Premenstrual dysphoric disorder: General overview, treatment strategies, and focus on sertraline for symptom-onset dosing.

Abstract

Byline: Chittaranjan. Andrade Introduction The premenstrual syndrome is a common clinical condition; its prevalence depends on the threshold set for its identification. This article briefly describes its clinical features, examines issues related to its nomenclature and prevalence, considers controversies related to the diagnosis, and discusses its treatment. Special attention is paid to the use of sertraline as a treatment administered specifically within the window of symptom presence. Nomenclature Premenstrual dysphoric disorder (PMDD) has had a checkered history in the psychiatric nomenclature. Commonly referred to in lay parlance as premenstrual tension, it has been known as the premenstrual syndrome, late luteal phase dysphoric disorder, and now, premenstrual tension syndrome (International Classification of Diseases-10[sup]th revision [ICD-10]) or PMDD (Diagnostic and Statistical Manual of Mental Disorders fifth edition [DSM 5]). The current ICD-10 criteria are broad and easy to endorse;[sup][1] as a result, the current ICD concept would include a substantial proportion of women during their reproductive lifespan. In contrast, the DSM criteria are narrow and specific;[sup][1] as a result, the current DSM concept would identify only women at the severe end of the spectrum. As a striking example, in a sample of college students, the prevalence of the premenstrual syndrome was found to be 3.7% and 91.4%, depending on whether DSM or ICD criteria were applied.[sup][2] Prevalence PMDD is a modestly common condition. The prevalence of PMDD is 3%–9%.[sup][3] Similar numbers have been reported from India. In a small, early study of 62 women, Banerjee et al .[sup][4] obtained a prevalence of 6.4% for PMDD in New Delhi. In a larger, more recent study, Raval et al .[sup][2] identified a prevalence of 3.7% in a sample of 489 college girls in Bhavnagar, Gujarat. Mishra et al .[sup][5] obtained a prevalence of 37% in 100 female medical students residing in hostel facilities in Ahmedabad, Gujarat; this outlying finding may have resulted from the special nature of the sample, selection bias (symptom-free girls not returning the questionnaire), and other methodological issues. Other figures obtained were 4.7% in a sample of 1355 adolescent girls in Anand, Gujarat,[sup][6] 12.2% in a sample of 221 high school girls in Ahmedabad,[sup][7] and 10% in a sample of nursing staff and students in Wardha, Maharashtra.[sup][8] Clinical Features PMDD comprises mood symptoms such as anxiety, depression, irritability, anger, or affective lability; physical symptoms such as bloating or muscle pain; and other symptoms, such as poor concentration, decreased interests, lethargy, and changes in sleep and appetite. The symptoms require to be present across several menstrual cycles, appear in the week before the onset of a menstrual period, and diminish and disappear shortly after the onset of the period. To merit diagnostic status, the symptoms need to cause significant distress or impairment in work, social, or interpersonal spheres of functioning.[sup][9] Controversies PMDD has for long been a controversial diagnosis. It has been considered to stigmatize or marginalize women, to comprise an attempt by the pharmaceutical industry, to medicalize a normal experience, and to represent a culture-specific syndrome rather than a universally prevalent condition. These and other concerns about the research on PMDD were addressed in a detailed review by Hartlage et al .;[sup][10] the authors concluded that PMDD is a global disorder that merits full diagnostic attention. Treatment A large number of treatments have been trialed for PMDD. These include hormonal treatments, psychological treatments (from stress management to formal psychotherapy), physical treatments (e.g. yoga, aerobic exercise), mineral supplements (e.g. calcium), nutritional supplements (e. …