What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that causes significant mood disturbance -- depression, anxiety, irritability, or emotional instability -- in the 1-2 weeks before menstruation. It affects approximately 5-8% of women of reproductive age and is a formally recognized psychiatric diagnosis.
PMDD is distinct from typical PMS in both severity and clinical significance. Patients with PMDD describe a predictable monthly cycle of emotional disruption that interferes with work performance, relationships, and overall quality of life.
Treatment Approach
SSRIs are the first-line treatment for PMDD, with strong clinical evidence supporting their effectiveness. Some patients respond to continuous daily dosing, while others benefit from luteal-phase dosing -- taking medication only during the symptomatic portion of their cycle. We determine the best approach based on your specific symptom pattern.
Commonly prescribed medications include sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro). For patients who do not respond adequately to SSRIs, we explore additional options and can coordinate with your OB-GYN regarding hormonal interventions.
What to Expect
During your evaluation, we will review your symptom pattern, cycle timing, and any mood tracking data you have collected. If you have not been tracking, we may ask you to monitor symptoms for one to two cycles to confirm the diagnostic pattern. Treatment can often begin at the first visit based on clinical history.
Insurance and Payment
PMDD evaluation and treatment is covered by most insurance plans including Blue Cross NC, Aetna, Cigna, UnitedHealthcare, and NC Medicaid. Cash pay is available.
When to Seek Evaluation
If your mood predictably deteriorates before your period, if you experience monthly episodes of depression or rage that resolve after menstruation begins, or if premenstrual symptoms are affecting your professional or personal life -- a psychiatric evaluation for PMDD is appropriate. Most patients see meaningful improvement within one to two treatment cycles.