What is Premenstrual
Dysphoria?
Many women experience some physical, emotional and behavioral
changes associated with phases of their menstrual cycles.
In some women, these changes are severe, occur regularly,
and include depressed feelings, irritability, and other emotional
and physical changes. These changes are referred to as
(PMS) or
(PMDD). These changes typically begin after ovulation and
become gradually worse until menstruation starts.
While many women report some history of
premenstrual mood changes and physical symptoms,
an estimated 3-4 % suffer severe symptoms
that significantly interfere with work and
social functioning. For these women, there
appears to be an abnormal response to normal
hormone changes. Researchers are studying
what makes some women susceptible to PMDD,
including differences in hormone sensitivity,
history of other mood disorders, and individual
differences in the brain. Women who are
at risk for depression may be more vulnerable
to the mood shifting effects of hormones.
What are the
symptoms of Premenstrual Dysphoric Disorder (PMDD)?
Symptoms of PMDD include depressed mood, anxiety or tension,
irritability, decreased interest or pleasure in activities,
difficulty concentrating, low energy, change in appetite,
overeating, increase or decrease in sleep, feeling overwhelmed,
bloating, headache, joint or muscle pain, and breast tenderness.
Women with PMDD are more likely to develop
depressive disorders and postpartum disorders.
If you are having these symptoms at other
times of the month you should consider being
evaluated for depression. Discuss this with
your health care provider.
What can I do about
PMDD?
You have already taken one of the most important steps in
helping your depression -- you have come for help. Fortunately,
there are many ways to treat PMDD.
Record symptoms
-
The first step is to start a calendar
that records your symptoms including when
and where. This will help you and your
health care provider look at your mood
and your menstrual cycle together.
Dietary changes
-
Having a well balanced diet and eating
on a regular schedule is also important.
Decreasing refined sugar, caffeine, alcohol,
and chocolate may help. Use of calcium,
and B vitamins (B6) may also decrease
symptoms.
Exercise -
The benefits of exercise in depression
are well documented. Exercise helps treat
depression by releasing the body's mood-elevating
compounds, reducing the depression hormone,
cortisol, in the blood, providing perspective
on life, providing a feeling of accomplishment,
enhancing self-esteem, and increasing
levels of
(a
found to be key in the development of
depression). It doesn't matter what you
do as long as you do something physical
for 20 to 30 minutes three times a week
or more. Even exercising as little as
10 minutes a day has been found to have
beneficial effects. Walking is perhaps
the most accessible form of exercise because
it costs nothing and you can start it
immediately.
Therapy -
Therapy involves talking with a trained professional (psychologist,
psychiatrist, clinical nurse or social worker) for usually
a few sessions. Cognitive
Behavioral Therapy (CBT) targets negative thoughts and
behaviors that tend to worsen depressed mood and teaches
better ways of thinking and behaving. A therapist can help
you plan for these more difficult times in the month.
Relaxation Techniques
-
Relaxation techniques are useful in reducing
the additional stress you feel at "that
time" of the month. These can include
deep breathing, deep muscle relaxation,
biofeedback, yoga, meditation, and massage.
Promote sleep
- Take care to keep your sleep cycle regular
by going to bed and waking around the
same time. Develop relaxing bedtime rituals
such as reading or a warm bath. Avoiding
long naps during the day helps nighttime
sleep.
Support and Stress
Management -
Plan to have extra help with items like
household tasks and childcare during difficult
times of the month. Be sure to keep a
reasonable schedule.
Antidepressant Medication-
Antidepressant medications are effective
in relieving premenstrual symptoms. There
are many safe, effective, well-tolerated
antidepressant medications. Some studies
suggest that taking antidepressants only
during the latter half of the menstrual
cycle may be helpful. Discuss their potential
benefits and risks with your health care
provider.
Alternative medicine,
herbal remedies and dietary supplements
-
There has been rising interest in the use of herbs and dietary
supplements for the treatment of depression. St John's Wort
(hypericum perforatum) has been the most common of these.
However, scientific studies of these alternative forms of
treatment have so far been short-term and not well controlled.
There is not uniformity of dose or even amounts or types
of ingredients because the Food
and Drug Administration does not regulate them. Be sure
to tell your health care provider if you are taking an herbal
or dietary supplement. Some of them may negatively interact
with antidepressant medication or other medications you
are taking.
Spend time with others
-
Depressed women often withdraw from others
because they mistakenly feel they would
not be good company. Being with others
is another way to gain perspective, which
helps with the symptoms of depression.
