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Clinical Crossroads
January 27, 1999

A 45-Year-Old Woman With Premenstrual Dysphoric Disorder

Author Affiliations

Author Affiliations: Dr Parry is Professor of Psychiatry and Associate Director, Program in Consultation Liaison Psychiatry and Behavioral Medicine, University of California, and Director, Psychiatric Emergency Room, University of San Diego Medical Center, San Diego, Calif.

JAMA. 1999;281(4):368-373. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jxr80008

DR DALEY: Ms V is a 45-year-old office worker and mother of 2 adolescents with a long history of premenstrual syndrome (PMS). She lives in a suburb of Boston, Mass, and has commercial indemnity insurance.

Ms V experienced menarche at age 16 years and is gravida 2, para 2, abortas 0. Her menstrual periods were irregular for many years. She recalls mood swings, irritability, and feeling overwhelmed and depressed prior to menses since her menarche, although she states that it was only in retrospect that she recognized her symptoms corresponded to the 7 to 10 days prior to her menses. During her 2 pregnancies and the 2 years in which she breast-fed her children after each pregnancy, her cyclical symptoms were much better. During her 20s, diazepam was prescribed to improve her symptoms, but the medication made her feel more depressed. During her 30s, a gynecologist prescribed several oral contraceptive agents, which made Ms V feel suicidal, very vulnerable, and "weepy" all the time. Subsequently, dietary modification, vitamins, and exercise were recommended; Ms V tried each of these without improvement in her cyclic symptoms. Alprazolam was prescribed and "made the crying and depressive feelings much worse." Progesterone was never prescribed. She had a tubal ligation in 1984.