PMDD Flashcards
Often PMDD may be suspected, but not diagnosed, based on history. In order to be diagnosed, ___ is typically required.
Often PMDD may be suspected, but not diagnosed, based on history. In order to be diagnosed, menstrual/symptom journaling is typically required.
Affective lability
Rapid changes in affect, for example, “mood swings”
Diagnostic criteria for PMDD
- Symptoms occur during the majority of menses over the past year
- Multiple symptoms begin the week before menses and improve within days after the onset of menses, and are minimal or absent post-menses
- At least 5 symptoms in total involving the following domains:
- Affective
- Physical (somatic)
- Behavioral
Four characteristic PMDD affective symptoms
- Affective lability
- Irritability or anger – often characterized by increased interpersonal conflicts
- Marked depressed mood, hopelessness, or self-deprecating thoughts (Depressive sx)
- Anxiety, tension, or feeling on edge (Anxious sx)
When in the menstrual cycle does PMDD occur?
They begin during last 3-4 days of the luteal phase
They end up to 3 days into the new cycle’s follicular phase
PMDD is a signfiicant risk factor for. . .
. . . post-partum depression
Can hormones be used to treat PMDD?
Yes and no!
A daily OCP often exacerbates the problem, since there are more ups and downs in hormone levels.
However, longer term hormonal therapies may be effective. GnRH/leuprelide is most effective, as it eliminates hormones entirely for a period of time.
Any hormonal therapy longer than 3 months must be managed by a gynecologist.
PMS vs PMDD
PMS is less severe than PMDD, and more common
Some features of PMS, such as dysmenorrhea, only begin during menses, while PMDD improves during menses.
Most patients with PMDD experience ___ depressive symptoms, while most patients with MDD experience ___ depressive symptoms
Most patients with PMDD experience activating depressive symptoms (irritability, labile affect), while most patients with MDD experience deactivating depressive symptoms (depressed mood, fatigue, poor concentration, lack of motivation for ADLs/IADLs)
Treatment of PMDD
SSRIs are first-line
Notably, they work faster in PMS/PMDD compared to any other psychiatric disorder, and are effective at a lower dose. This makes intermittent dosing possible for PMDD while it is not for MDD.
However, if menstrual cycle is erratic, continuous therapy may still be optimal.
Otherwise, not much works except for the one specific TCA clomipramine.
___ is a common mimic of PMS/PMDD
IBS is a common mimic of PMS/PMDD
Many women who believe that they have PMDD actually have. . .
. . . PDD or MDD
Menstrual journaling is the best way to distinguish these
