Can you take antidepressants for PMDD (premenstrual dysphoric disorder)?

Premenstrual dysphoric disorder (PMDD) causes intense physical and emotional distress in the weeks leading up to one’s menstrual cycle. If you think you may have PMDD, don’t worry. You’re not alone. Around 5% of menstruating women experience this disorder. It’s important to view PMDD as a treatable medical condition that can impact daily life rather than dismissing it for moodiness around the time of your period.  

Studies show that some antidepressants improve PMDD symptoms, which we’ll discuss in this article, along with how PMDD differs from depression. Most importantly, we’ll discuss the first step in finding treatment. Because getting treatment means relieving symptoms and disrupting the regular cycle of distress you feel each month.

What is PMDD?

PMDD, or premenstrual dysphoric disorder, is a disorder that causes physical and emotional distress leading up to a menstrual period during the luteal phase. It is a constellation of symptoms interfering with a persona’s daily functioning. Although it bears similarities to premenstrual syndrome (PMS), PMDD is much more severe. It’s important to remember that PMDD is a diagnosable medical condition, and symptoms of PMDD are not simply “mood swings.” Nor are they considered normal premenstrual symptoms.  

Currently, the cause of PMDD is unknown. However, it’s likely due to fluctuations, namely the sharp decline, in progesterone and estrogen after ovulation—as well as the changes in serotonin throughout your menstrual cycle. Regardless of the cause, PMDD is a serious condition that can negatively impact your quality of life if you have it.

PMDD symptoms

People with PMDD experience symptoms 1 to 2 weeks before their period starts. Symptoms typically subside within a few days after the affected person’s period begins.

If you have PMDD, here are some of the symptoms you may experience.  

Core mood symptoms:

• Irritability
• Intense moodiness and mood changes
• Depressed mood
• Increased anxiety and panic attacks
• Thoughts of harming yourself or suicide
• Anger
• Trouble concentrating

Physical symptoms:

• Changes to or difficult sleeping
• Bloating and cramps
• Confusion and/or forgetfulness
• Changes to eating habits and experiencing food cravings
• Dizziness and/or fainting
• Extreme fatigue
• Gastrointestinal issues, including nausea, vomiting, and constipation
• Headaches

If you experience any of these symptoms in the weeks leading up to your period, it’s possible you have PMDD. Work with your doctor to track your monthly symptoms. This will help your doctor provide a medical diagnosis and come up with a treatment plan that’s right for you.

Related article: What's the difference between PMDD and bipolar disorder?

Is PMDD a mental health condition?

PMDD is a mental health condition, even though those with PMDD experience both psychological and physical distress. In 2013, PMDD was added to the DSM-5—the diagnostic manual that defines mental health conditions. That means doctors and psychiatrists can officially diagnose and treat PMDD as a mental health condition. Ultimately, this is a positive step forward for those with PMDD, as the condition has become easier to diagnose and prescribe medication for.  

PMDD vs. depression

The short answer is no; PMDD isn’t the same as major depressive disorder (MDD). Some differences include that  those with major depression experience longer depressive episodes. They also usually need treatment before feeling like themselves again.  

Although those with PMDD may feel depressed leading up to their period, their symptoms are relatively short-lived and resolve within a few days of their period starting. (Though that isn’t necessarily a reason not to get treatment). PMDD symptoms will also return around the same time of each monthly cycle.  

Similarly, those with PMDD may experience anxiety symptoms or even panic attacks in the weeks before their period. However, anxiety symptoms also resolve themselves within a few days of their period.

Learn more about what depression feels like.

PMDD vs. PMS

Symptoms of premenstrual syndrome (PMS) are actually very similar to PMDD symptoms. The main difference is the severity of the symptoms of these hormonal changes. People who experience PMS may feel irritable and have breast tenderness and bloating in the days leading up to their period. However, those with PMDD experience those symptoms and more, but they feel them much more intensely. They’re also more likely to have intense psychological distress before their period.

What medications help treat PMDD?

Throughout this article we've discussed that PMDD shares some symptoms with depression and anxiety disorders. So, it makes sense that antidepressants also treat PMDD. Several studies have shown that antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), dramatically improve PMDD symptoms.  

What are SSRIs, exactly? Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by blocking your brain’s neurons from reabsorbing serotonin, a chemical neurotransmitter that affects mood and sleep. Doing so makes more serotonin available in your brain to improve mood and emotional regulation. SSRIs are a first-line treatment for depression and have the potential for fewer side effects than other types of antidepressants.  Studies have also found that SSRIs, such as Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline), are effective in treating PMDD symptoms. People who took these antidepressant medications showed an improvement to their mood during the luteal phase compared to those who took a placebo.

Oral contraceptives like birth control pills may also help relieve symptoms of PMDD. If you’re interested in learning more about whether contraceptives are the right choice for you, work with your gynecologist or primary care doctor.  

Other treatments for PMDD

There are other treatment options for premenstrual dysphoric disorder, including therapy. Cognitive behavioral therapy is a wonderful way to learn about your emotions, understand the root causes of your distress, and learn healthy coping mechanisms. You can also work with a therapist on implementing behavioral modification and lifestyle changes to improve structure and routine in the context of your daily routine, exercise, hydration, making healthy food choices, and limiting substance use.  

Consider working with a mental health professional, even if you’re taking PMDD medication. Therapy is a great supplement to medication and it teaches you how to process your emotions in a healthy way. Plus, the skills you learn in therapy will help you live a more fulfilling, peaceful life—even long after you stop seeing a therapist.

Do I have PMDD?

If you experience intense physical and emotional distress in the weeks leading up to your period, with relief shortly after your period starts, you may have PMDD. The first step in the treatment of PMDD? Getting a diagnosis. A psychiatrist has the mental health care expertise required to determine whether you have PMDD or even a similar condition. Although a diagnosis may sound intimidating, many people find it validating because it gives you an explanation for your symptoms. Plus, once you have a diagnosis, you can work with your healthcare provider on a treatment plan that will help relieve your symptoms.  

At Talkiatry, we can help you get the diagnosis you need and come up with a personalized treatment plan. We’re a national psychiatry practice that provides in-network, virtual care—and you can schedule a first visit within days. Get started with a short online assessment.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.