Pretreatment pattern of symptom expression in premenstrual dysphoric disorder.
Level 3 - non-randomized controlled study
Prospective observational cohort analysis of pre-treatment baseline daily charting data.
PubMed 15780697 · doi:10.1016/j.jad.2004.10.004
What was done
Researchers analyzed daily symptom logs from 276 women meeting DSM-IV criteria for premenstrual dysphoric disorder (PMDD) who prospectively tracked two menstrual cycles using the Daily Record of Severity of Problems (DRSP) prior to commencing treatment with sertraline.
What was found
The most frequent PMDD symptoms lasting moderate-to-severe for at least 3 days were anger/irritability (76%), anxiety/tension (71%), tired/lethargic (58%), and mood swings (58%). Mean DRSP scores peaked at day -2 relative to menses onset. Within-patient day of PMDD-level symptom onset differed cycle-to-cycle by 4 or more days in 45% of women, and symptom duration varied cycle-to-cycle by 3 or more days in 50% or more of women. One day post-onset of menstruation, 34% to 46% of women continued to report moderate to severe symptoms.
Why it matters
Because intermittent or luteal-phase dosing strategies assume predictable symptom timing, high within-patient cycle-to-cycle variability in onset and offset suggests fixed dosing schedules may require individualized adjustment.
Limits
The sample was limited to women seeking entry into a clinical trial, which may not represent community populations with PMDD. Symptom patterns were observed for only two menstrual cycles, and the abstract does not report cycle length variation or physiological markers.
Cited by
- supports Premenstrual dysphoric disorder (PMDD) symptoms typically onset 10 days before menstruation and resolve 2 to 3 days after menstruation starts.