The pharmacotherapeutic management of premenstrual dysphoric disorder

Introduction Premenstrual dysphoric disorder (PMDD) is a prevalent psychiatric condition associated with substantial mental distress, impaired psychosocial functioning, high rates of co-morbid psychiatric conditions, and elevated risk of suicide. Areas covered We provide an update on epidemiology, pathophysiology, clinical presentation, and diagnosis of PMDD, with a focus on the pharmacological management of this condition. Expert opinion Given the high rates of false positives from retrospective assessments, prospective daily symptom monitoring for a minimal of two symptomatic menstrual cycles is critical to accurately confirm (or rule out) the diagnosis of PMDD. Serotonin-based antidepressants are well-established first-line treatments of PMDD. Second-line treatment includes the use of combined, monophasic oral contraceptives. In mild to moderate cases, independent meta-analyses have shown efficacy of Chasteberry extract (Vitex agnus cactus). Preliminary results with compounds blocking the synthesis of allopregnanolone are promising.

Automated summary

This article provides an update on the epidemiology, pathophysiology, clinical presentation, and diagnosis of premenstrual dysphoric disorder (PMDD), with a focus on the pharmacological management of this condition. Prospective daily symptom monitoring is crucial for accurately diagnosing PMDD. Serotonin-based antidepressants are the recommended first-line treatment, while Chasteberry extract and compounds blocking the synthesis of allopregnanolone may be effective in mild to moderate cases.