Premenstrual Dysphoric Disorder & Premenstrual Exacerbation: Diagnosis and Treatment

Kristin Yeung Lasseter, MD, Founder and President, Reproductive Psychiatry Clinic of Austin, Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, Dell Medical School at The University of Texas at Austin, presented a session titled “Mood Disorders Related to the Menstrual Cycle” at this weekend’s Psych Congress in San Antonio, Texas. Her session explored the research supporting neurohormonal influences of cognitive and emotional symptoms that can arise premenstrually and discussed evidence-based treatments for premenstrual dysphoric disorder.

In this Q&A she expands on her session and talks key takeaways for clinicians.

Question: What are the key differences between premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation of underlying mood or anxiety disorders that clinicians should be aware of?

Answer: The key difference between PMDD and premenstrual exacerbation (PME) of underlying mental illness is the persistence of symptoms, even if only mild, after the menstrual cycle. Specifically, in PMDD symptoms improve once the menstrual cycle starts, and are absent in the week after the menstrual cycle. With PME of mental illness though, symptoms can still be present throughout the menstrual cycle and become more severe or distressing in the week or two before the start of the next menstrual cycle. The most common misdiagnosis of PMDD is actually due to premenstrual exacerbation of another underlying mental illness, which is why using a diagnostic tool is required for PMDD assessment.

Q: What diagnostic tools are available for clinicians to utilize when diagnosing PMDD?

A: The most commonly used diagnostic tool for PMDD is the DRSP, or Daily Record of Severity of Problems. Other tools available include, Visual Analogue Scales for Premenstrual Mood Symptoms, Premenstrual Tension Syndrome Rating Scale, Calendar of Premenstrual Experiences, and the Premenstrual Assessment Form.

Q: What is the “gold standard” evidence-based treatment for PMDD?

A: The first-line, evidence-based treatment for PMDD is an SSRI, specifically sertraline, fluoxetine, paroxetine, citalopram, or escitalopram.

Q: Are there any misconceptions on this topic that you would like to clear up?

A: Despite what many believe, PMDD has not been shown to be related to abnormal hormone levels. In fact, patients with PMDD are indistinguishable from healthy controls when looking at peripheral ovarian hormone levels. The pathophysiology is more complex, which is likely why the majority of hormone replacement therapies have no significant effect in treating this disorder.

Kristin Yeung Lasseter, MD, is a Board-Certified Psychiatrist based in Austin, Texas who specializes in Reproductive Psychiatry and Women’s Mental Health. She is the Founder and President of Reproductive Psychiatry Clinic of Austin, which hosts multiple psychiatrists and psychotherapists in Central Texas specializing in mental health across the reproductive life span. Dr Lasseter is also the Secretary of the Austin Psychiatric Society, the Lead Perinatal Psychiatry Consultant at The Women’s Center of Texas at St. David’s North Austin Medical Center, and Affiliate Faculty at The University of Texas Dell Medical School, Department of Psychiatry and Behavioral Sciences. She volunteers her time at Postpartum Support International’s Psychiatric Consult Line and raises awareness about reproductive mental health through speaking engagements and social media (Facebook & Instagram: @the.reproductive.psychiatrist).