Is it Depression or Premenstrual Dysphoric Disorder (PMDD)?

Have you experienced a slew of unpleasant feelings lately that have left you questioning if you could be depressed? Maybe you've noticed it worsening as you age. But ask yourself: do your low times happen a few days right before your period, just to completely disappear when your period starts? 

You’ve probably heard of PMS (or premenstrual syndrome), which is a collection of symptoms commonly experienced by women in the time between ovulation and their period starting. Low feelings may be linked to PMS if they seem to intensify around your period. Depending on how severe those low feelings are, you might be suffering from something more than regular PMS. 

Premenstrual dysphoric disorder or PMDD is far less common than PMS. It affects only around 2-10% of people who menstruate in their reproductive years. But for people with PMDD, dealing with the symptoms can be unbearable.

Below, I’m sharing more information about what PMDD is, what its symptoms are, and how to know if you might have PMDD. 

What is Premenstrual Dysphoric Disorder (PMDD)? 

Premenstrual dysphoric disorder, or PMDD, is a more severe kind of premenstrual syndrome (PMS). 

Your experience with PMDD may not be like anyone else’s, as symptoms can vary greatly. They typically begin during the luteal phase –– a week or two before your next menstrual cycle starts — and they subside when your period starts.

While PMS is generally very treatable, PMDD can seriously interfere with your quality of life, even to a disabling extent. Feelings of hopelessness, sadness, and suicidal ideation due to PMDD can feel insurmountable. They very often will stop you from engaging in your regular activities such as work, exercise, and social activities.

Common symptoms of PMDD

To be diagnosed with PMDD, you must experience five or more of the following symptoms during most menstrual cycles over the course of a year: 

• Depression

• Changes in appetite 

• Decreased interest in activities you used to enjoy

• Insomnia or excessive sleepiness

• Mood swings

• Anger 

• Trouble concentrating 

• Feeling overwhelmed or out of control

• Any other physical symptoms, including headaches, bloating, and more.

When the above symptoms are seriously interfering with your life, preventing you from engaging in work or social activities, and it cannot be linked to another medical issue, it might be PMDD. You should not wait to seek help for this serious condition. 

How to tell if it’s PMDD or something else

Monitoring your symptoms and your cycles will be the best way to determine if you have PMDD. If symptoms subside almost as soon your period arrives, then there is a good reason to suspect that you have PMS or PMDD. 

If feelings of sadness, hopelessness, and depression persist long after you get your period and don’t correlate with your menstrual cycles, then it’s likely that you are dealing with something other than PMDD.

There is no formal medical test for diagnosing PMDD since symptoms may be physical, emotional, or both. And unfortunately, PMDD is often misdiagnosed as generalized depression or written off as its less severe form, PMS. 

That doesn’t mean you shouldn’t advocate for yourself. Talk to your gynecologist about your symptoms. It may be helpful for you to keep a wellness journal for documenting your experiences as they occur. Your OB-GYN or healthcare professional may recommend that you see a mental health professional to rule out generalized depressive disorder, but they’ll be able to support you through this time.

What causes PMDD?

The exact cause of PMDD is still unknown. 

Pre-existing mental illness, especially anxiety and depression, is common among people with PMDD. This may indicate that hormonal changes trigger the worsening of mood disorders, thus resulting in PMDD. 

Genetic factors may also play a role in causing PMDD. Thus, a family history of PMDD or of related mental illnesses, such as depression, may indicate a predisposition to this condition.

How is PMDD treated?

If you are suffering from PMDD, you have many different options for treating your symptoms, which are aimed at lessening or preventing them altogether. Because there are many unique symptoms of PMDD, the best treatment will depend on your particular situation and the severity of what you’re experiencing.

Medication

One common form of treatment for PMDD is medication. Your doctor may suggest a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). SSRIs can alleviate emotional symptoms, insomnia, appetite changes, and improve mood. Common SSRIs include Prozac, Zoloft, and Lexapro.

Birth control pills are another option for treatment. Because oral contraceptives regulate hormones, they may be able to reduce or even prevent symptoms related to PMDD that worsen prior to you getting your period. The birth control pill Yaz, or drospirenone-ethinyl estradiol, is an FDA-approved treatment for PMDD. 

Lifestyle

If you are hesitant to try medication, lifestyle changes can also alleviate some symptoms of PMDD.  Yoga, mediation, and exercise are proven to reduce stress levels and help ease emotional symptoms related to PMDD.

Another often overlooked lifestyle measure is sleep. Getting sufficient, high-quality sleep can also lessen PMDD symptoms.

Changes in diet can also reduce some PMDD symptoms. Diets that are high in processed sugars and fats can make you more sensitive to stress and irritability, so limiting or eliminating these foods can make you more resilient to stress overall. The ideal diet for PMDD is well-balanced, rich in nutrients that you can get from fruits and vegetables, and free of excessive sugars, salts, and fats. Additionally, reducing caffeine and alcohol can help minimize symptoms of PMDD.

So, is it depression or premenstrual dysphoric disorder?

There is a lot of overlap between PMDD and depression, but the biggest differentiator is a strong correlation to your menstrual cycles — which is why it’s so important to start tracking your cycles and symptoms if you haven’t already.

If you think you might have PMDD, you should definitely talk to your gynecologist. They may prescribe you medication to alleviate symptoms or direct you towards a mental health specialist.

In the meantime, you can minimize your symptoms by getting enough sleep, eating well, and exercising regularly.