Talk:Premenstrual dysphoric disorder

Deletion of past talk page

Earlier, the PMDD article was subjected to repeated vandalism, in the form of unsupported claims to the effect that there was "controversy" about whether PMDD existed. The controversy was given as pretext for misogynistic innuendo smearing PMDD as merely a socially constructed malady hyped by manipulative women to excuse periodic bitchy outbursts.

Refutation of the non-existent controversy included a Swedish P.E.T. study showing objectively that mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. Since the past vandalism was persistent and recurring, this citation should not be lost.

That there is an objective correlation doesn't resolve the controversy. Correlation doesn't mean causation, and so to say that mood and serotonin is correlated is to say that the two move together, only, AND that we should not claim that one CAUSES the other. I can't access the article in full to learn more about their methods, but it's generally safe to assume that proper double blinds were followed and yet the abstract itself states:

"Positive mood variables showed positive associations, whereas physical symptoms generally displayed weak or no associations." AND "...due to small sample size and methodological shortcomings, be considered preliminary." Let's not call this more than it is. Especially when there is interviewing or self-report involved for mood symptoms. It's a good start and quite typical in this sort of research, but that the physical symptom are not even weakly related gives me reason to say this is not strong evidence.Briholt (talk) 18:12, 1 April 2009 (UTC)

The PubMed citation for the P.E.T. study is http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16515859&dopt=Abstract and the full article is as follows:

Psychiatry Res. 2006 Mar 31;146(2):107-16. Epub 2006 Mar 2.

Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria.

Eriksson O, Wall A, Marteinsdottir I, Agren H, Hartvig P, Blomqvist G, Långström B, Naessén T.

Department of Women's and Children's Health/Obstetrics and Gynecology, University Hospital, SE-751 85 Uppsala, Sweden. olle.eriksson@kbh.uu.se

The cardinal mood symptoms of premenstrual dysphoria can be effectively treated by serotonin-augmenting drugs. The aim of the study was to test the serotonin hypothesis of this disorder, i.e. of an association between premenstrual decline in brain serotonin function and concomitant worsening of self-rated cardinal mood symptoms. Positron emission tomography was used to assess changes in brain trapping of 11C-labeled 5-hydroxytryptophan, the immediate precursor of serotonin, in the follicular and premenstrual phases of the menstrual cycle in eight women with premenstrual dysphoria. Changes in mood and physical symptoms were assessed from daily visual analog scale ratings. Worsening of cardinal mood symptoms showed significant inverse associations with changes in brain serotonin precursor trapping; for the symptom "irritable", r(s)=-0.83, and for "depressed mood" r(s)=-0.81. Positive mood variables showed positive associations, whereas physical symptoms generally displayed weak or no associations. The data indicate strong inverse associations between worsening of cardinal symptoms of premenstrual dysphoria and brain serotonin precursor (11C-labeled 5-hydroxytryptophan) trapping. The results may in part support a role for serotonin in premenstrual dysphoria and may provide a clue to the effectiveness of serotonin-augmenting drugs in this disorder but should, due to small sample size and methodological shortcomings, be considered preliminary.

PMID: 16515859 [PubMed - indexed for MEDLINE]

History section?

When I first heard of PMDD, it was in the context of the original Prozac patent ending. The owner of the patent to Prozac created a new trade name for the fluoxetine and basically said that this 'new' drug is useful for PMDD.

In other words, the pharmaceutical company created PMDD to justify having a new patent on fluoxetine, as a way to extend the life of their patent. I don't remember seeing PMDD in the DSM, but it may be there. When PMDD came out it seemed controversial, not because it was a social construct hyped by manipulative women" but a social construct hyped by the pharma industry to extend a patent. I don't claim to be an expert here, so having someone point to the original research would be helpful.Briholt (talk) 00:27, 30 December 2008 (UTC)

here is an opinion/review article that backs up my claim above: From the article:

[...]According to the Wall Street Journal [July 2000], however, industry analysts do not expect Sarafem to have a significant impact on Prozac sales. If Sarafem were prescribed only for those 3%-5% of women who qualify for the diagnosis of PMDD, this might be the case. At present, Prozac is so widely prescribed, for even minor cases of depression, that in 1990, just three years after the drug came onto the market, the New York Times (December 3, 1993) referred to the rise of a "legal drug culture". Just as the anti-anxiety drug Valium (diazepam) attained wide popularity in the 1960s and 1970s, in 1994 Newsweek wrote that ‘Prozac has attained the familiarity of Kleenex and the social status of spring water" (February 7). Against this background, the substantial number of women who experience minor symptoms of PMS, even if they do not suffer from full-blown PMDD, promises to greatly enlarge market for a drug that is already the #2 best-selling drug in the world (#1 is the ulcer drug Zantac).

In addition, the patent protections on Prozac, which began in 1987 are about to run out. Marketing essentially the same drug (fluoxetine hydrochloride) under a new trade name effectively extends patent protections for another 14 years.[...] (emphasis mine)

--Briholt (talk) 05:09, 30 December 2008 (UTC)

Criticisms section

In the criticisms section it says something to the effect that severity of a disorder is not a medical attribute. As someone working in the allied health fields, I would disagree and say that severity is an extremely important concept in medicine, psychiatry in particular, and that this part of the section may violate NPOV. Ehb 18:45, 9 February 2007 (UTC)

Severity is a subjective, not objective, trait. Someone who says something really hurts may really just have a low pain tolerance. I work in the medical field as well and sometimes people, to be frank, can be rather exagerating and intolerant of any sort of suffering. Pmdd can be nothing more than a women's inability to cope with the same symptoms that someone who can cope with it has. PMDD seems to me just another medical scapegoat, to say "oh its not my fault I am different I have PMDD and I need to buy drugs." I think its a crime to use medical study in this way.

First off, mental illness is generally defined by a condition being so debilitating it affects the individual's ability to function normally in society; the fact that someone else might be unaffected in a similar situation is irrelevant. Second off, it still seems inappropriate to have these criticisms in the article at all unless one can point to a notable effort by a public figure or publicly known organization to advance the view you describe. I think the criticisms should be removed unless they are better documented and referenced. --Soultaco 00:34, 6 May 2007 (UTC)

Should the entire Criticism section be deleted?! Wikipedia should only present acknowledged facts, not original opinions of minor groups. Heidit

Why does it seem this article is written by a drug company?

It seems doubtful that a drug company would mention generics.

Not a drug company, it seems to be written by a pissed off feminist who doesn't want her inner workings being displayed on Wikipedia.

Comment Whether a clinical condition or not, living with a partner who has PMDD or severe PMS is a nightmare. It's a nightmare also for the women concerned where the only solution is medication to numb evry bit of feeling and emotion inside. The common notion of either Doctors just wanting to pigeon-hole (& medicate) a difficult patient or the patient herself being hypochondrical or exaggerating doesn't cover everyone. My opnion is if you haven't any experience living with it or as a practicisng clinician caring for patients then stay out of the disussion. You don't know! --JpProxy-Connection: keep-alive Cache-Control: max-age=0 gott 01:44, 20 March 2007 (UTC)

I can understand what you are saying, but I think there is still room for criticism as it may not cover "everyone" but it can still cover some. So the argument is whether the result of pmdd is for the most part exaggeration by some women or that enough of them genuinely suffer from it to consider it a separate medical condition meriting its own name. If severity is a trait of something (such as pms) then could we not just refer to it as severe pms with severity being a trait of that condition. And in regards to experiencing it, you are right. A lot of doctors are men, and some of them do not have any experience with even minor ill-effects of the menstrual cycle which can be a reason to say that severity of pms is going unnoticed and should be taken more seriously and yes, even merit considering it its own situation. But we are only human : )The point I am trying to make is that there is room for a criticism section, and that I think it would be best to leave something rather than delete the entire thing. I did notice no citation though, and think that because this is an encyclopedia and not a discussion forum that it should be supported by genuine evidence on the critique.

Comment I find it sad that there is still so much talk about it wether it is an illness or not. I was just diagnosed with it. It took me twenty years to figure it out and one year and several tests to be diagnosed with it. The doctors don't diagnose someone quickly with it. It is more then an odyssey for the patient and the family. One thing I totally miss here. There are so many physical symptoms with PMDD, like: Palpitations, diarrhea, headaches, skin changes, acne, weigh gain, tremulousness… that comes with it. Hardly things you can argue away. As a scientist (PhD) I find it almost unbelievable that so many people still only focus in their arguments on the mental condition of PMDD. I have to take two Tylenol III to get over my stomach pain and I gave birth without any medication. When will you start to argue other mental illness away? --[[User:helper1412| —Preceding undated comment added 00:11, 20 November 2009 (UTC).

I think The Veronicas have been promoting the awareness of this? ... sad ...

The Veronicas have been promoting the awareness of this?

It is sad to think that with such medical advances that the subject of Pmdd is so controversial. If this was a disease of all people the treatment would be sought and that would be the end of discussion. Just like depression, something the coincides with pmdd for years has been marked as "all in someone's head". Granted there should not be a pat answer of pushing medication, but in the same token there should be an answer not just a criticism. —Preceding unsigned comment added by 72.19.34.193 (talk) 03:42, 7 September 2007 (UTC)

How do you get a treatment ... without applying a psychiatric label?

Menses and perimenopause are part of a healthy life, yet cause some women unpleasant or disabling symptoms. Under the U.S. medical model it seems there is no treatment without a diagnosis of pathology. The model isn't well-adapted to the situation where a treatment can reduce the hardship some women experience in normal or perimenopausal menstrual cycles.

Treatment with SSRIs is effective, but does have side effects, which ideally would be weighed by a woman against her symptoms, perhaps aided by her doctor, to allow her to decide based on her own balance. Since menses and perimenopause are both normal, she shouldn't have to first be declared to suffer from a psychiatric disorder. Normal menses makes many demands on the body, but that hardly makes it a pathology -- like menses-related iron-depletion anemia, the sufferer and the symptoms deserve respect -- and the sufferer deserves to have the symptoms treated without being labeled as diseased. Anyone who can think of suggestions about how to get relief from PMDD for those women who need it, without applying a psychiatric label, please add them below. Please feel free to think outside the box. 67.101.68.116 14:01, 16 September 2007 (UTC)ocdcntx

Make one or more SSRIs available over the counter?

Some clinicians prescribe generic Prozac, in a substantial quantity. This empowers the PMDD sufferer to take whenever may seem indicated for symptoms, much as she might use aspirin, ibuprofen, coffee, tampons, etc. for other unwanted symptoms encountered around the time of menses. This achieves a maximum of empowerment of the sufferer while allowing minimum oversight by the woman's chosen health professional of any side effects that might appear from the use of SSRIs.

There is a non-psychiatric treatment option

I suffer from this condition and am being treated by a Reproductive Endocrinologist by being put into chemical menopause via Lupron, and then having a small amount of Estrogen add back therapy. It has completely eliminated all of my symptoms. However, I cannot tolerate progestins/progesterone and have to have endometrial biopsies often because inducing a period causes symptoms to start again so I only do it once a year. --Ieatbugs (talk) 01:31, 10 November 2008 (UTC)

I know well a case of PMDD that was diminished by using the mesigyna monthly contraceptive , using pill, diu or using nothing at all was the worst scenario. May someone add some references to that ? i think mesigyna is the ultimate solution to PMDD. By the way mesigyna must be injected SLOWLY —Preceding unsigned comment added by 189.231.90.147 (talk) 16:21, 7 October 2009 (UTC)

On its face, above appears a commercial advertisement. —Preceding unsigned comment added by 66.167.61.214 (talk) 18:05, 18 April 2010 (UTC)

The cardinal symptom is -- tiredness

A survey of women found that overwhelmingly, tiredness was the most distressing symptom of PMDD for them. Not anger, though an aside from an abstract of a study that did not actually study the issue of what women found most distressing is given by the article as a demonstration that anger is the "cardinal symptom". Maybe it is for those for whom anger may be inconvenient -- perhaps even for some PMDD sufferers. But shouldn't the view of the majority of women surveyed on the exact subject -- that tiredness is the most important of the constellation of symptoms -- be given some weight? It was taken down, with cite, when I posted it here some time back.

Vitamin B and Magnesium

" Yet, many patients report a significant decrease of symptoms, to their almost complete disappearence, by following a simple therapy with magnesium orotate, B vitamins and folic acid. ^{(source needed)}"

This needs to be removed, there is no source for this because this information is incorrect. —Preceding unsigned comment added by 68.84.140.25 (talk) 16:49, 16 August 2009 (UTC)

Mayo Clinic places incidence of PMDD as up to 10% of menstruating women, distinguishes from PMS by severity

From: http://www.mayoclinic.com/health/pmdd/AN01372

Question:

":What is premenstrual dysphoric disorder (PMDD)? How is it treated?

Answer

from Sandhya Pruthi, M.D.

About 75 percent of menstruating women experience mild to moderate premenstrual symptoms. But up to 10 percent of menstruating women have premenstrual dysphoric disorder (PMDD) — a severe, sometimes disabling form of premenstrual syndrome (PMS).

Premenstrual dysphoric disorder is distinguished from PMS by the severity of its symptoms and its impact on relationships and daily activities. Symptoms of PMDD — which occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins — include:"