Premenstrual Dysphoric Disorder

What is Premenstrual Dysphoric Disorder (PMDD)? The Diagnostic and Statistical Manual of Mental Disorders lists Premenstrual Dysphoric Disorder (PMDD) as a "depressive disorder not otherwise specified. " A severe form of Premenstrual Syndrome (PMS). PMDD symptoms are quite similar to those of Major Depressive Disorder (MDD) and include: •Depressed mood most of the day, nearly every day.

•Decreased interest in usual activities. •Markedly diminished interest or pleasure in all activities. •Lethargy •Fatigability •Lack of energy. •FatigueJean Endicott, PhD, director of the premenstrual evaluation unit at Columbia Presbyterian Medical Center, believes that "It's a real biological condition for which women seek treatment and for which effective treatment is available. " (Jennifer Daw, October 2002, Vol 33, No. 9 Print version: page 58).

Somewhere around about 3 to 9 percent of women’s daily lives and routines are affected due to this affliction. There are those such as Psychologist Paula Caplan, who believe that PMDD is made up as a psychiatric disorder and that it stigmatizes women as being mentally ill and is truly covering up the real reasons of women's anguish.It's a label that can be used by a sexist society that wants to believe that many women go crazy once a month," Caplan explains. (Jennifer Daw, October 2002, Vol 33, No. 9 Print version: page 58). The exact cause of PMDD is not known.

However, some researchers believe PMDD is brought about by the hormonal changes related to the menstrual cycle. Low levels of serotonin, a chemical in the brain that helps transmit nerve signals also shows a connection to PMDD. There are certain brain cells that utilize serotonin as a messenger and are involved in controlling mood, attention, sleep, and pain.It is believed that chronic changes in serotonin levels can lead to PMDD symptoms. There are others who believe it is caused by conditions resulting from the interaction of hormones produced by the ovaries at different stages in the menstrual cycle (such as estrogen and progesterone) with the neurotransmitters in the brain.

While the hormone levels in the ovaries are normal in women with PMDD, what is abnormal is the brain’s response to these normally-fluctuating hormones.One thing is for certain those who experience symptoms of PMDD should be diagnosed and treated. A small trial performed in the 90’s using Serotonin Reuptake Inhibitor’s such as Citalopram, Clomipramine, Fluoxetine, Paroxetine and Sertraline proved to be highly effective in treating the effects of PMDD. In fact the response rate for those patients taking those medications was between 60-100%. Doses given were the same as (or lower) as those given to patients who suffer from depression. Hence the drugs given were also those used in treatment of depression.

In spite of the fact that the same medications used for depression are given to those suffering from PMDD, there is a difference between the two for example, as stated earlier, the dosage level of medications given for PMDD are usually lower, the effects of the drugs have a shorter span because they are normally taken on a short term basis and noradrenergics are not as effective. The impressive relief gotten from the SRI’s is more likely due to the anti-irritability effects of the serotonin.There are not many side effects associated with the intake of SRI’s, but those recorded are noted as slight weight gain, nausea, a “weird” feeling and a decrease in sexual libido, though these only last a short period of time. Women have been suffering from this affliction since Eve first decided to bite into the apple.

Very little respect has been given to the women who suffer from PMDD. This affliction is all too real in the lives of many. Only in the past decade has true help become available, instead of the as in the past when most women were thought to be mad or just plain evil. PMDD is unique because there is virtually no other disease that people insist upon having," says Dr. Nada Stotland, chair of psychiatry at Illinois Masonic Medical Center.

(Carla Spartos, Sarafem Nation. The Village Voice).“What would happen, for instance, if suddenly, magically, men could menstruate and women could not? The answer is clear - menstruation would become an enviable, boast-worthy, masculine event: Men would brag about how long and how much. Boys would mark the onset of, that longed-for proof of manhood, with religious ritual and stag parties. (Gloria Steinem, Outrageous Acts and Everyday Rebellions. NY: NAL, 1986).

How different our world would be, the new laws to span and take effect? I don’t think they could weather the storm. One thing is for sure, the debate as to whether PMDD is real or not…would be over. Quickly! The reality is, that this is alone a women’s burden to bury, but help is here. There are answers to the centuries old questions. The suffering may now begin to end in spite of the continuing debate. Doctors are listening and acting according.