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'''For patient information click [[Premenstrual dysphoric disorder (patient information)|here]]''' | '''For patient information click [[Premenstrual dysphoric disorder (patient information)|here]]''' | ||
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{{CMG}}; {{AE}} {{KS}} | {{CMG}}; {{AE}} {{KS}} | ||
{{SK}} Late luteal phase dysphoric disorder; LLPDD; PMDD | |||
==Overview== | ==Overview== | ||
Premenstrual dysphoric disorder (PMDD) is a severe form of [[premenstrual syndrome]], affecting 1.8%-5.8% of menstruating women.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> It is a mood disorder associated with the luteal phase of the [[menstrual cycle]]. | |||
==Historical Perspective== | |||
Originally called late luteal phase dysphoric disorder, the disorder was renamed PMDD by the [[American Psychiatric Association]] in its May 1993 revision of the [[DSM-IV]]. PMDD was moved from a position in the appendix of the manual to a "disorder requiring further study."<ref>{{cite news| author=Laurence, Leslie | title=Psychiatric group scruitinzes categorizing form of PMS | publisher=Chicago Tribune | date=1993-05-16 }}</ref><ref>{{cite news| author=Lehman, Betsy | title=A little revision is creating a big furor |publisher=Boston Globe| date=1993-05-10}}</ref> While few would prefer to leave disabling and treatable symptoms untreated, some groups of psychiatrists and women's groups object to the labeling of a severe form of PMS as a psychiatric disorder. | |||
PMDD is accepted as illness by the [[Food and Drug Administration]] (FDA) but has not as been listed as a separate disorder in the [[World Health Organization]]'s [[ICD|International Classification of Diseases]]. In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for [[fluoxetine]] sold in Europe.<ref>{{cite journal| url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=341379 | title=Controversial disease dropped from Prozac product information| author=Ray Moynihan | journal = BMJ | volume=328 | page = 7436 | date=2004-02-14}}</ref> The committee found that PMDD is not a well-established disease entity across Europe. There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.<ref>{{cite web| url=http://www.emea.eu.int/pdfs/human/referral/326303en.pdf | title=Summary Information...for Prozac and associated names| author=European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products| date=2003-06-13}}</ref> PMDD is not listed on the Australian [[Pharmaceutical Benefits Scheme]]. <ref>[http://www.npsradar.org.au/site.php?page=1&content=/npsradar/content/sertraline.html Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD)] National Prescribing Service Limited. (Australia)</ref> | |||
Some commentators suggest that PMDD (along with [[social anxiety disorder]], [[restless leg syndrome]], and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments. Of course the marketing of a cure is no proof that the underlying condition does not exist, or that the distress of the sufferers is not real. | |||
==Pathophysiology== | |||
There is, in fact, significant evidence of a neurological foundation in PMDD. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be strongly correlated with the concomitant worsening of their brain serotonin function measured objectively by [[positron emission tomography]] (PET).<ref name="pmid16515859">{{cite journal| author=Eriksson O, Wall A, Marteinsdottir I, Agren H, Hartvig P, Blomqvist G et al.| title=Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. | journal=Psychiatry Res | year= 2006 | volume= 146 | issue= 2 | pages= 107-16 | pmid=16515859 | doi=10.1016/j.pscychresns.2005.02.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16515859 }} </ref> | |||
While the underlying pathophysiology of PMDD has not been definitively established, a leading theory suggests it is due to the lack of [[serotonin]] (a [[neurotransmitter]]) and mediated by the fluctuations of the levels of sex hormones ([[progesterone]], [[estrogen]], and [[testosterone]]) in the luteal phase of the menstrual cycle.<ref name="pmid16515859">{{cite journal| author=Eriksson O, Wall A, Marteinsdottir I, Agren H, Hartvig P, Blomqvist G et al.| title=Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. | journal=Psychiatry Res | year= 2006 | volume= 146 | issue= 2 | pages= 107-16 | pmid=16515859 | doi=10.1016/j.pscychresns.2005.02.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16515859 }} </ref> | |||
Supporting the hypothesized important role of [[serotonin]], a number of [[selective serotonin reuptake inhibitor]]s (SSRIs) have been proven in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Premenstrual syndrome]] | * [[Premenstrual syndrome]] | ||
*[[Dysmenorrhea]] | * [[Dysmenorrhea]] | ||
*[[Bipolar disorder]] | * [[Bipolar disorder]] | ||
([[dysthymia]]) | * [[Major depressive disorder]] | ||
*Use of hormonal | * [[Persistent depressive disorder]] ([[dysthymia]]) | ||
* [[Hormonal therapy|Use of hormonal therapy]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | |||
PMDD is similar to [[premenstrual stress syndrome|premenstrual syndrome]] (PMS), but differs from it in severity and in that it requires treatment, because it interferes with the sufferer's ability to function in her environment. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability. Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include<ref>http://www.4women.gov/FAQ/pms.htm "Premenstrual Syndrome" // | |||
Includes concise discussion re: "What is Premenstrual Dysphoric Disorder (PMDD?" </ref> | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Prevalence=== | ===Prevalence=== | ||
The prevalence of premenstrual dysphoric disorder is 1,800-5,800 per 100,000 (1.8%-5.8%) of | The prevalence of premenstrual dysphoric disorder is 1,800-5,800 per 100,000 (1.8%-5.8%) of menstruating women.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
*History of interpersonal trauma | *History of interpersonal trauma | ||
*Seasonal changes | *Seasonal changes | ||
* | *Socio-cultural aspects of female sexual behavior | ||
*Stress<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Stress<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Natural History,Complications,and Prognosis== | ==Natural History,Complications,and Prognosis== | ||
Good prognostic factors include: | Good prognostic factors include: | ||
* Use of [[oral contraceptives]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | |||
==Diagnosis== | ==Diagnosis== | ||
===DSM-V Diagnostic Criteria for Premenstrual Dysphoric Disorder <ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ===DSM-V Diagnostic Criteria for Premenstrual Dysphoric Disorder <ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
{{cquote| | {{cquote| | ||
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'''''AND''''' | |||
*F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.(<SMALL>''Note:The diagnosis may be made provisionally prior to this confirmation .''</SMALL>) | *F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.(<SMALL>''Note:The diagnosis may be made provisionally prior to this confirmation .''</SMALL>) | ||
| Line 111: | Line 113: | ||
*G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., [[hyperthyroidism]]). | *G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., [[hyperthyroidism]]). | ||
}} | }} | ||
== | ===Symptoms=== | ||
*Feelings of sadness or despair, or possibly suicidal thoughts | |||
*Feelings of tension or [[anxiety]] | |||
*Panic attacks | |||
*Mood swings, crying | |||
*Lasting irritability or anger that affects other people | |||
*Disinterest in daily activities and relationships | |||
*Trouble thinking or focusing | |||
*Tiredness or low energy | |||
*Food cravings or [[binge eating]] | |||
*Having trouble sleeping | |||
*Feeling out of control | |||
*Physical symptoms, such as bloating, breast tenderness | |||
*[[Headache]]s | |||
*Joint or [[muscle pain]] | |||
==Treatment== | ==Treatment== | ||
Lifestyle changes may ameliorate some of the effects of PMDD, and certain [[SSRI]]s provide relief as well.<ref>http://www.4women.gov/FAQ/pms.htm</ref> The U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of PMDD: [[Fluoxetine]] (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. [[Sertraline]] (Zoloft) was approved in 2002, and [[Paroxetine]] HCI (Paxil) has also been approved by the FDA. The patent for [[Fluoxetine]] has expired, but [[Eli Lilly and Company|Eli Lilly]] was able to obtain a new patent for its use in the treatment of PMDD, which has since marketed heavily under the trade name Sarafem.<ref name=APA>{{cite journal| url=http://www.apa.org/monitor/oct02/pmdd.html |publisher=American Psychological Association Monitor on psychology | title=Is PMDD real?| author=Jennifer Daw| volume=33| date=2002-10-09}}</ref> However [[ | Lifestyle changes may ameliorate some of the effects of PMDD, and certain [[SSRI]]s provide relief as well.<ref>http://www.4women.gov/FAQ/pms.htm</ref> The U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of PMDD: [[Fluoxetine]] (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. [[Sertraline]] (Zoloft) was approved in 2002, and [[Paroxetine]] HCI (Paxil) has also been approved by the FDA. The patent for [[Fluoxetine]] has expired, but [[Eli Lilly and Company|Eli Lilly]] was able to obtain a new patent for its use in the treatment of PMDD, which has since marketed heavily under the trade name Sarafem.<ref name=APA>{{cite journal| url=http://www.apa.org/monitor/oct02/pmdd.html |publisher=American Psychological Association Monitor on psychology | title=Is PMDD real?| author=Jennifer Daw| volume=33| date=2002-10-09}}</ref> However, [[fluoxetine]] is now available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
Latest revision as of 20:56, 20 October 2014
For patient information click here
| Premenstrual dysphoric disorder | |
| MedlinePlus | 007193 |
|---|---|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Synonyms and keywords: Late luteal phase dysphoric disorder; LLPDD; PMDD
Overview
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, affecting 1.8%-5.8% of menstruating women.[1] It is a mood disorder associated with the luteal phase of the menstrual cycle.
Historical Perspective
Originally called late luteal phase dysphoric disorder, the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. PMDD was moved from a position in the appendix of the manual to a "disorder requiring further study."[2][3] While few would prefer to leave disabling and treatable symptoms untreated, some groups of psychiatrists and women's groups object to the labeling of a severe form of PMS as a psychiatric disorder.
PMDD is accepted as illness by the Food and Drug Administration (FDA) but has not as been listed as a separate disorder in the World Health Organization's International Classification of Diseases. In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe.[4] The committee found that PMDD is not a well-established disease entity across Europe. There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.[5] PMDD is not listed on the Australian Pharmaceutical Benefits Scheme. [6]
Some commentators suggest that PMDD (along with social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments. Of course the marketing of a cure is no proof that the underlying condition does not exist, or that the distress of the sufferers is not real.
Pathophysiology
There is, in fact, significant evidence of a neurological foundation in PMDD. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be strongly correlated with the concomitant worsening of their brain serotonin function measured objectively by positron emission tomography (PET).[7]
While the underlying pathophysiology of PMDD has not been definitively established, a leading theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle.[7]
Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been proven in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase.
Differential Diagnosis
- Premenstrual syndrome
- Dysmenorrhea
- Bipolar disorder
- Major depressive disorder
- Persistent depressive disorder (dysthymia)
- Use of hormonal therapy[1]
PMDD is similar to premenstrual syndrome (PMS), but differs from it in severity and in that it requires treatment, because it interferes with the sufferer's ability to function in her environment. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability. Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[8]
Epidemiology and Demographics
Prevalence
The prevalence of premenstrual dysphoric disorder is 1,800-5,800 per 100,000 (1.8%-5.8%) of menstruating women.[1]
Risk Factors
- History of interpersonal trauma
- Seasonal changes
- Socio-cultural aspects of female sexual behavior
- Stress[1]
Natural History,Complications,and Prognosis
Good prognostic factors include:
- Use of oral contraceptives[1]
Diagnosis
DSM-V Diagnostic Criteria for Premenstrual Dysphoric Disorder [1]
| “ |
AND
AND
Note:The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.. AND
AND
|
” |
Symptoms
- Feelings of sadness or despair, or possibly suicidal thoughts
- Feelings of tension or anxiety
- Panic attacks
- Mood swings, crying
- Lasting irritability or anger that affects other people
- Disinterest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Having trouble sleeping
- Feeling out of control
- Physical symptoms, such as bloating, breast tenderness
- Headaches
- Joint or muscle pain
Treatment
Lifestyle changes may ameliorate some of the effects of PMDD, and certain SSRIs provide relief as well.[9] The U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of PMDD: Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. Sertraline (Zoloft) was approved in 2002, and Paroxetine HCI (Paxil) has also been approved by the FDA. The patent for Fluoxetine has expired, but Eli Lilly was able to obtain a new patent for its use in the treatment of PMDD, which has since marketed heavily under the trade name Sarafem.[10] However, fluoxetine is now available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Laurence, Leslie (1993-05-16). "Psychiatric group scruitinzes categorizing form of PMS". Chicago Tribune.
- ↑ Lehman, Betsy (1993-05-10). "A little revision is creating a big furor". Boston Globe.
- ↑ Ray Moynihan (2004-02-14). "Controversial disease dropped from Prozac product information". BMJ. 328: 7436.
- ↑ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products (2003-06-13). "Summary Information...for Prozac and associated names" (PDF).
- ↑ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
- ↑ 7.0 7.1 Eriksson O, Wall A, Marteinsdottir I, Agren H, Hartvig P, Blomqvist G; et al. (2006). "Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria". Psychiatry Res. 146 (2): 107–16. doi:10.1016/j.pscychresns.2005.02.012. PMID 16515859.
- ↑ http://www.4women.gov/FAQ/pms.htm "Premenstrual Syndrome" // Includes concise discussion re: "What is Premenstrual Dysphoric Disorder (PMDD?"
- ↑ http://www.4women.gov/FAQ/pms.htm
- ↑ Jennifer Daw (2002-10-09). "Is PMDD real?". 33. American Psychological Association Monitor on psychology.