What Is PMDD?
Premenstrual Dysphoric Disorder is a cyclical mood disorder affecting an estimated 3-8% of women of reproductive age. PMDD is classified in the DSM-5 as a depressive disorder and is clinically distinct from premenstrual syndrome (PMS) in both severity and neurobiological mechanism. Symptoms -- which include severe depression, irritability, anxiety, emotional lability, and concentration difficulty -- emerge during the luteal phase of the menstrual cycle and remit within days of menses onset.
The pathophysiology involves abnormal central nervous system sensitivity to normal progesterone and allopregnanolone fluctuations. This is not a condition of excessive hormones but of atypical neuronal response to hormonal cycling. PMDD causes significant functional impairment in occupational, social, and interpersonal domains.
How We Treat PMDD
SSRIs are the evidence-based first-line pharmacological treatment for PMDD. Uniquely, SSRIs exert therapeutic effects on PMDD symptoms within 1-2 days of dosing -- far faster than the 2-4 weeks required for major depressive disorder. Two prescribing strategies are effective: continuous daily dosing throughout the menstrual cycle, or luteal-phase dosing (taking the SSRI only during the approximately 14 days between ovulation and menses).
Luteal-phase dosing is particularly appealing for patients who prefer to minimize medication use. We help patients select the approach that best fits their symptoms, cycle regularity, and treatment goals. For refractory cases, coordination with gynecology for hormonal interventions -- including specific oral contraceptive regimens or GnRH agonists -- may be warranted.
What to Expect at Your First Visit
Diagnosis requires documentation of the temporal relationship between symptoms and menstrual cycle phases. Prospective symptom tracking over 2-3 cycles using validated tools (such as the DRSP scale) is the gold standard for confirmation. If you have existing cycle tracking data, bring it. We will review your history, rule out overlapping conditions, and initiate treatment if diagnostic criteria are met.
Insurance and Payment
PMDD evaluation and treatment are covered by most insurance plans. First-line SSRI medications are available as low-cost generics. Contact us to verify your specific coverage.
When to Seek Help
If you experience a predictable, cyclical deterioration in mood and functioning that aligns with the second half of your menstrual cycle -- and that pattern resolves within days of your period starting -- PMDD should be evaluated. If these episodes cause significant distress, impair your ability to work or maintain relationships, or involve thoughts of self-harm, seek evaluation promptly. PMDD is a recognized medical condition with highly effective treatment options.