How much do you know about premenstrual dysphoric disorder?

You feel depressǝ, irritable, don't you feel like doing anything? It could be premenstrual dysphoric disorder (which does not coincide with premenstrual syndrome!)                                                                                           

When you find yourself facing the week before the menstrual cycle, the body begins to undergo changes: swollen breasts, pain, tiredness. Suddenly, the evil of living takes possession of our body without knowing why. Often we begin to have mood changes, we cry for no reason, hate mankind, empty nutella jars and we are much more stressful. All symptoms that, when menstruation begin, magically disappear ... and then reappear the following month, in the same period. For some people this time span represents a real tragedy (even if temporary), because symptoms compromise social life, work, interpersonal relationships. We are talking about those who suffer from premenstrual dysphoric disorder (PMDD).           

What is premenstrual dysphoric disorder?

According to DSM V, so that it can be called PMDD, the symptoms must be present in the previous week the menstruation, start improving with the onset of menstruation and reduce to the minimum or disappear completely in the post -menstruation week. In addition, they must be present in most menstrual cycles during the last year and must negatively affect working and social functioning. Therefore, in the period indicated above, one or more of the symptoms between:

• Marked emotional lability (e.g. mood swings or sudden cry);
• feelings of irritability, anger or onset of the increase in interpersonal conflicts;
• Depressed mood, feelings of despair or self -valutative thoughts;
• Anxiety and tension.

In addition to these symptoms, to reach the diagnosis of premenstrual dysphoric disorder, one or more of the subsequent symptoms must be recorded (in order to reach the total of five symptoms, adding the first and following):

• less interest compared to habitual activities;
• Difficulty concentration, increase in lethargy, incisive lack of energy;
• Remarkable change of appetite (excessive consumption of food or specific food cravings);
• Hypersonnia or insomnia;
• Physical symptoms such as: breast tension or swelling, joint or muscle pain, feeling of "swelling" or weight gain.

The symptoms can be compared (not for duration) to those of other disorders, such as the major depressive episode or the generalized anxiety disorder. In order to diagnose the PMDD, it is necessary to carry out several daily perspective assessments for at least two symptomatic cycles. If the symptoms are not confirmed by the assessments, it must be noted "temporary" after the name of the diagnosis (ie, "premenstrual dysphoric disorder, provisional"). 

But why does this disorder arise? 

The etiology of premenstrual dysphoric disorder is still the subject of research still today. It has not yet been possible to demonstrate that there is a hormonal imbalance in women with this disorder. In fact, the hormonal levels of a woman suffering from PMDD and a woman not suffering from the latter are indistinguishable. 

They hypothesized, however, that women with PMDDs are more sensitive to hormonal fluctuations, such as estrogen and progesterone, hormones that activate biochemical events in the nervous system underlying premenstrual symptoms. Moreover, it has been assumed that perhaps there is also an inheritance component, since premenstrual symptoms have an inheritance estimate that oscillates between 30% and 80%.  

What does it differ from premenstrual syndrome?

Although premenstrual syndrome can also occur in severe form (in fact it is divided into slight, moderate and serious),), These are symptoms more than anything else physicists. In the premenstrual syndrome, a minimum of five symptoms is not required and there are not always emotional symptoms (such as depressed mood, loss of interest in the normal activities of everyday life, etc.). Finally, there is talk of premenstrual dysphoric disorder when the symptom compromises everyday life and family or social relationships.  

Can premenstrual dysphoric disorder coexist with other disorders?

Individuals suffering from premenstrual dysphoric disorder frequently report that they have crossed a greater depressive episode in the past. A wide range of medical disorders (for example, migraine, asthma, allergies, convulsive disorders) or other mental disorders (such as depressive or bipolar disorders, anxiety disorders, nervous bulimia, substances use disorders) can worsen during the premenstrual phase. The premenstrual dysphoric disorder, however, must not be considered only the cause of the worsening of other disorders, but must be detected separately. In the latter case, it is possible to consider it as a separate disorder, if the symptoms of premenstrual dysphoric disorder differs totally from the symptoms of coexist disorder.

Is there a cure for premenstrual dysphoric disorder? 

The premenstrual dysphoric disorder disappears with the onset of menopause and does not appear during the phrase prior to the menarca and pregnancy, since they are periods in which ovarian activity is not present. However, to face the symptoms during the fertile period, an aspect not to be overlooked is the awareness of one's clinical picture. Once you have known its condition, the individual manages to face the premenstrual period with more tranquility and manages to better manage the symptoms. The use of a calendar or a diary can help the person better understand what are and how intense symptoms are. Specifically, these tools will be useful to doctors and psychologists for the purposes of diagnosis of PMDD, who will help the achievement of the most appropriate treatment. Psychotherapy plays a fundamental role in the event of a premenstrual symptoms that has not benefited with other treatments. The symptomatology can often have psychological causes, especially if there is a conflicting experience towards menstruation. In particular, cognitive-behavioral therapy has proved particularly effective with this type of disorder.     

The drug therapy of premenstrual dysphoric disorder.

When psychotherapy alone is not enough, drugs can be prescribed. First choice drugs are the selective inhibitors of the recipient of serotonin (SSRI), which are part of a category of antidepressants. Unlike treatments for depressive disorders, SSRI should not be taken daily but can only be taken in the luteal phase or during the most marked symptoms of premenstrual dysphoric disorder. This is because those who respond well to the SSRI benefits from 1-2 days from the onset of symptoms. The administration during the luteal phase can start 14 days before menstruation and subsequently interrupted after the start of the cycle. People who take SSRI in the treatment of premenstrual dysphoric disorder generally report a 50% reduction of symptoms, a significant improvement compared to the group treated with placebo. The drugs help to correct psychic symptoms, but are not always effective in physical symptoms: for this reason, the choice of the drug must be scrupulously evaluated by the specialist in order to calculate risks and benefits before the start of the treatment.

We leave you with an appeal: if you notice the onset of this kind of symptoms, go to a specialistǝ that do not underestimate this kind of experience because the awareness around it is still too low. You are not wrong, it could be a serious syndrome still affected by a few studies.

Antonella Patalano