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Dr. Paul Latimer: PMDD PMS on steroidsPMS: those three letters have been made the brunt of many jokes and snide comments since they were coined to describe the variety of symptoms many women experience at a certain point in their menstrual cycle.

Unfortunately, while the symptoms of PMS are distressing to the 80 per cent of women who experience them, a small percentage of women experience more severe symptoms – termed premenstrual dysphoric disorder (PMDD) – which cause serious disruption to work, relationships and functioning.

PMDD, which affects approximately two per cent of women, is more serious than the mild irritability or other symptoms commonly associated with PMS. In order to diagnose PMDD, symptoms must be severe enough to interfere with occupational and social functioning. Unlike its mild cousin,  is a disturbing and disabling condition that requires treatment.

Not only do PMDD patients experience disruption in their lives as a result of the condition, they present at least one of the following depressive symptoms: markedly depressed mood with feelings of hopelessness or self-depreciation; sudden sadness or tearfulness with increased sensitivity to personal rejection; decreased interest in usual activities; or a marked lack of energy.

In addition, in order to be diagnosed with PMDD, at least four other symptoms – marked changes in appetite and cravings for certain foods; insomnia or hypersomnia; marked anxiety or tension; persistent or marked irritability or anger and increased interpersonal conflicts; feelings of being overwhelmed or out of control; difficulty concentrating; or physical symptoms including breast tenderness or swelling, headaches, joint or muscular pain, weight gain or a bloated feeling – must also be present.

Several psychological and medical conditions can appear similar to PMDD and should be ruled out before a diagnosis is made. Such conditions include depression, anxiety disorders, eating disorders, substance abuse, thyroid disease, occult malignancy, chronic infection, anemia and endometriosis.

While the cause of PMDD is not fully understood, there appear to be both genetic and hormonal factors.

Several medical treatments and lifestyle changes are available to help ease the severity of PMDD symptoms. Because of the involvement of serotonin in the disorder, some of the most widely used antidepressants have proven effective at alleviating symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as paroxetine, fluoxetine, or sertraline have the best evidence supporting their use. Interestingly, these are effective when used intermittently for the 10 days or so before the menses. They do not have to be taken all month. Less compelling evidence supports the usefulness of anti-anxiety medications and diuretics in PMDD.

Non-medicinal treatments are also available and include cognitive behaviour therapy or light therapy for those with a seasonal component to their condition.

Lifestyle changes such as diet modification, aerobic exercise and stress management can also provide some relief. These have some, but not compelling evidence.

Most importantly, if you feel your premenstrual symptoms are more severe than is normal, discuss it with your doctor. There may be some simple steps you can take to feel better and improve your functioning.

Dr. Latimer is president of Okanagan Clinical Trials and an Okanagan psychiatrist.

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PMDD PMS on steroids

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