PMS, PMDD or Bipolar Disorder?

by Terry Coyier

PMS (premenstrual syndrome), PMDD (premenstrual dysphoric disorder) and mood disorders seem to have innumerable symptoms in common. So is there a clear-cut way to distinguish between them? Well there is and it is about as clear mud. Determining their subtle nuances is like deciphering the DSM-IV and even trained doctors have difficulty in that arena. So how does the sufferer try to get a decent picture of what is what so they know where to go for help or can at least get a handle of their problem? Right here, I hope. After hours of research on several different websites, I have what I think is a fairly clear understanding of the distinctions.

The daunting task in decoding the disparity is knowing that the information given is done voluntarily and relies on the patient to report the symptoms. Overall the descriptions appear to be comparable so that I don’t doubt their validity. The criteria for PMS and PMDD is that any indications must be tracked for at least two cycles and that the severity must occur in the 1 – 2 weeks prior to menses and that a major reduction or elimination occurs at the onset or shortly after the menstrual period begins.

One major difference to note is that PMS is much more common and that PMDD is actually in the DSM-IV as a psychiatric mood disorder so the symptoms are more acute. PMDD will effect approximately 5% of women during their reproductive years.

Most Frequently Reported Symptoms of PMS

*Irritability
*Fatigue
*Anxiety or tension
*Nervous tension
*Mood swings
*Depression
*Feeling overwhelmed or out of control
*Physical symptoms:
+Swelling or bloating of the abdomen orextremities
+Appetite changes
+Food cravings
+Aches
+Brest Tenderness

PMDD Symptoms

Note: patient must report at least 5 of the following symptoms (can be different symptoms during each cycle) before and during the cycle and they must interfere significantly with work, school, social activities or relationships.

*Marked depressed mood or feeling of hopelessness
*Marked anxiety or tension, feeling keyed up or on edge
*Marked shifts in mood (suddenly tearful or overly sensitive)
*Persistent, marked anger or irritability, increased conflicts
*Loss of interest in usual activities
*Difficulty concentrating and focusing attention
*Lack of energy, feeling easily tired out
*Marked change in appetite, overeating or food cravings
*Sleeping to

much or having difficulty sleeping
*Feeling overwhelmed or out of control
*Physical symptoms:
+Breast tenderness or swelling
+Headache
+Joint or muscle pain
+Bloated
+Weight gain

PMS & PMDD Common Medications

SSRI’s (Serotonin Selective Reuptake Inhibitors)
*Sarafem (Prozac)
*Paxil
*Zoloft
*Celexa

Anxiety Medications
*Xanax
*Klonopin
*Ativan
*Buspar

These medications can be taken just during the 2 weeks prior to menses for milder cases or throughout the month for more severe symptoms. In general birth control pills or other types of hormones are not used as initial treatment.

Other considerations in treatment of PMS or PMDD are nutritional and behavioral approaches. Generally it is recommended to avoid or limit consumption of alcohol, caffeine and salt. Some also believe that avoiding sugar and complex carbohydrates is effective. Calcium, although beneficial to women does not seem to have an effect on PMDD. Exercise is strongly recommended for PMS, although again, it has not been proven to help PMDD. Other helpful tools are: relaxation techniques, meditation and yoga. Psychotherapy is suggested for both PMS and PMDD.

PMDD VS. Other Mood Disorders (Specifically Bipolar Disorder)

PMDD is distinctive from other mood disorders because there is a clear interval of 7 – 10 days during each month where the woman feels “well” mentally and physically. This interval doesn’t take place on a traceable, reoccurring basis with other mood disorders like depression, bipolar, borderline personality disorder or schizophrenia. Another important difference is that PMDD does NOT occur during pregnancy or when breastfeeding (at least for the first few months until the menstrual cycle starts again) and after menopause. Other mood disorders continue throughout all of these scenarios.

The causes of PMDD and other mood disorders differ also. It is thought that with PMDD the brain chemistry is vulnerable to the monthly fluctuations of estrogen and progesterone. Presumably they have a negative effect on the way the nerve cells of the brain function. This is unlike other mood disorders which have continual chemical imbalances of neurotransmitters in the brain. Also, a woman’s gynecologist usually treats PMDD and a psychiatrist or sometimes a family doctor treats other mood disorders.

Obviously medications will come into play in treatment of PMS,

PMDD and other mood disorders.

Some Common Medications Used to Treat Bipolar Disorder

Mood Stabilizers and Anticonvulsants
*Lithium, Lithobid or Eskalith
*Depakote
*Tegretol
*Neurontin
*Lamictal
*Topamax

Antipsychotics
*Zyprexa
*Zeldox
*Seroquel

SSRI’s (Serotonin Selective Reuptake Inhibitors)
*Sarafem (Prozac)
*Paxil
*Zoloft
*Celexa

Anxiety Medications
*Xanax
*Klonopin
*Ativan
*Buspar

Tricyclic Antidepressants (TCA’s)
*Tofranil
*Pamelor
*Norpramin
*Elavil
*Sinequan

Monoamine Oxidase Inhibitors (MAOI’s)
*Nardil
*Parnate
*Marplan

Tranquilizers
*Haldol
*Clozaril
*Loxitane
*Permitil
*Geodon

The last factor to consider is brain imaging, specifically SPECT imaging. I couldn’t find any specifics on PMDD but did find images and descriptions for PMS and for Bipolar Disorder. PMS imaging shows increased deep limbic activity often accompanied by temporal lobe hypoperfusion that correlates with cyclic mood changes. On the other hand, Bipolar, along with similar imaging as PMS, is characterized with increased activity across the cerebral cortex. During manic phases scans often look hyperactive, especially in the lateral frontal cortex, lateral parietal lobes and the lateral temporal lobes. Even though I don’t understand what this brain imaging means, I can distinguish the difference between the areas that are effected by PMS and the additional areas that are effected by Bipolar Disorder.

I know that doing the research for this article cleared up a lot of misunderstanding for me. It also helped me to realize why I act like I’m having an episode right before my menstrual cycle and why I feel so much better about 2 or 3 days later.

Terry J. Coyier is a 37-year-old college student studying for an Associates of Applied Sciences degree. She is also a freelance writer who writes about bipolar disorder and other mental illnesses. Terry was diagnosed with bipolar ten years ago. She lives with her son in the Dallas/Ft. Worth Metroplex. Terry is an author on http://www.Writing.Com/ which is a site for Writers and her personal portfolio can be viewed here.

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