Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. Originally called 'late luteal phase dysphoric disorder,' this disorder consists of a variety of affective, behavioral and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle. It is a disorder that affects women from their early teens up until menopause, excluding those suffering from hypothalamic amenorrhea or during pregnancy and breastfeeding. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. It has 11 possible symptoms, and a person has to exhibit a minimum of 5 symptoms in order to qualify for PMDD. It has been found that roughly 20% of women show signs pre-menstrual distress similar to PMDD, but they do not qualify for diagnosis, for reasons of not meeting the 5-symptom minimum or failing to meet the functional impairment requirement.GA34.41 Premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. Originally called 'late luteal phase dysphoric disorder,' this disorder consists of a variety of affective, behavioral and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle. It is a disorder that affects women from their early teens up until menopause, excluding those suffering from hypothalamic amenorrhea or during pregnancy and breastfeeding. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. It has 11 possible symptoms, and a person has to exhibit a minimum of 5 symptoms in order to qualify for PMDD. It has been found that roughly 20% of women show signs pre-menstrual distress similar to PMDD, but they do not qualify for diagnosis, for reasons of not meeting the 5-symptom minimum or failing to meet the functional impairment requirement. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via selective serotonin reuptake inhibitors (SSRIs) as well as ovulation suppression using contraception and GnRH analogues. SSRIs are the most common treatment, as they tend to improve both the physical and emotional symptoms as well as the general behavior and functionality of the patient. GnRH agonists are the more extreme treatment in comparison, as they suppress ovulation through inhibition of the gonadotropic hormones, LH and FSH. The emotional effects of premenstrual dysphoric disorder are theorized to be the result of severe gonadal steroid fluctuations, as they cause dysregulation of serotonin uptake and transmission, and potentially calcium regulation, circadian rhythm, BDNF, the HPA-axis and immune function as well. Some studies have suggested that those who suffer from PMDD are more at risk of developing postpartum depression after pregnancy, but other evidence has been found to suggest against that notion. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins. On average, the symptoms last six days but can start up to two weeks before menses. Severe symptoms begin about 6 days before the start of menstruation, with the most intense symptoms occurring two days before the start through to the first day of menstrual blood flow. The symptoms usually cease shortly after the start of the menstrual period. The onset of symptoms only during or around the luteal phase is key for diagnosing a patient with PMDD rather than any other mood disorders. The symptoms in PMDD can be both physical and emotional, but mood symptoms must be present for the diagnosis. Individuals experiencing PMDD may note suicidal ideation and temptation to self-harm. Many doctors recommend patients keep a mood log to record their mood patterns over the course of the high point of the symptoms in order to prescribe the proper treatment for the individual. The International Society for the Study of Premenstrual Disorders (ISPMD) defines two clinical categories for premenstrual disorders: Core PMD has six characteristics, all mainly focusing on the cyclical nature of PMDD and its typical onset pre-menses tracked over the course of more than two menstrual cycles. The four classified Variant PMDs involve more unexpected variables that cause the onset of premenstrual distress; such as, PMD with absent menstruation or premenstrual exacerbation, wherein the symptoms of another preexisting psychological disorder may be heightened as a result of PMDD onset. A large majority of menstruating people claim feeling premenstrual symptoms to some degree, with 20-30% feeling enough symptoms to qualify for diagnosis of PMS and only 3-8% of that group qualifying for diagnosis of PMDD. The most agreed-upon possibilities for what causes PMDD currently are heightened sensitivity to fluctuating levels of certain hormones (i.e. the reproductive hormones), environmental stress, and genetic predisposition. The sex steroids—estrogen and progesterone—are neuroactive; they have been noted in rat models to be involved in serotonin pathways. Serotonin is involved in mood regulation alongside estrogen, whose receptors are found in the prefrontal cortex and hippocampus—the regions most known for their involvement in regulating one's mood and cognition overall. The etiology of PMDD is still an active area of research. While the timing of symptoms suggests hormonal fluctuations as the cause of PMDD, a demonstrable hormonal imbalance in women with PMDD has not been identified. In fact, levels of reproductive hormones and their metabolites in women with and without PMDD are indistinguishable. It is instead hypothesized that women with PMDD are more sensitive to normal levels of hormone fluctuations, predominantly estrogen and progesterone, which produces biochemical events in the nervous system that cause the premenstrual symptoms. These symptoms are more predominant in women who have a predisposition to the disorder. It is apparent that the premenstrual disorders are biologically driven and are not only psychological or cultural phenomena. PMDD has been reported by women and other menstruating individuals worldwide, indicating a biological basis that is not geographically selective. Most psychologists infer that this disorder is caused by both a reaction to hormone flux and also genetic components. There is evidence of heritability of (retrospectively-reported) premenstrual symptoms from several twin and family studies done in the 1990s, with the heritability of PMDD proving to be about 56%. The investigation into which genes are involved is ongoing; one study has tested the gene-based haplotypes of alpha and beta estrogen receptors (ESR1 and ESR2) in women with PMDD by comparing their structures to 25 SNPs from two government databases. The researchers uncovered a number of loci responsible for indirectly facilitating serotonin receptor function through the concurrent functioning of the estrogen receptors. They also checked a specific polymorphism in the COMT gene, which is known to be involved in estrogen metabolism, contains estrogen response elements, is often cited as a cause of sex steroid associated cancers, and regulates dopamine levels in the prefrontal cortex (a region whose cerebral function and blood flow is regulated by estradiol); that polymorphism has been linked to risk for schizophrenia and OCD, and can moderate the effects of environmental factors on expression of the disorders.