What Is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome that affects roughly 3-8% of women of reproductive age. PMDD is not just "bad PMS." It causes debilitating mood changes -- intense irritability, depression, anxiety, or hopelessness -- in the one to two weeks before your period. These symptoms are severe enough to disrupt work, relationships, and daily functioning, then largely resolve once your period starts.
PMDD is a recognized psychiatric condition with a biological basis. It involves an abnormal sensitivity to normal hormonal fluctuations during the menstrual cycle. Many women with PMDD spend years being told their symptoms are "just hormonal" before getting a proper diagnosis and effective treatment.
How We Treat PMDD
SSRIs (selective serotonin reuptake inhibitors) are the first-line treatment for PMDD and are effective for most patients. What makes PMDD treatment unique is that SSRIs can work within days rather than the weeks required for depression. Two dosing approaches are available: continuous daily dosing throughout the month, or luteal-phase dosing where you take the SSRI only during the two weeks before your period. We help you decide which approach fits your symptoms and preferences.
For patients who do not respond to SSRIs alone, we can discuss hormonal options including certain oral contraceptives that stabilize hormonal fluctuations. We work with your OB/GYN or primary care provider to coordinate care when hormonal treatments are involved.
What to Expect at Your First Visit
We will ask you to describe your symptoms, when they occur in your cycle, and how severe they are. Tracking your symptoms for 2-3 cycles with a mood diary or app helps us confirm the diagnosis. If you already have tracking data, bring it. We will review your history, rule out other conditions, and discuss treatment options that day.
Insurance and Payment
PMDD evaluation and treatment visits are covered by most insurance plans. SSRIs prescribed for PMDD are widely available as generics, keeping medication costs low. Contact us to verify your coverage.
When to Seek Help
If your mood takes a sharp dive before your period every month -- if you feel like a different person for a week or two, then fine again once your period arrives -- that pattern is worth evaluating. If PMS symptoms are severe enough to cause conflict at home, missed work, or thoughts of self-harm, do not wait. PMDD is highly treatable once properly diagnosed.