Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is defined as a depressive disorder, not otherwise specified, in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. It is characterized by mood, appetite, energy, and cognitive changes that occur during the late luteal (premenstrual) phase of the menstrual cycle and remit shortly after the onset of menses. Symptoms are severe enough to interfere with functioning at home, school, or work. It occurs in an estimated 5% of women, and if left untreated, may become more severe and extend in duration over time. Based on current evidence, serotonergic dysfunction appears to be linked with its hormonal etiology, as selective serotonin reuptake inhibitors (SSRIs) demonstrate efficacy and safety. Both fluoxetine and sertraline have been approved by the Food and Drug Administration for use in PMDD. More recent studies suggest that at least among the SSRIs with longer half-lives, such as fluoxetine, the medication can be given in the second-half (luteal phase) only to achieve beneficial effects. Once the medication is stopped, however, symptoms recur in a majority of women within a few months. Other nonpharmacological approaches to treatment, such as sleep and light therapies, are being developed based on chronobiological hypotheses.