Premenstrual dysphoric disorder is a more severe form of premenstrual syndrome (PMS), characterized by a significant change in mood. More accurately, PMDD mirrors the symptoms of depression and anxiety, causing them to peak approximately ten days before and shortly after the start of every period.
Some cases of PMDD may be a form of depression triggered by an exceptional sensitivity to normal hormone changes during menstruation, while others may be a case of an underlying depression or anxiety disorder amplified by the physical changes during a teen’s menstrual cycle. While symptoms of PMS include irritability and moodiness, PMDD symptoms are much more severe.
Premenstrual dysphoric disorder is primarily linked to a combination of psychological and biological phenomena and is uniquely tied to the menstrual cycle. When the menstrual cycle is interrupted or ends, such as during a pregnancy or after menopause, PMDD goes away. Other underlying disorders may remain, including a variety of different possible mood disorders, but PMDD is strictly reliant on the existence of a menstrual cycle.
Hormone sensitivity – research determined that it’s not an abnormal level of hormones that causes PMDD, but a heightened sensitivity to normal hormone changes that occur throughout the menstrual cycle. This is largely genetic.
Brain differences – women with PMDD or milder, yet still significant PMS may be struggling with abnormal serotonin neurotransmission. Serotonin is a neurotransmitter (brain chemical) responsible for a number of important psychological and physical processes, including feeling happy and calm. Other systems of neurotransmission may also be involved, although this isn’t clear yet.
Co-occurring disorders – fluctuations in estrogen and progesterone during menstruation commonly affect various different processes in the brain, possibly exacerbating pre-existing mental disorders that have previously been much subtler. Nearly half of women seeking treatment for PMDD actually have an underlying mood disorder, exacerbated by hormone changes during their premenstrual phase.
of menstruating women have symptoms of PMS
of menstruating women struggle with PMDD
of women with PMDD have or will attempt suicide
Help your teen accurately track their period – while it doesn’t alleviate any symptoms, knowing when the range for PMDD symptoms begins can help your teen feel more in-control, and anticipate when they might have to start taking medication, for example. It may also help to maintain a weekly or monthly journal, especially during the premenstrual phase, to help write out bothering thoughts and contemplate ways to overcome negative thinking, through the help of lessons learned during therapy.
Adopt healthier habits with your teen – exercise, a consistent sleeping schedule involving at least 8 hours of down time, and a healthy diet are all part of a necessary trio of lifestyle changes for any girl struggling with PMS and PMDD. Exercise not only provides an emotional outlet, but it boosts self-esteem and happiness, leading to an increased release of various endorphins, and a more confident body image. A strong body simply feels better. Food is also important – a balanced diet helps the body, and even without herbal supplementation, simply eating right can alleviate some symptoms exacerbated by a poor diet. It’s important to adopt these habits with your teen – it can be very frustrating and difficult to go through with these changes alone, especially while struggling with depression. But if the entire family makes an endeavor to be healthier, it’s easier to commit to it.
Help your teen relax at home – teenage responsibilities and obligations at home are an important part of growing up, but it’s important to recognize when your teen is going through a significant amount of stress. Depending on your teen’s age and their difficulties at school – either academically or socially – the stress of what they’re dealing with on a daily basis may be detrimental to their treatment and may in fact cause their depression to worsen significantly when they enter the premenstrual phase. Help your teen find ways to relax, calm down, and see home as a healing environment by talking to your teen about their problems, helping them assuage their fears, affirm positive beliefs, and deny their depressive thoughts.
Teen premenstrual dysphoric disorder can be managed through a number of different ways, primarily through medication. While psychotherapy can help teens manage their depressive thoughts a little better, much like with other forms of depression triggered by an abnormality in neurotransmission, medication is typically a more effective short-term treatment and is commonly prescribed to be used throughout the premenstrual phase. Long-term, however, both therapy and a number of different lifestyle changes are necessary.
There are a number of potentially effective alternative treatments and remedies for PMDD. Although the FDA hasn’t approved these, there are a variety of recommended herbal supplements that may help. The reason these generally aren’t recommended is because herbal supplement companies and vitamin supplement companies are not regulated as well as drug companies, meaning it is difficult to recommend any given herb or vitamin without standardizing their source.
There is also conflicting evidence and limited research for most recommended “natural” remedies, partially because they don’t work for everyone. Some supplements that have been studied for use against PMDD include calcium, magnesium, vitamin B6, St. John’s wort, chasteberry and ginkgo. Never take herbal supplements without consulting a doctor if you’re taking existing medication. SSRIs and St. John’s wort have a drug interaction, for example, and could potentially lead to serotonin syndrome if taken together at the right dosage
Stress is a big factor that can heavily accentuate and exacerbate the symptoms of PMDD. While it’s generally impossible for a teen to completely avoid stressful situations throughout their premenstrual phase, it is important to learn effective stress management. This looks a little different for everyone, but generally involves a series of tools, strategies, therapies, or tricks to stay calm, relax, and eradicate negative thinking.
Selective serotonin reuptake inhibitors are typically the first line of treatment for PMDD, because they have the fewest side effects among antidepressants while exclusively targeting serotonin neurotransmission by slowing the reuptake of serotonin by the brain’s cells, allowing more serotonin to roam freely in the brain, thus better regulating a negative mood.
If SSRIs are ineffective, doctors may prescribe other antidepressants, or move on to a form of hormone therapy, such as birth control pills. While PMDD is not shown to be caused by abnormal hormone levels, contraceptives in particular seems to help the brain interrupt aberrant signaling sometimes linked to PMDD. This can come with other side-effects, from weight gain to further mood shifts, so it’s not prescribed as often. Other forms of hormone therapy include estrogen.
One of the most important parts of teen premenstrual dysphoric disorder treatment is a proper diagnosis, from the very beginning. In cases where teens do have premenstrual dysphoric disorder and don’t have a co-occurring disorder, we may recommend continuing therapy and antidepressant use after the program has ended. In cases where teens may have premenstrual dysphoric disorder alongside another mental illness, teen premenstrual dysphoric disorder treatment is going to require a holistic approach that takes all of a teen’s symptoms into account. At Paradigm Malibu, we start treatment by taking a better look at the whole picture.
Taking Holistic to Heart
At Paradigm Malibu, we’re emphatic about an extensive diagnosis process, which takes special consideration of the mental, emotional, and physical elements of each teen. Specification is especially important during the early teen years – while PMDD is rare in early adolescence and usually shows up when a teen is closer to the age of 20, symptoms can change and evolve throughout the teenage years. During treatment at Paradigm Malibu, by incorporating physical aspects of treatment, such as nutrition plans and exercise, we work to provide teens with resources that can positively support their physical health.
Life After Treatment
Teaching is a big part of any treatment – we want to teach teenagers how closely related their mental and physical health are, so that they can support themselves in holistic ways, when moving forward past the program. By working with both teens and their families, we help them prepare themselves by arming them with the right repertoire to deal with various individual challenges presented by PMDD, from increased negative thinking to worsening anxieties, constant fatigue, physical discomfort, and more.
Paradigm Malibu is an exceptional program with an incredible staff. They have goals and strategies and a process to help the kids to overcome their struggles. I highly recommend!
– Kenan K.
How do I know if my daughter has Premenstrual Dysphoric Disorder?
PMDD shares symptoms with depression, anxiety, fibromyalgia, chronic fatigue, PMS, and a series of other disorders or syndromes. It’s difficult to pinpoint whether a person has PMDD without getting a through diagnosis from a professional who has all the facts. Because of this, it’s a good idea to prepare a list of things when first visiting the doctor with your daughter to help them determine whether PMDD might be a probable cause for your teen’s symptoms.
Ask your daughter to take note of all their symptoms and when they started (anything that’s off, and the severity of it in terms of how it deviates from the usual), a list of any medication, as well as certain key personal information, such as the age at which she had her first period, as well as any history of mental or physical illness. Be sure to give your doctor any information regarding family medical history, as well.
If I’m feeling better, can I stop going to therapy?
Ideally, you should be sticking to your regular schedule and should continue psychotherapy sessions even when you’re feeling better. In fact, you should continue your sessions especially when you start to see significant progress. It’s crucial to capitalize on that, and your therapist will likely help you continue to find ways to manage your symptoms should they return. PMDD can get worse over time without treatment, and your symptoms may come back if you stop therapy.
It’s the same way with any prescribed medication. If you’re sure you don’t need your meds anymore, work with your doctor or psychiatrist to slowly and safely get off your antidepressants. Antidepressant withdrawal is a real issue, and can be avoided with a proper plan.