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Clinical Crossroads Update
August 25, 1999

A 45-Year-Old Woman With Premenstrual Dysphoric Disorder, 1 Year Later

Author Affiliations

From the Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 1999;282(8):770. doi:10.1001/jama.282.8.770

At Obstetrics and Gynecology Grand Rounds in May 1998, Barbara L. Parry, MD, discussed the diagnostic criteria for premenstrual dysphoric disorder (PMDD), along with its relationship to other psychiatric disorders.1 Ms V, the patient, had disabling symptoms of mood swings, irritability, and depression prior to her menses since menarche. Over the years, physicians prescribed several medications and recommended dietary modifications, vitamins, and exercise, none of which provided consistent relief. For 9 months in 1996, Ms V took fluoxetine, which improved her symptoms of PMDD, but caused troubling adverse effects so that she stopped taking the medication. Dr Parry explained the importance of a careful medical history and stressed that any underlying conditions be addressed before treating PMDD. For patients who meet the criteria for PMDD after 2 consecutive cycles, Dr Parry recommended counseling and other treatment strategies, such as stress reduction, vitamin supplements, or medications including selective serotonin reuptake inhibitors, hormones, and anxiolytics. For Ms V, Dr Parry suggested trying a selective serotonin reuptake inhibitor other than fluoxetine, such as sertraline or paroxetine, to diminish the symptoms of PMDD and possibly avoid the adverse effects Ms V experienced with fluoxetine.

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