Premenstrual Dysphoric Disorder (PMDD): The Daily PANCE Blueprint

Home Premenstrual Dysphoric Disorder (PMDD): The Daily PANCE Blueprint

Premenstrual Dysphoric Disorder (PMDD): The Daily PANCE Blueprint

A 28-year-old woman presents to her primary care physician reporting severe emotional symptoms that occur predictably 7-10 days before her menstrual period. She describes becoming extremely anxious, having frequent crying spells, and experiencing intense irritability that affects her relationships at home and work. These symptoms are accompanied by breast tenderness, fatigue, and food cravings. All symptoms resolve completely within a few days of starting her period. She keeps a symptom diary showing this pattern has persisted for the past 8 months. She has no significant medical history and takes no medications. Physical examination is unremarkable. Which of the following is the most appropriate initial treatment for this patient?

A. Sertraline
B. Combined oral contraceptives
C. Evening primrose oil
D. Natural progesterone cream
E. Bilateral salpingo-oophorectomy

Answer and topic summary

The answer is A. Sertraline

This patient’s presentation of severe mood symptoms occurring during the luteal phase with complete resolution after menses is characteristic of premenstrual dysphoric disorder (PMDD). The presence of multiple psychological symptoms (anxiety, irritability, emotional lability) along with physical symptoms (breast tenderness, fatigue) that cause significant functional impairment confirms the diagnosis. PMDD is thought to be caused by abnormal sensitivity to normal hormonal changes, affecting serotonin signaling. The diagnosis requires documentation of symptoms for at least two menstrual cycles and the presence of at least five symptoms including one mood-related symptom. Treatment with selective serotonin reuptake inhibitors (SSRIs) like sertraline is considered first-line therapy and can be given either continuously or during the luteal phase only. Other management options include lifestyle modifications, cognitive behavioral therapy, and in some cases, hormonal treatments.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Depressive disorders ⇒ Premenstrual dysphoric disorder

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