Premenstrual Dysphoric Disorder: Symptoms, Causes and Treatment

PMDD (Premenstrual Dysphoric Disorder) is a much more severe form of the collective symptoms known as Premenstrual Syndrome (PMS). It is said that Premenstrual Dysphoric Disorder (PMDD) affects approximately 5% of women of reproductive age, although this figure is in truth probably closer to 42% or more. PMDD is considered a severe and chronic medical condition that requires attention and treatment.

Premenstrual Dysphoric Disorder (PMDD) came into "official" being with the advent of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in 1994, but its roots extend back into antiquity. Hippocrates (460-377 B.C.) commented on women with suicidal thoughts and other premenstrual symptoms. In 1847, Dr. Ernst von Feuchtersleben stated, "The menses in sensitive women is almost always attended by mental uneasiness, irritability, and sadness." Frank, in 1931, wrote about hormonal causes of premenstrual tension. In 1953, Green and Dalton wrote about "the premenstrual syndrome," and since then numerous articles have addressed the subject. Most recently, the FDA-approval of fluoxitine (Sarafem) in 2000 and sertraline (Zoloft) in 2002, as treatments for PMDD, has stimulated substantial interest in this disorder by both professionals and laymen.

Causes of PMDD

Although the exact cause of PMDD has not been established by conventional medicine, several theories have been proposed.

The theory that PMDD is caused by an abnormal reaction to normal hormonal changes is in truth, simply an ill-informed conclusion, yet it is still an opinion widely held by the medical community and touted with alarming regularity as truthful fact in many respected media sources, especially on the Internet. This is very misleading, as it draws attention away from the true causes of PMDD. Please see PMS & PMDD - An Exposé for a more detailed explanation.

The truth is that a great majority (about 50-60%) women who experience PMS and PMDD may have an abnormal response to the 'stress response' (fight or flight response); hence a disruption of normal levels of certain key hormones, neurotransmitters, etc. Such a disruption in turn gives way to the stress-induced depletion and suppression of certain neuro-chemical hormones, and other vital 'building block' nutrients, such as for example the amino acid L-Tryptophan, which directly results in the manifestation of disturbing physical and emotional symptoms; collectively known as Premenstrual Syndrome or Premenstrual Dysphoric Disorder and other depressive disorders.

There are many respectable medical studies and research papers published about the effects of stress on health. With this kind of well-established information in hand, it is thus relatively easy to put two and two together and arrive at a conclusive answer, namely the appearance of 'PMS' and 'PMDD', amongst other ills, especially where women are concerned. It is surprising (not to mention disturbing) that the medical fraternity is not paying more attention to the severe effects of stress on women's health.

Treatment

Your physician should determine specific treatment for PMS/PMDD.

Your overall health and medical history
Extent of the condition
Symptoms present
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

Currently, the US Food and Drug Administration (FDA) has approved 2 brands of SSRI (Selective Serotonin Reuptake Inhibitors) for treating PMDD: Fluoxitine (a.k.a. Prozac or Sarafem) and Sertraline (Zoloft). However, PMDD is a serious, chronic condition that requires a more comprehensive treatment approach than merely prescribing an SSRI.

Several of the following treatment approaches may help alleviate or decrease the severity of PMDD symptoms:

Dietary modifications:

To increase: protein i.e. whole meats (including moderate amounts of meat fats), eggs, milk, cheese, cottage cheese, live cultured yoghurt, unsalted butter, cold-pressed oils and complex carbohydrates (i.e. fresh vegetables, fruits, whole grains, legumes, nuts, honey.) and significantly decrease, or avoid altogether: foods containing processed flour, processed sugar, sugar replacements such as aspartame and saccharine, sodium or foods fried or grilled in corn or processed canola oils. Also avoid caffeine, soda pop, sugared drinks, and alcohol. It is also advisable to avoid consumption of red meat (beef) during the time leading up to and during menses.

Regular exercise: at least 30 mins. of brisk walking per day is sufficient to produce excellent results. However, it is advisable to avoid strenuous exercise or physical labor during the time of menses. Listen to your body. If you require rest and time alone, do prevail upon friends or family to help with the chores and child care.

Vitamin and mineral supplements: a good daily multi-vitamin/mineral complex should cover all the bases. It is important to take multi-vitamin supplements at meal times to ensure proper uptake and utilization.

Anti-inflammatory medications: or natural products proven to alleviate the physical pain and discomfort sometimes associated with PMS and PMDD

Selective serotonin reuptake inhibitors (SSRI): for only the most severe of cases as an emergency short-stop until the much more effective long-term naturopathic therapies or other suitable treatments have been well established, and the patient is committed to sticking to the treatment regime, after which it is suggested patients be weaned off SSRI drug treatment to avoid health complications, drug dependency, and relapses from over-use of these drugs in the long term.

What are the most effective treatments for PMDD?

The very best treatment method, in my own opinion and personal experience (after proper diagnosis and thorough medical examinations), is to follow a treatment consisting of proper nutrition, supplementation with a good multi-vitamin/mineral complex, supplementation with the amino acid L-Tryptophan, sensible exercise and stress reduction as well as positive lifestyle changes if needed. Moreover, it is the correct combination of these therapies, rather than any single therapy, which is most effective and which has the most beneficial long term effects overall.

For example: Simply cutting out sugar and salt from your diet, and/or exercising, and/or supplementing with some vitamins will perhaps alleviate some of the symptoms, but will not be entirely effective in preventing some of the more serious symptoms of either PMS or PMDD to re-occur, or become more serious, over time.

The popular press is engorged with all kinds of 'helpful hints' on how to combat the monthly blues, however, this helpful advice sorely lacks the vital message that PMDD treatment must encompass a host of treatments, in combination and according to a specific consistent regimen, in order to see any real results.

The same holds true for taking only an SSRI as a treatment method without employing other key supportive naturopathic and/or psycho-therapeutic therapies at the same time, so that drug dependency does not become a long-term problem and health hazard as the woman moves towards her menopause years.

This is information the money-hungry pharmaceutical industry and conventional medicine in general don't want you to know!! Why? It would not look too good on Wall Street if the truth were known by the masses. To prove my point, please read the following excerpt from an article, written by a respected practicing Naturopathic Doctor in Arizona, U.S.A.

"According to the Journal of the American Medical Association, drug companies spent $15.7 billion in the year 2000 promoting drugs to patients and doctors. On average, drug companies spend anywhere from $10,000 to $13,000 per doctor per year to ensure that you receive patented pharmaceuticals, chemicals unknown in Nature, rather than nutrients that will bring you back in balance. While there can be some improvement in symptoms with drugs, the side effects can be insidious and serious. Moreover, drugs like the Selective Serotonin Reuptake Inhibitors (SSRI's) simply cannot replenish the depleted L-tryptophan levels that serve to produce serotonin and thus restore health. They work by merely conserving the serotonin already available. Given the knowledge and the choice, which would you choose?"

What happens if PMDD remains untreated?

Most women are shocked to learn that PMDD can get worse if it remains untreated (including those following SSRI treatment) over a long period of time.

At first, the PMDD sufferer will notice that her symptoms become incrementally worse each month, both in intensity and length of time (i.e. symptoms can start appearing at ovulation, as opposed to the last week or days before menstruation). The worsening symptoms lead to further stress, which leads to deepening symptoms of depression and other physical illnesses, e.g. compromised immunity, etc.

Untreated PMDD is a veritable snowball rolling down a steep mountain, nothing stops it until it crashes and crumbles at the bottom, with most serious and disconcerting effects for the sufferer, both emotionally, psychologically and physically. PMDD is not an issue to be ignored, and needs attention as soon as symptoms first start appearing.

Symptoms of PMDD

The primary symptoms that distinguish PMDD from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms -- with symptoms appearing from ovulation to the week before, and disappearing within a few days after, the onset of menses -- and the level by which these symptoms disrupt daily living tasks. Classic debilitating symptoms of PMDD are so severe that women have an impaired level of functioning at home, at work, and in interpersonal relationships during this symptomatic time period. (This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.)

Please Note: The symptoms of PMS and PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder, amongst others. Please consult a physician for diagnosis.

Symptoms to look out for include (all symptoms not listed):

Mood symptoms such as -

Depression
Unreasonable anger
Irritability
Anxiety
Low self-esteem
Inability to focus or concentrate
Irrational behavior
Labile feelings
Homicidal or suicidal tendencies
Hopelessness

Difficulty in maintaining healthy relationships at home work and socially

Physical symptoms such as -

Breast tenderness
Cramping
Bloating and food cravings
Pain or stiffness of joints and muscles
Migraine headaches

Insomnia

With severe PMDD; symptoms are debilitating and affect the sufferer's home-life, work and social situation to a crippling degree. Symptoms are very strongly linked to the woman's reproductive cycle and may appear from as much as 2 weeks before menstruation and disappear completely 2 to 3 days after commencement of menstruation.

The sufferer usually has a "window" each month where she will feel, act and behave completely normal and capable. She may have difficulty reconciling the fact that she undergoes, on a monthly basis, such drastic changes in her personality for up to two weeks each month (some reports are up to three weeks!).

This often unrecognized inability at self-realization often leads to a great deal of inner turmoil, fear, guilt, confusion and strife within herself which tends to have a negative impact on her most intimate relationships, i.e. husbands, boyfriends (or same-sex partners) and children, who often bare the brunt of the emotional ups and downs the PMS or PMDD sufferer experiences. One may only imagine the outcome of such untenable situations the longer severe PMS, PMDD remains untreated or unrecognized, either by the sufferer, her family members, or her attending physician.

If you think that you (or a close loved-one) fits the description above, I invite you to take some time and read through my web site as a starting point to getting to know this disorder from the inside out.

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