Premenstrual Dysphoric Disorder (PMDD) can be thought of as a severe form of PMS (Premenstrual Syndrome). PMDD symptoms usually occur the week before the onset of menstruation and they usually subside within a few days after. Women with this disorder experience extreme monthly mood swings along with physical symptoms that interfere with everyday life. Relationships with family and friends often suffer during this period.

Women with PMDD usually experience several of the following symptoms: anxiety, depressed mood, irritability, sleep disturbance, difficulty concentrating, angry outbursts, breast tenderness and bloating. The actual diagnostic criteria for PMDD emphasize depressed mood, anxiety, and mood swings or irritability.

The physical symptoms of PMS and PMDD are the same, but the emotional symptoms of PMS are much milder.

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Women with PMS may experience sadness or mild depression, while women with PMDD experience much more significant depression - sometimes including suicidal or homicidal thoughts.
Women with a history of depression are at increased risk for PMDD (and some studies suggest that women who have had PMDD are at risk for depression after menopause). Some have estimated that 5% of women who are menstruating meet the criterea for PMDD, but further research is needed in this area.

A group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are used to treat PMDD. The US Food and Drug Administration has approved two medications for treatment of PMDD. In 2000 fluoxetine was approved to treat this disorder. Eli Lilly marketed this antidepressant under the name Prozac, but they decided to rename it Sarafem in order to market it to women with PMDD. Sertraline (marketed by Pfizer as Zoloft) was the second medication approved to treat PMDD in May of 2002. Another company, SkyePharma, has developed a time-released version of GlaxoSmithKline's antidepressant Paxil (paroxetine) and was hoping to see that drug on the market for PMDD in the future.

Should you take a medication for pre-menstrual symptoms? Most women with PMS are unlikely to need this. Many women with PMDD may also not want to take an antidepressant during this time of the month. Each woman has to make that decision for herself. If your symptoms include severe depression with suicidal or homicidal thoughts then you should certainly talk with your doctor about taking one of these medications. If your life (and your family's life) is a living for several days a month then you should also consider one of these medications. As with many mental health problems, the key is to look at how badly the symptoms are getting in the way in your life.