PMDD — Premenstrual Dysphoric Disorder

PMDD is a recognized psychiatric diagnosis involving severe mood symptoms in the luteal phase of the menstrual cycle (the week before and first few days of your cycle). It is not ordinary PMS, and it is not something to just white-knuckle through.

How is PMDD different from PMS?

By severity and by impact. PMS is common and generally manageable. PMDD produces symptoms severe enough to disrupt relationships, work and daily function, and the predominant symptoms are psychiatric rather than physical.

Typical PMDD symptoms include marked irritability or anger, hopelessness, anxiety or tension, mood swings with rejection sensitivity, and a sense of being overwhelmed — appearing in the week or two before menstruation and resolving within days of it starting.

How is PMDD diagnosed?

Through prospective symptom tracking across at least two cycles. This matters: retrospective recall is unreliable, and the defining feature of PMDD is the timing rather than the symptoms themselves. If you are considering an evaluation, start tracking now. Daily ratings of mood, irritability and anxiety alongside cycle day gives us something far more useful than memory.

Is PMDD just depression that gets worse before my period?

No, and the distinction changes treatment. In PMDD, symptoms substantially or completely resolve in the follicular phase — there is a genuinely symptom-free interval each month. Premenstrual exacerbation of an underlying mood disorder is different: symptoms are present throughout the cycle and worsen premenstrually. Both are real and treatable, and they are treated differently, which is why tracking matters.

What treatments work?

PMDD responds well to treatment. Options include SSRIs and other serotonergic medications — which for PMDD can sometimes be taken only in the luteal phase rather than continuously, unusually among psychiatric medications — hormonal approaches, and attention to sleep, exercise and nutritional factors. See nutritional psychiatry.

Which approach fits depends on your symptom pattern, whether you want contraception, and what you have already tried.

Does PMDD change with age?

It frequently worsens in the late thirties and forties as cycles become more erratic, and can be difficult to distinguish from early perimenopause — which may be happening at the same time. See perimenopause depression and anxiety.

PMDD resolves after menopause, since it depends on cyclical hormonal change.

If you are in crisis, please immediately call or text 988 for the Suicide & Crisis Lifeline, or call 911. Safety is our top priority, and our outpatient office is not equipped to handle emergencies.

Treatment in person and throughout Arizona

We see patients in person at our office in Glendale (in the Arrowhead area) and via telehealth anywhere in Arizona — from Tucson, to Flagstaff, to the east valley, and everywhere between. Virtual visits are the same appointment with the same provider at the same rate.

Getting Started

Our comprehensive, new patient evaluations are $375 and require 60 to 90 minutes.

Our psychiatric follow-up visits are $125 and require 30 minutes.

(Thank you for arriving early, as we are unable to see late patients and must reschedule if life gets in the way of you arriving on time.)

We are out-of-network with all insurance carriers but will gladly provide a superbill you can submit to insurance to seek reimbursement.

For more info, please see our fees page.

Pinnacle Psychiatry

17505 N 79th Ave, Suite 309, Glendale, AZ 85308
Phone 623.321.2221 · Text 877.749.7502
Monday–Wednesday 8:00am–5:00pm · Thursday 7:00am–5:00pm