Monday, September 26, 2016

Experts Offer Several Strategies for Treating Premenstrual Exacerbations of Mood Disorders

The fluctuation of psychiatric symptoms across the menstrual cycle is an important, yet often overlooked aspect of treatment, Elizabeth Fitelson, M.D., an assistant professor of psychiatry at Columbia University Medical Center,l and Laura G. Leahy, Dr.N.P., A.P.R.N., a family psychiatric advanced practice nurse in psychopharmacology at APNSolutions LLC, wrote in a recent column appearing in Psychiatric News PsychoPharm. In the article, Fitelson and Leahy described several strategies to help patients experiencing premenstrual exacerbations of mood disorders.

An estimated 3 to 8 percent of women with severe premenstrual symptoms meet the diagnostic criteria for premenstrual dysphoric disorder—a syndrome characterized by the emergence of mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the premenstrual phase, interfere with daily life, and remit after the onset of menses. Other patients with underlying mood disorders will experience a worsening of symptoms over the course of the menstrual cycle, known as premenstrual exacerbation (PME).

By asking patients about their menstrual cycle and mood changes around those times, the authors noted that clinicians will likely be better able to differentiate PME symptoms—including irritability, anger, anxiety, tearfulness, depressed mood, social withdrawal, impaired cognition, fatigue and lack of energy, food cravings, and disrupted sleep—from those of other psychiatric illnesses.

“Although little is known about potential remedies to treat PME of mood disorders, practitioners can optimize symptom relief and improve the quality of life for women with PME and psychiatric comorbidities by drawing on current dosing strategies for SSRIs,” Leahy wrote. “One recommended approach for the treatment of this patient population is semi-intermittent dosing, which involves treating continuously with an SSRI whose dose is increased during the luteal phase and then reduced to the prior level upon the onset of menses.” Leahy goes on to describe the dosing strategy for treating patients suspected of having PME at the clinic where she works.

Fitelson added, “[M]any of the strategies that are helpful for PMDD patients are also helpful for women with premenstrual exacerbations. Some of these strategies include dietary changes, supplementation with calcium and magnesium, exercise, herbal formulations, cognitive-behavioral strategies, and intermittent light therapy. In addition, women on hormonal contraception or who have an indication for it may consider switching formulations or working with their gynecologists to discuss whether they may benefit from continuous dosing of the oral contraceptive, decreasing the number of menstrual cycles (and possibly the related mood disruptions) in the year.”

For related information, see the American Journal of Psychiatry article “Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS).”

(Image: iStock/Patrick Heagney)


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