How are PMS and Depression Related?

PMS Depression or Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS and is diagnosed by the pattern of symptoms.  PMS (premenstrual syndrome) is a group of approximately 150 different symptoms that happen in the 2 weeks prior to the start of a woman’s period.  The symptoms can be both physical and emotional and are very real.

Symptoms were once thought to be ‘hysterical’ and only in the mind of the woman.  But, after years of research, scientists have found that over 50 million women suffer from these symptoms each month.  These symptoms can significantly interfere with social, occupational and sexual functioning. (1)

For a diagnosis of PMDD to be made the woman must have a symptom free period during her follicular phase of the menstrual cycle to distinguish it from other pre-existing anxiety and mood disorders.

The features of PMDD and depressions have considerable overlap.  Approximately 30-75% of the women diagnosed with PMDD also have a lifetime history of depression, compared to the 15% of women without PMDD who suffer from depression.

Despite this, many women with PMDD may not have depression symptoms; therefore PMDD should not be considered a simple variant of a depression disorder.

Symptoms of PMDD must be present in the week prior to a woman’s period and must be relieved when menses starts.  The American Psychiatric Association lists 11 potential symptoms of PMDD in the DSM V (Diagnostic Manual).  These symptoms are: (2)

1. Feeling sad, hopeless, or self-deprecating

2. Feeling tense, anxious, or \”on edge\”

3. Marked lability of mood interspersed with frequent tearfulness

4. Persistent irritability, anger, and increased interpersonal conflicts

5. Decreased interest in usual activities, which may be associated with withdrawal from social relationships

6. Difficulty concentrating

7. Feeling fatigued, lethargic, or lacking in energy

8. Marked changes in appetite, which may be associated with binge eating or craving certain foods

9. Hypersomnia or insomnia

10. A subjective feeling of being overwhelmed or out of control

11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, weight gain

The goals of treatment are to reduce the symptoms and improve the patient’s occupational function.  Lifestyle changes that often help to relieve symptoms of PMDD are increasing aerobic exercise, decreasing caffeine and reducing sodium intake.

Psychosocial stressors should also be addressed since stress is known to alter brain chemistry and stress related hormonal activity.  (3)

Seritoninergic antidepressants are the first line pharmacological treatment for severe PMDD.  Although there are case studies for use of herbal remedies there are no studies that have been approved by the FDA.  Also, the manufacturing of herbal products is not uniform – what is labeled on the bottle may not actually be in the bottle.

Inducing annovulation and amenorrhea has also been shown to provide significant relief of symptoms with depression.  However, these medications can also induce menopausal symptoms such as hot flashes, vaginal dryness and fatigue.

The diagnosis and treatment plan for PMDD should be done by both the woman and her physician.  Only the woman can determine the extent that the symptoms affect her daily life and how she can incorporate the treatment plan into her life.

(1) WomensHealth.gov: Premenstrual Syndrome Fact Sheet

(2) American Psychiatric Association DSM-5 Development: Premenstrual Dysphoric Disorder

(3) American Family Physician: Diagnosis and Treatment of Premenstrual Dysphoric Disorder