An In-depth Look at Premenstrual Dysphoric Disorder (PMDD) and Available Treatments

Written by Lauren Doucher

One day, you are fine, feeling pretty optimistic, and getting things done at work and around the house. The next day, it feels like the weight of the world is on your shoulders and you are deeply sad for no particular reason. And everything – literally everything – annoys you and causes you to go into what seems like endless bursts of anger, followed by periods of depression, tears, and zero motivation to get off the couch. You just want to crumple up in a corner and hide. You may find yourself staring at the bottom of that carton of ice cream you just devoured, or you may find that your appetite is completely gone. Sleep doesn’t come so easily, but sometimes, it doesn’t seem to want to go away.

It feels like the depths of winter in your body and mind. Your period comes, and things get worse before they get better. Then you wake up one morning, and the storm has passed. You feel like yourself again and can breathe easy…until your cycle comes around again. If that sounds like you, consider yourself seen and heard. You may have a disorder that might as well be considered PMS’ evil twin.

What is PMDD?

PMDD, or Premenstrual Dysphoric Disorder, is a complex and debilitating condition that affects many women worldwide. It is characterized by severe physical and emotional symptoms that interfere with daily life, and these symptoms typically occur during the luteal phase of the menstrual cycle. In simple terms, the luteal phase is the second phase of the menstrual cycle, and it kicks off around the 15th day of your cycle and ends with your period. It is also during the luteal phase that PMDD symptoms tend to rear their ugly heads more clearly.

PMDD often goes undiagnosed or misdiagnosed. It may be confused with the garden-variety PMS or mistaken for major depressive disorder, thyroid disorders, and a variety of other conditions. But if you find yourself struggling with disabling symptoms that make it impossible to go about your daily life once you hit the second half of your cycle, it may be worth learning more about this disorder and possible treatment options that can help you reduce your symptoms and take back control of your life.

What are the differences between PMDD and PMS?

PMDD and PMS, or Premenstrual Syndrome, are often used interchangeably, but there are some key differences between the two conditions. PMS is characterized by mild to moderate physical and emotional symptoms that occur during the luteal phase of the menstrual cycle, typically starting around a week before menstruation and ending within a few days of starting. These symptoms can include mood swings, irritability, bloating, headaches, and changes in appetite. While PMS can disrupt daily life, the symptoms are typically not as severe or debilitating as in PMDD and typically do not last as long.

On the other hand, PMDD is a much more severe and debilitating form of PMS. It is estimated to affect 5% to 8% of women of reproductive age, causing moderate to severe symptoms that interfere with their personal, professional, and social lives. In other words, the key differences between PMDD and PMS lie in the length and severity of symptoms and their impact. With PMDD, the symptoms are well beyond a mild irritation – instead, they can be severe enough to impair a woman’s quality of life and functioning significantly.

Symptoms of PMDD can include mood swings, irritability, anxiety, depression, fatigue, changes in appetite, and difficulty concentrating. Some women may also experience physical symptoms such as breast tenderness, headaches, and abdominal cramps. The severity of these symptoms can vary from person to person and can severely impact daily activities and relationships. In the most severe cases of PMDD, women may present symptoms of major depressive disorder, including suicidal thoughts.

How Do I Know If I Have PMDD?

There is a list of at least 11 symptoms that have been associated with Premenstrual Dysphoric Disorder. In general, a woman may be considered to have PMDD if they present at least five of the described symptoms and their symptoms are severe enough to interfere with various aspects of their life. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), PMDD symptoms may include:

  • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • Marked anxiety, tension, feelings of being “keyed up” or “on edge”
  • Marked affective lability
  • Persistent and marked anger or irritability or increased interpersonal conflicts
  • Decreased interest in usual activities (e.g., work, school, friends, and hobbies)
  • Subjective sense of difficulty in concentrating
  • Lethargy, easy fatigability, or marked lack of energy
  • Marked change in appetite, overeating, or specific food cravings
  • Hypersomnia or insomnia
  • A subjective sense of being overwhelmed or out of control
  • Other physical symptoms include breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.¹

It is also important to note that a PMDD diagnosis requires these symptoms to be directly related to a woman’s menstrual cycle. In other words, if a woman already has a related mental health diagnosis, such as MDD (Major Depressive Disorder) that is exacerbated by her menstrual cycle, a PMDD diagnosis is likely not appropriate. In addition, the PMDD symptoms should be observed for at least two consecutive menstrual cycles in order for a PMDD diagnosis to be made.

So, how do you know if you have PMDD? If you answered yes to at least five of the symptoms described, it may be worth visiting your doctor and discussing what you are experiencing. Your doctor may be better equipped to determine if your symptoms are due to PMDD or another condition. PMDD is treatable, and there are a variety of pharmaceutical and non-pharmaceutical treatments that can help you manage the intensity and duration of your symptoms.

Traditional Treatments for PMDD

There are several traditional treatments available for managing the symptoms of PMDD. These include medications, lifestyle changes, and therapy. Medications are often used to control severe symptoms and reduce the impact of PMDD on daily life. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for PMDD as they can help regulate mood and improve anxiety and depression symptoms. Because SSRIs tend to work more effectively in reducing symptoms of PMDD, some women may not need to take these medications continuously. Instead, taking SSRIs during the 14-day luteal phase may be enough to alleviate PMDD symptoms. Other medications, such as birth control pills and hormonal therapy, may also be prescribed to regulate hormones and alleviate physical symptoms.

Lifestyle changes can also help manage symptoms and improve the overall quality of life, but if you have PMDD, the traditional dietary advice of eating smaller, frequent meals and reducing your intake of alcohol, sugar, and caffeine may often prove to be ineffective. Aerobic physical activity may help with the improvement of mood and energy levels, as well as taking certain supplements such as vitamin B6 and calcium, but there is no substantial scientific evidence documenting the effectiveness of these strategies in reducing PMDD symptoms.

Therapy can also be essential in helping support women with PMDD. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) can help individuals learn strategies to cope with their symptoms, manage stress, and improve relationships. Therapy can provide a supportive environment for individuals to discuss their experiences and emotions and develop coping strategies. While therapy itself has no direct effects on PMDD symptoms, having a safe space to talk about your challenges and learn ways to cope with the many emotional and mental health-related symptoms associated with PMDD can be extremely helpful when combined with other treatments.

An Integrated Approach to Treat PMDD

At APN, we believe in an integrated approach that treats the whole body and helps patients experience relief right away and in the long term. If you have PMDD and find that the treatments you are receiving are not as effective as they should be, it may be worth considering alternative treatments to help you keep your symptoms under control. At APN, you can find a variety of cutting-edge, integrated treatments administered by our team of trained mental health professionals.

Many patients find that, in addition to medication and therapy, these other treatment options can truly make a difference in their quality of life. At APN, patients can access a variety of alternative treatments, such as ketamine-assisted therapy, hyperbaric oxygen therapy, and Deep TMS. These techniques are considered safe, and many have been approved by the FDA for the treatment of depression and a variety of mood disorders in combination with medication and therapy.

Ketamine-Assisted Therapy

APN offers ketamine-assisted therapy. Once used as a psychedelic street drug, the medically approved version of ketamine is now FDA-approved for use in conjunction with therapy when administered under the supervision of a medical professional. At APN, patients experiencing depression symptoms and struggling with suicidal thoughts find both immediate and long-term relief of their symptoms, with many reporting remission for an average of six months.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy is another option offered at APN. This treatment delivers 100% pure oxygen that helps stimulate the patient’s entire body and promote healing, reducing inflammation and providing a significant degree of pain relief. This treatment may be beneficial to help with the physical symptoms of PMDD and promote overall health.

Deep Transcranial Magnetic Stimulation (Deep TMS)

Deep TMS is another non-invasive, FDA-approved treatment that uses magnetic waves to help stimulate key areas of the brain and help patients find relief from depression and other mental health issues, such as anxious depression and OCD. Many patients notice a degree of improvement in about six weeks, with no negative side effects.

While it is true that further research needs to be conducted to determine how to best treat women with PMDD, taking an integrated approach to help promote healing of the entire body and mind can be extremely beneficial for anyone struggling with disorders that are negatively impacting their mental health.

Finding Integrated Treatment for PMDD

PMDD is a real condition, and there is no reason you should struggle with it alone. You are not just being hormonal; you are not losing your mind, and there is no reason to allow this disorder to continue controlling your life every month. If you believe you have PMDD, talk to a doctor and see what treatments may be available to you.

If you want to learn more about how APN’s integrated treatment approach may help you take back control of your symptoms and improve your overall well-being, contact APN for an evaluation by calling 424.644.6486 or filling out our online contact form to learn more.


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th, ed. American Psychiatric Publishing, 2013. DSM-V, appi.books.9780890425596.dsm02 . Accessed 12 February 2024.