women suffer from premenstrual dysphoric disorder (PMDD), a severe form of the premenstrual syndrome (PMS) that most women experience.

For women with PMDD, this segment of the menstrual cycle is a nightmare. Much worse than simply the mild irritability and other symptoms commonly associated with PMS, PMDD is serious and disabling.

In order to be diagnosed with PMDD, women must have depressive symptoms as well as at least four other symptoms such as appetite changes and cravings, insomnia or hypersomnia, anxiety, marked or persistent irritability or anger, increased interpersonal conflicts, difficulty concentrating, breast tenderness or swelling, headaches, joint or muscular pain, weight gain or a bloated feeling.

While the cause of PMDD is not fully understood, genetic and hormonal factors seem to play a role.

Several medical treatments and lifestyle changes are available to help ease the severity of PMDD symptoms. Because of the involvement of serotonin in the disorder, some of the most widely used antidepressants have proven effective at alleviating symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as paroxetine, fluoxetine, or sertraline have the best evidence supporting their use. Interestingly, these are effective when used intermittently for the 10 days or so before the menses. They do not have to be taken all month. Less compelling evidence supports the usefulness of anti-anxiety medications and diuretics in PMDD.

Non-medicinal treatments are also available and include cognitive behaviour therapy or light therapy for those with a seasonal component to their condition.

Lifestyle changes such as diet modification, aerobic exercise and stress management can also provide some relief. These have some, but not compelling evidence.

Last year Okanagan Clinical Trials was involved in a study to test Paxil CR in the treatment of PMDD and that study found that the medication was more effective than placebo when taken for the 10 days premenstrually. For some it produces quite impressive improvement.

We are just starting another study that will look at the effect of hormones in treating this condition. The medication will suppress the menstrual cycle and we expect that this will alleviate the symptoms of PMDD. This study will last 4 menstrual cylces once the initial assessment is over.

For information about the ongoing PMDD study at Okanagan Clinical Trials, contact our office at 862-8141 or email the doctor at

Most importantly, if you feel your premenstrual symptoms are more severe than is normal, discuss it with your doctor. There may be some simple steps you can take to feel better and improve your functioning.


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