Premenstrual Dysphoria
What is Premenstrual
Dysphoria?
Many women experience some physical, emotional and behavioral
changes associated with phases of their menstrual cycles.
In some women, these changes are severe, occur regularly,
and include depressed feelings, irritability, and other emotional
and physical changes. These changes are referred to as premenstrual syndrome
(PMS) or premenstrual dysphoric disorder
(PMDD). These changes typically begin after ovulation and
become gradually worse until menstruation starts.
While many women report some history of premenstrual mood changes and physical symptoms, an estimated 3-4 % suffer severe symptoms that significantly interfere with work and social functioning. For these women, there appears to be an abnormal response to normal hormone changes. Researchers are studying what makes some women susceptible to PMDD, including differences in hormone sensitivity, history of other mood disorders, and individual differences in the brain. Women who are at risk for depression may be more vulnerable to the mood shifting effects of hormones.
What are the
symptoms of Premenstrual Dysphoric Disorder (PMDD)?
Symptoms of PMDD include depressed mood, anxiety or tension,
irritability, decreased interest or pleasure in activities,
difficulty concentrating, low energy, change in appetite,
overeating, increase or decrease in sleep, feeling overwhelmed,
bloating, headache, joint or muscle pain, and breast tenderness.
Women with PMDD are more likely to develop depressive disorders and postpartum disorders. If you are having these symptoms at other times of the month you should consider being evaluated for depression. Discuss this with your health care provider.
What can I do about
PMDD?
You have already taken one of the most important steps in
helping your depression -- you have come for help. Fortunately,
there are many ways to treat PMDD.
Record symptoms - The first step is to start a calendar that records your symptoms including when and where. This will help you and your health care provider look at your mood and your menstrual cycle together.
Dietary changes - Having a well balanced diet and eating on a regular schedule is also important. Decreasing refined sugar, caffeine, alcohol, and chocolate may help. Use of calcium,
Exercise - The benefits of exercise in depression are well documented. Exercise helps treat depression by releasing the body's mood-elevating compounds, reducing the depression hormone, cortisol, in the blood, providing perspective on life, providing a feeling of accomplishment, enhancing self-esteem, and increasing levels of serotonin (a neurotransmitter found to be key in the development of depression). It doesn't matter what you do as long as you do something physical for 20 to 30 minutes three times a week or more. Even exercising as little as 10 minutes a day has been found to have beneficial effects. Walking is perhaps the most accessible form of exercise because it costs nothing and you can start it immediately.Therapy - Therapy involves talking with a trained professional (psychologist, psychiatrist, clinical nurse or social worker) for usually a few sessions. Cognitive Behavioral Therapy (CBT) targets negative thoughts and behaviors that tend to worsen depressed mood and teaches better ways of thinking and behaving. A therapist can help you plan for these more difficult times in the month.
Relaxation Techniques - Relaxation techniques are useful in reducing the additional stress you feel at "that time" of the month. These can include deep breathing, deep muscle relaxation, biofeedback, yoga, meditation, and massage.
Promote sleep - Take care to keep your sleep cycle regular by going to bed and waking around the same time. Develop relaxing bedtime rituals such as reading or a warm bath. Avoiding long naps during the day helps nighttime sleep.
Support and Stress Management - Plan to have extra help with items like household tasks and childcare during difficult times of the month. Be sure to keep a reasonable schedule.
Antidepressant Medication - Antidepressant medications are effective in relieving premenstrual symptoms. There are many safe, effective, well-tolerated antidepressant medications. Some studies suggest that taking antidepressants only during the latter half of the menstrual cycle may be helpful. Discuss their potential benefits and risks with your health care provider.
Alternative medicine, herbal remedies and dietary supplements - There has been rising interest in the use of herbs and dietary supplements for the treatment of depression. St John's Wort (hypericum perforatum) has been the most common of these. However, scientific studies of these alternative forms of treatment have so far been short-term and not well controlled. There is not uniformity of dose or even amounts or types of ingredients because the Food and Drug Administration does not regulate them. Be sure to tell your health care provider if you are taking an herbal or dietary supplement. Some of them may negatively interact with antidepressant medication or other medications you are taking.
Spend time with others - Depressed women often withdraw from others because they mistakenly feel they would not be good company. Being with others is another way to gain perspective, which helps with the symptoms of depression.
