BLOG No. THIRTY TWO

Welcome back to my blog on anxiety and depression. Today I want to discuss a topic called premenstrual dysphoric disorder, or PMDD. PMDD is a disorder some women get that hits around 7 to 10 days prior to their cycle and lasts until about the second or third day of menses. For the men who think menses is an IQ test, I would not actually take an IQ test; you will be disappointed. Instead, substitute the word “period”.

Most people are familiar with PMS, or premenstrual syndrome, which makes women a little moody and emotional prior to menses. But PMDD is much more severe, disrupting a woman’s life and requiring treatment. There are numerous symptoms, but some of the biggest are fatigue, anxiety and depression, focus and memory issues, emotional lability, paranoia, hypersomnia or insomnia, G.I. symptoms, libido loss, and headache. And once again this starts 7 to 10 days before menses.

I remember going to a family practice course years ago when a doctor got up to speak on PMDD. When the speaker announced the topic, there were a handful of men in the crowd that let out a little snicker. The doctor became enraged and slammed his fist down on the podium. He then proceeded to lecture us like a Mississippi preacher in regards to PMDD and how male doctors—along with a few female doctors—just didn’t get it. When he finished, he received a standing ovation. PMDD is a condition that brings serious suffering to women around the world. It needs to be taken seriously. Of the 30% of women who suffer from PMS, an estimated 5 to 10% of those have the more severe form of PMDD.

Jon: Did you know that PMS is mentioned in the Bible?

Joan: That’s preposterous. There is no such reference to PMS in the Bible.

Jon: Sure there is. In Luke he says that Mary rode Joseph’s ass all the way to Bethlehem.

So how does one treat PMDD? Well let’s look at some of the symptoms discussed above… paranoia, anxiety, depression, insomnia or hypersomnia to name a few. What are these symptoms of? If you said serotonin, I would donate your body to science… right now!

But if you said dopamine type two, you are correct. And of course these unfortunate ladies usually see whom when they get these symptoms? Right again, their gynecologist. And what medication do you think she gets from them? If you said D2 suppressing drugs, you have more faith and hope than a Mississippi evangelist.

Yeah, they’re going to get serotonin.

And understand, these patients are usually not pure bipolar type one patients, so there is both a serotonin component and a more predominant D2 dopamine component. So, of course, they get a little bit better, perhaps 30%. But who wants to be 30% better, when you can be 100%?

And if you don’t quite believe me that PMDD is predominately affected by D2 dopamine, look at what the NIH says. They state that one of the biggest risk factors for PMDD is a history or family history of a mood disorder. And what did we learn earlier about mood disorders in previous blogs?

We learned that they are caused by D2 dopamine excess.

So what do you do if you have PMDD and it is going untreated or not being fully treated? Ask your provider about adding a direct D2 lowering drug like Abilify, Geodon, or Vraylar to the SSRI of the day that was chosen for you, or you might add Lamictal or Trileptal. If you’re not being treated at all, I would start with Lamictal or Trileptal first. It is morbidly unfair to allow a disease to steal a third of every month from you! You deserve better!

Well, a bee just flew out of my Chardonnay and is trying to pollinate the cats ear. Until next time when I give you a case study of PMDD, this is Dr. G saying, keep the faith!