Breaking Down the Latest Treatments for Premenstrual Dysphoric Disorder

What is premenstrual dysphoric disorder?

Premenstrual Dysphoric Disorder (PMDD) is a severe and debilitating form of premenstrual syndrome (PMS) that affects approximately 3-8% of individuals born female and of reproductive age. While PMS is characterized by mild to moderate emotional and physical symptoms, PMDD has a significant impact on mental health, relationships, and daily functioning. The disorder usually appears during the luteal phase of the menstrual cycle, which occurs after ovulation but before menstruation, and goes away a few days after the period begins.

PMDD is distinguished by the severity of mood-related symptoms. Individuals frequently experience severe mood swings, irritability, depression, anxiety, and feelings of hopelessness. These emotional changes can result in strained relationships, difficulty concentrating at work or school, and a lower overall quality of life. Physical symptoms such as bloating, headaches, breast tenderness, and fatigue may accompany emotional distress.

Unlike PMS, which can be treated with lifestyle changes and over-the-counter medications, PMDD necessitates more targeted medical and psychological interventions due to its severity. Fortunately, advances in medical research have resulted in more effective treatment options that address both the physical and psychological aspects of the disorder. Recognizing PMDD early on and seeking treatment can significantly improve the emotional and physical well-being of those affected.

Traditional Treatment Options for Premenstrual Dysphoric Disorder

Traditional treatments for Premenstrual Dysphoric Disorder (PMDD) aim to alleviate both psychological and physical symptoms that interfere with daily life. These treatments typically include a combination of medications, lifestyle changes, and psychological therapies aimed at restoring balance during the luteal phase of the menstrual cycle. Here are some well-established methods for managing PMDD.

1. Selective Serotonin Reuptake Inhibitors (SSRIs): Managing Mood

The most commonly prescribed medications for PMDD are selective serotonin reuptake inhibitors (SSRIs). Antidepressants like fluoxetine, sertraline, and paroxetine are especially effective at treating PMDD’s emotional symptoms, such as mood swings, depression, and anxiety.

SSRIs work by increasing the amount of serotonin in the brain, a neurotransmitter that controls mood and emotional stability. Research has shown that people with PMDD are more sensitive to hormonal changes, particularly those affecting serotonin pathways. SSRIs, which stabilize serotonin levels, can reduce the severity of mood-related symptoms.

One of the benefits of using SSRIs for PMDD is their versatility. Unlike long-term depression treatment, people with PMDD can take SSRIs throughout the month or just during the luteal phase, beginning about two weeks before menstruation. This cyclical approach allows for targeted treatment of PMDD symptoms while eliminating the need for daily medication.

2. Hormonal Therapies: Treating the Cause of Hormonal Imbalances

Because PMDD is closely associated with hormonal fluctuations during the menstrual cycle, hormonal therapies are frequently used to treat symptoms. These treatments aim to regulate or suppress ovulation, thereby reducing the hormonal changes that cause PMDD.

• Combined Oral Contraceptives (COCs): Birth control pills containing both estrogen and progestin can help regulate the hormonal fluctuations that cause PMDD symptoms. Drospirenone-containing oral contraceptives have been shown to alleviate both physical and emotional symptoms of PMDD. Continuous use of these pills (without the typical placebo week) may help keep hormones stable throughout the month.
• Gonadotropin-Releasing Hormone (GnRH) Agonists: For people with severe PMDD who do not respond to other treatments, GnRH agonists such as leuprolide may be recommended. These medications suppress ovarian function, effectively causing a temporary state of menopause by interrupting the menstrual cycle. While effective, GnRH agonists are typically used for short-term treatment due to potential side effects such as bone density loss, which can be mitigated with add-back therapy (the administration of small amounts of hormones).
• Progestin-Only Pills: For those who are unable to use estrogen-based contraception, progestin-only pills or hormonal intrauterine devices (IUDs) may provide relief by regulating the hormonal changes that cause PMDD.

3. Cognitive Behavioral Therapy (CBT): Rewire Negative Thought Patterns

Cognitive Behavioral Therapy (CBT) is a well-established psychological treatment for PMDD that assists patients in managing the disorder’s emotional aspects. CBT focuses on identifying and changing negative thought patterns that cause feelings of hopelessness, anxiety, or irritability during the premenstrual period.

Therapists work with clients to develop coping mechanisms that can be used when symptoms worsen. These coping strategies may include relaxation techniques, problem-solving methods, and mindfulness exercises. CBT is especially effective when combined with medical treatments such as SSRIs or hormonal therapy because it treats both the physical and emotional aspects of PMDD.

According to research, people who receive CBT for PMDD report less emotional distress and a higher quality of life. The ability to regulate emotional responses and stress can significantly reduce the psychological burden of PMDD, making it easier to live with the disorder in everyday life.

4. Lifestyle Modifications for Mental and Physical Well-Being

Although medication and therapy are essential components of PMDD treatment, lifestyle changes can also help with symptom management. Making specific changes to one’s diet, exercise, and sleep habits can improve overall well-being and help alleviate PMDD symptoms.

• Exercise: Studies have shown that regular physical activity reduces stress, improves mood, and boosts overall health. Aerobic exercises such as walking, running, or swimming can increase endorphin levels, assisting people in managing the irritability, anxiety, and fatigue associated with PMDD.
• Dietary Adjustments: Limiting caffeine, alcohol, and processed sugars can help regulate mood and energy levels. Consuming foods high in omega-3 fatty acids (such as fish), magnesium, and complex carbohydrates (such as whole grains) may alleviate symptoms of mood swings and fatigue.
• Sleep Hygiene: Inadequate sleep can exacerbate the emotional symptoms of PMDD. Creating a consistent sleep schedule, practicing relaxation techniques before going to bed, and getting enough rest can all help with symptom management.
• Stress Management: Practicing stress-reduction techniques like yoga, meditation, or deep breathing exercises can boost emotional resilience and reduce the severity of PMDD symptoms.

5. Supplements and Vitamins: Natural Help for PMDD

Nutritional supplements and vitamins have also been investigated as complementary approaches to PMDD management. Several studies suggest that specific supplements may help alleviate symptoms:

• Calcium: Studies have shown that daily calcium supplementation (around 1,200 mg) may alleviate emotional and physical symptoms of PMDD, such as mood swings, fatigue, and bloating.
• Magnesium: Magnesium is thought to help with mood regulation and reduce water retention. Magnesium supplementation may improve PMS and PMDD symptoms, especially in people who are deficient in this mineral.
• Vitamin B6: This vitamin has been investigated for its involvement in neurotransmitter production and mood regulation. Some evidence suggests that Vitamin B6 supplementation (100 mg per day) may alleviate PMDD-related depressive symptoms and irritability.

6. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Handling Physical Pain

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are frequently used to treat PMDD’s physical symptoms, which include cramps, headaches, and breast tenderness. While NSAIDs do not treat the emotional symptoms of PMDD, they can alleviate the physical discomfort associated with the condition.

These medications work by reducing inflammation and inhibiting the production of prostaglandins, which cause pain and inflammation during the menstrual cycle. NSAIDs can be taken as needed during the luteal phase to relieve physical discomfort.

Currently Available Treatment Options for Premenstrual Dysphoric Disorder

Advances in medical research have resulted in the development of novel and effective treatments for Premenstrual Dysphoric Disorder (PMDD), providing new hope for those who have not found relief through traditional methods. These emerging therapies aim to address the underlying causes of PMDD more directly and provide faster, more long-lasting symptom relief.

1. Saffron Extract is a natural antidepressant for PMDD

One of the most recent natural treatments for PMDD is saffron extract, which is derived from the Crocus sativus flower. Saffron has long been used in traditional medicine for its antidepressant and mood-enhancing properties, and recent research has demonstrated its efficacy in treating mood disorders such as PMDD.

According to research, saffron works by influencing serotonin levels in the brain, similar to SSRIs but with fewer side effects. A study published in the journal Human Psychopharmacology discovered that taking 30 mg of saffron extract daily significantly reduced the emotional and physical symptoms of PMDD, such as irritability, mood swings, and fatigue.

Saffron provides a natural alternative for people who want to avoid taking prescription medications to treat their PMDD. However, before incorporating saffron or any other supplement into a treatment plan, consult with a healthcare professional.

2. Neurostimulation Devices: Noninvasive Brain Stimulation for Mood Regulation

Neurostimulation devices are an emerging field in the treatment of mood disorders, including PMDD. These devices, such as Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), use non-invasive electrical or magnetic pulses to stimulate specific areas of the brain that regulate mood.

• Transcranial Magnetic Stimulation (TMS): TMS stimulates nerve cells in the brain, specifically the prefrontal cortex, which is involved in emotional regulation and decision-making. TMS has already been FDA-approved for treatment-resistant depression, and it is now being investigated for PMDD. According to research, TMS can reduce depressive symptoms and mood instability by improving brain function in areas that become dysregulated as a result of hormonal fluctuations during the menstrual period. TMS sessions are non-invasive, last several weeks, and have minimal side effects.
• Transcranial Direct Current Stimulation (tDCS): tDCS modulates brain activity by delivering low electrical current. It has shown promise as a treatment for mood disorders and is being studied for its use in PMDD. tDCS can be administered in clinical settings or with at-home devices under supervision, providing a versatile treatment option. This therapy is especially appealing because it avoids the systemic side effects that come with pharmacological treatments.

TMS and tDCS are both novel approaches that address the neurological roots of PMDD, providing an alternative for people who do not respond well to medication or prefer non-drug interventions.

3. Light Therapy to Regulate Circadian Rhythms and Mood

Light therapy has long been used to treat mood disorders such as Seasonal Affective Disorder (SAD), and it is currently being investigated for PMDD. Light therapy mimics natural sunlight, which regulates the body’s circadian rhythms and stabilizes mood-related neurotransmitters such as serotonin and melatonin.

PMDD is sometimes associated with disturbed circadian rhythms caused by hormonal shifts during the menstrual cycle. Regular exposure to bright light, particularly in the morning, may help to stabilize mood swings, irritability, and fatigue. Light therapy can be especially helpful for people who have PMDD symptoms that worsen during the darker winter months.

Studies have shown that using light therapy on a daily basis, particularly bright light boxes, can help improve both emotional and physical symptoms of PMDD. As a non-invasive treatment, light therapy is a safe and accessible option for managing this disorder, particularly when combined with other treatments such as SSRIs or hormonal therapies.

4. Brexanolone (Zulresso): A Promising Treatment for Hormonal Mood Disorders

Brexanolone, marketed under the brand name Zulresso, is an FDA-approved intravenous medication for the treatment of postpartum depression, with potential for treating PMDD. Brexanolone is a synthetic version of allopregnanolone, a natural neurosteroid that affects GABA receptors in the brain.

Given that allopregnanolone levels fluctuate during the menstrual cycle and play a role in mood regulation, brexanolone’s effects on GABA receptors may help to stabilize the mood swings and depressive symptoms of PMDD. While currently approved for postpartum depression, ongoing research is looking into its use for PMDD, which could provide a targeted treatment that addresses the neurochemical changes caused by hormonal shifts.

5. Sage 217 (Zuranolone): A Novel Oral Therapy for PMDD

Another promising development is Sage-217 (zuranolone), an oral medication that, like brexanolone, targets GABA receptors but comes in a more convenient pill form. Sage-217 is a neuroactive steroid that works by increasing GABAergic signaling, which helps to stabilize mood and anxiety.

Sage-217, which is currently being tested in clinical trials for PMDD, has demonstrated rapid efficacy in reducing PMDD’s emotional and physical symptoms in early-phase studies. This treatment is appealing because it is quick to work—symptoms can improve in days rather than weeks, as is typical with SSRIs. If Sage-217 is approved for PMDD, it could provide a game-changing option for people looking for faster and more consistent relief.

6. Digital Health Platforms: Personal and Accessible Mental Health Support

The rise of digital health platforms provides new opportunities for people with PMDD to receive care from the comfort of their own homes. Many apps now offer personalized mental health support, such as cognitive-behavioral therapy (CBT), mindfulness practices, and mood tracking, that are specifically designed for PMDD.

Some of these platforms use artificial intelligence (AI) to create personalized treatment plans based on the user’s symptom patterns, allowing them to identify triggers and manage symptoms more effectively. These digital tools can be used alongside traditional medical treatments to provide ongoing support and coping strategies for managing PMDD.

Digital platforms make mental health care more accessible by providing on-demand resources, especially for people who may be unable to attend in-person therapy due to geographical or logistical constraints. The combination of digital therapy and medical treatments could improve the quality of care for people suffering from PMDD.

Holistic and Alternative Therapies for Premenstrual Dysphoric Disorder

Many people find that holistic and alternative treatments help them manage their PMDD symptoms effectively. These methods frequently emphasize the mind-body connection, stress reduction, and overall wellness, serving to supplement traditional medical approaches.

1. Acupuncture: Balance Hormonal Energy

Acupuncture, a traditional Chinese medicine practice, is used to treat a wide range of hormonal and mood disorders, including PMDD. Acupuncture is the practice of inserting thin needles into specific points on the body to balance the flow of energy (Qi) and regulate physiological functions. Acupuncture is thought to help alleviate mood swings, anxiety, and physical discomfort in PMDD patients by regulating hormonal balance and improving circulation.

According to some studies, regular acupuncture sessions can help to reduce the severity of PMDD’s emotional and physical symptoms, especially when combined with other holistic treatments such as herbal medicine or diet changes. While more research is needed, acupuncture is regarded as a low-risk treatment option for people seeking natural ways to manage PMDD.

2. Herbal Remedies: Boosting Hormonal Health Naturally

Herbal supplements have long been used in alternative medicine to treat hormonal imbalances, and some herbs may help with PMDD symptoms. Popular PMDD herbs include:

• Chasteberry (Vitex agnus-castus): Known for its ability to balance estrogen and progesterone levels, chasteberry is widely used to treat menstrual disorders, including PMDD. Some studies indicate that it may alleviate irritability, breast tenderness, and other PMS-like symptoms.
• **St. *St. John’s Wort* is commonly used as a natural antidepressant. John’s Wort** has been studied for its ability to improve mood and reduce depressive symptoms in people with PMDD. It is thought to work by raising serotonin levels in the brain, similar to SSRIs.
• Evening Primrose Oil: Evening primrose oil, which is high in gamma-linolenic acid (GLA), is commonly used to treat breast tenderness and other physical symptoms of PMDD. While the evidence is mixed, many people report that regular use relieves pain and discomfort.

Before beginning any herbal regimen, consult with your healthcare provider, as some herbs may interact with medications or have contraindications.

3. Mindfulness-Based Stress Reduction (MBSR): Promoting Present-Moment Awareness

Mindfulness-Based Stress Reduction (MBSR) is a therapeutic approach that uses meditation and relaxation techniques to help people become more aware of the present moment. MBSR has been shown to reduce stress, anxiety, and depressive symptoms in people with mood disorders, such as PMDD.

MBSR reduces the intensity of PMDD-related mood swings and emotional distress by teaching people to observe their thoughts and emotions without judgment. Regular mindfulness practice can also improve emotional regulation and overall well-being, making it an effective tool for treating both the psychological and physical symptoms of PMDD.

4. Dietary Changes: Nourish the Body to Alleviate Symptoms

Making strategic dietary changes can help to manage PMDD symptoms. According to research, certain nutrients play an important role in hormonal balance and mood regulation.

• Omega-3 Fatty Acids: Omega-3s, which can be found in fatty fish such as salmon, are known to have anti-inflammatory and mood-stabilizing properties. Taking omega-3 supplements or eating more omega-3-rich foods may help reduce PMDD’s emotional symptoms, such as depression and irritability.
• Magnesium: Magnesium is essential for hundreds of bodily processes, including hormone production and regulation. Magnesium-rich foods include leafy greens, nuts, and seeds, which can help relieve physical symptoms such as bloating, fatigue, and headaches.
• Complex Carbohydrates: Consuming complex carbohydrates such as whole grains, fruits, and vegetables can help regulate blood sugar levels and increase serotonin production, potentially reducing mood swings and irritability during the luteal phase.