Oral Papers: Women's Mental Health & Pediatrics
Background: Premenstrual dysphoric disorder (PMDD) is a serious condition that causes significant suffering in 2%–8% of women of reproductive age worldwide and their families. PMDD is characterized by affective, cognitive, behavioral, and somatic symptoms that occur consistently during the luteal phase of the menstrual cycle. The impairment related to the affective and somatic symptoms in PMDD is particularly striking when expressed in terms of disease burden, calculated according to the World Health Organization model that determines disability-adjusted life years (i.e., the years of life lost to premature death or lived with a disability). Based on the 2000 U.S. census and a PMDD prevalence of 5%, researchers estimated the number of symptomatic menstrual cycles a woman with PMDD would experience during her reproductive life, and they determined that the disability-adjusted life-years burden for the United States is 14.5 million years (Baller, 2013).
Methods: A review of the epidemiologic, neuroimaging, genetic and metabolomic studies on PMDD since the 1980s was performed.
Results: Studies have consistently shown that women with PMDD have a sensitivity to physiologic hormone levels(Schmidt 1998). Furthermore, PMDD is extremely treatable; up to 85% of women respond to SSRIs and some women even respond to intermittent SSRI dosing during their menstrual cycle, indicating a unique mechanism of action of these drugs. Despite their elegant work, PMDD is under-screened and under-treated, and continues to be the subject of pseudoscientific debate in this country.
Conclusions: PMDD is a common, treatable condition. Further discussion and education of physicians and patients on the biological, neurological, and genetic basis of the condition may facilitate increased diagnosis and treatment of the condition.
Additional Information: "Menstrual Mysteries: The Case of PMDD," on which this oral paper will be based, is a commentary currently being prepared for Biological Psychiatry. It will address the history of the disease, some seminal scientific studies, and the current tension in our culture to address and treat this condition. The oral presentation of this article will use a novel format developed by the National Neuroscience Curriculum Initiative, termed “This Stuff is Really Cool.” It will highlight the interaction of estrogen and progesterone on brain function in a group of women with PMDD as compared to a group of healthy controls.
1) Baller EB, Wei S-M, Kohn PD, Rubinow DR, Alarcón G, Schmidt PJ, Berman KF. Abnormalities of
dorsolateral prefrontal function in women with premenstrual dysphoric disorder: a multimodal neuroimaging
study. American Journal of Psychiatry 2013; 170(3):305-314.
2) Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR: Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 1998; 338:209–21.