What Is PMDD?
Premenstrual dysphoric disorder (PMDD) is a mood disorder linked to the luteal phase of the menstrual cycle. It affects approximately 5-8% of women of reproductive age. PMDD is clinically distinct from premenstrual syndrome (PMS) -- the severity of symptoms, particularly depression, anxiety, irritability, and emotional dysregulation, significantly impairs daily functioning for one to two weeks each cycle.
PMDD is underdiagnosed in part because it is cyclical. The symptoms resolve with menses, which can make both patients and providers attribute them to stress or personality rather than a treatable neurobiological condition. It is neither.
How We Treat PMDD
SSRIs are the first-line pharmacological treatment for PMDD, supported by robust clinical evidence. Sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro) are the most commonly prescribed. Two dosing strategies are evidence-based: continuous daily dosing or luteal-phase dosing, which involves taking the medication only during the symptomatic portion of the cycle. We determine the appropriate approach based on your symptom pattern and preferences.
For patients who do not fully respond to SSRIs, we explore adjunctive strategies. In some cases, coordinating with your OB-GYN on hormonal approaches is clinically appropriate and something we facilitate.
What to Expect at Your First Visit
We conduct a full psychiatric evaluation -- approximately 60 minutes. We review your symptom pattern across cycles, medical and psychiatric history, current medications, and any prior treatment attempts. Prospective symptom tracking over one or two cycles is useful diagnostic data, but not a prerequisite for scheduling.
Insurance and Payment
PMDD evaluation and pharmacotherapy are covered by most insurance. We accept Anthem Blue Cross, Aetna, Cigna, UnitedHealthcare, and Health First Colorado (Medicaid). Cash pay is available.
When to Seek Evaluation
If you experience a consistent and predictable pattern of severe mood symptoms in the premenstrual phase that resolve with menses -- and those symptoms disrupt your work, relationships, or daily functioning -- PMDD should be evaluated. This is not something to manage through willpower. The pharmacological interventions are well-established and effective, often producing noticeable improvement within the first treated cycle.