PREMENSTRUAL DYSPHORIC DISORDER

'Premenstrual dysphoric disorder (PMDD)' is a severe form of premenstrual syndrome, afflicting 8% of all women. It is a mood disorder associated with the luteal phase of the menstrual cycle. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability (PMID 11571794). Anxiety, anger, and depression may also occur. It 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.
Originally called 'late luteal phase dysphoric disorder' (LLPDD), 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."^[1][2] Some groups of psychiatrists and women's groups objected to the naming 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.^[3] 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 recieve a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.^[4]

PMDD is not listed on the Australian Pharmaceutical Benefits Scheme. ^[5]
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.(PMID 16597181)
There is, however, significant evidence of a neurological foundation. 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) (PMID 16515859).
The cause of PMDD has not been definitively established, but several theories exist. One 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 (PMID 16515859).
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. Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000, and Sertraline (Zoloft) was approved in 2002. Eli Lilly obtained another patent for fluoxetine for PMDD and marketed the new treatment heavily under the trade name Sarafem. Is PMDD real?, Jennifer Daw, , , ,

Contents

References

See also

External links

References

1. Psychiatric group scruitinzes categorizing form of PMS
2. A little revision is creating a big furor
3. Controversial disease dropped from Prozac product information, Ray Moynihan, , , BMJ,
4. Summary Information...for Prozac and associated names European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products
5. Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)

See also

★ Premenstrual syndrome (PMS)

External links

★ eMedicine on PMDD

★ Madison Institute of Medicine (a non-profit organization) on PMDD

★ A Disease for Every Pill, an article in The Nation questioning the reality of PMDD