Premenstrual Dysphoric Disorder – Psychotherapy Treatment and Antidepressants Medications

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When Katie was feeling all right, she was fun to be around. About seven days before the onset of her period each month, though, her character changed completely. She became abrasive and cutting, and belittled her husband’s sexual performance and earning capacity. Finally, he said that he couldn’t bear her attacks anymore, and threatened to leave her if she didn’t get help. Katie was stunned by his reaction because she hadn’t realized how hurtful her attacks were; at the time she always felt that her criticisms were completely legitimate.

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When she was in the early part of her cycle, she felt calm and content and pleased with her life. Only in the week before her period did she start to feel edgy, bloated and unattractive. At that stage, any slight joke her husband made would infuriate her, and she would be ready to do battle.
With her husband’s ultimatum, Katie decided that she had to do something about her moods. She went to her family doctor, who asked her to chart her moods for three months and coordinate them with her menstrual cycle. She soon noticed that she became irritable within five days of the onset of her period, almost like clockwork. This meant that, by watching the calendar, she could allow for the bad times. She tried not to overextend herself at that time of month. She would book any dinner parties and community work for her calm three weeks. She made sure she got adequate rest and extra help around the house, from her husband and children, during the bad week. She also made a point of looking after herself. She took the dog for a walk each evening. She cut down on coffee and alcohol, as they made her more irritable. She loved to sit in a hot bath in the evenings to unwind. She also treated herself and her husband to a restaurant meal where they could relax without the kids. She was careful to drink lots of water, decrease her salt intake, and eat fresh fruits and vegetables. She took a vitamin B6 pill each morning because she had read that this would help. She also tried positive self-talk such as ‘This is just a temporary situation’, and ‘I know I can get through this’. Her explosions lessened and Katie felt much less stressed out. As for her husband, he tried to be more caring and loving during the rough times. Katie asked him to try this all month long!

Katie had a classic case of premenstrual dysphoric disorder, a variant of depression caused by premenstrual alteration in the balance of estrogen and progesterone. (Premenstrual dysphoric disorder is also known as premenstrual syndrome, or PMS.) This illness is stable and recurrent, marked by anxiety, irritability, mood changes and physical discomfort. The symptoms start five to seven days before the onset of the period and ease up when the period starts. You feel fine until something unexpected happens, and then you explode like a firecracker. The disorder can be managed supportively, by eliminating coffee and alcohol from your diet, relaxing and exercising more, and adding vitamin B6 at a dose of 50 to 500 mg daily, for seven to ten days before your period starts. A diuretic such as bendrofluozide, a medication that increases urine output if there is bloating and water retention, sometimes helps. Your doctor can prescribe it.

Discuss what’s happening with your doctor. You might look at areas of stress in your life that can be minimized. You may need to do less during this time of month, or spend more time on activities you enjoy. You may feel it’s more ‘womanly’ to be all-giving and to neglect your own needs, but in the long run this tactic can backfire. Ask for help from your partner or other family members.

About 5 per cent of women with this disorder benefit from psychotherapy and antidepressants. Another 38 per cent also suffer from seasonal affective disorder. A severe form of premenstrual dysphoric disorder can develop if you were sexually abused as a child.

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