What is PMDD?
Premenstrual dysphoric disorder is a cyclical mood disorder driven by abnormal sensitivity to normal hormonal fluctuations during the luteal phase. It is distinct from PMS in both severity and neurobiological mechanism. Approximately 5-8% of women of reproductive age meet diagnostic criteria. PMDD causes clinically significant depression, anxiety, irritability, or emotional lability in the 1-2 weeks preceding menstruation, with symptom resolution shortly after onset.
PMDD is consistently underdiagnosed. Many patients have been evaluated for depression or anxiety without anyone identifying the cyclical pattern. Accurate diagnosis requires establishing temporal correlation between symptoms and menstrual cycle phase.
Treatment Approach
SSRIs are first-line pharmacotherapy for PMDD with strong evidence supporting their efficacy. A key clinical distinction: PMDD responds to both continuous daily SSRI dosing and luteal-phase-only dosing (medication taken only during the symptomatic 10-14 days). We determine the optimal regimen based on symptom severity, patient preference, and side effect tolerance.
Commonly prescribed medications include sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro). For SSRI non-responders, alternative pharmacological strategies are available. When combined hormonal approaches are warranted, we coordinate with the patient's OB-GYN.
What to Expect
We take a detailed symptom history with specific attention to cycle timing and severity. Prospective mood charting -- using a calendar or tracking app -- strengthens diagnostic accuracy. If you have existing tracking data, bring it. If not, we may request 1-2 cycles of prospective tracking before initiating treatment.
Insurance and Payment
PMDD evaluation and treatment is covered by most insurance. We accept Blue Cross NC, Aetna, Cigna, UnitedHealthcare, and NC Medicaid. Cash pay is available.
When to Seek Evaluation
If your mood, functionality, or relationships deteriorate predictably in the premenstrual window. If you have been treated for depression or anxiety without improvement because no one assessed cycle correlation. If you recognize a pattern that repeats monthly and significantly impairs your quality of life. PMDD is highly treatable -- most patients experience substantial symptom reduction within 1-2 treatment cycles.