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What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder


Premenstrual Dysphoric Disorder

Are you one of those women who’d take a sick leave from work because you feel awful before your expected monthly period?

You’re not alone. An estimated 70% to 90% of US women of reproductive age complain of premenstrual syndrome or PMS. Among these women suffering from PMS, 3% to 8% suffer from a more severe condition called Premenstrual Dysphoric Disorder or PMDD.

Ketamine IV infusion may be a promising therapy for you. For more information on ketamine IV infusion, you may check our website - The Injection and Infusion Clinic of ABQ.

Why ketamine? It targets to ease your depressive feelings whenever you experience PMDD. Your lousy mood is one of the major symptoms of PMDD.

Symptoms of PMDD:

  1. Physical: It’s a general feeling of being sick. Your head, muscles, or joints ache. Your breasts are tender and you feel bloated.

  2. Psychological: You may feel depressed, sad, or worthless. You may have bouts of mood swings, irritability, or increased anxiety.

  3. Behavioral: You may lack the energy and interest to do your usual activities. You skip a meal or binge eat as your appetite changes. You may experience either oversleeping or insomnia. There’s just no way for you to control the situation and you feel overwhelmed.

Prevalence of psychological symptoms in PMDD:

In 1997, a study was conducted to determine the link between PMDD and psychological or mood disorders. The researcher noted that women with PMDD have similar symptoms to other women suffering from psychological or mood disorders. But this doesn’t mean they can share the same kind of treatment. 

The researcher further stressed that PMDD should be differentiated from mood disorders in terms of treatment options. This should be based on biological and cognitive condition and response to treatment.

In 2013, PMDD was listed in the Diagnostic and Statistics Manual of Mental Disorders, 5th Edition (DSM-5). It’s a separate item under Depressive Disorders with a different criterion for diagnosis, depending on the severity of symptoms.

But a study reveals the existence of comorbidity with mood disorders among teenagers and young adults. Among these co-morbidities, anxiety disorder topped the rank at 47.4%. This was followed by other mood disorders 22.9%. The remaining 28.4% was somatoform or mental disorder with physical manifestations and 26.5% had no other mental disorder.

In a later study, the most frequent PMDD symptom was irritability or anger among 276 women under DSM-IV criteria for PMDD. This was followed by anxiety, lethargy, and mood swings. 

Premenstrual Dysphoric Disorder

Depressive symptoms in Premenstrual Dysphoric Disorder

Depression, anxiety, and irritability are the most studied PMDD symptoms. Because these mood disorders have been consistently observed among women with PMDD.

  • Researchers interviewed nine women in a two-year pilot study. They found out that PMDD posed a risk for major depressive symptoms. They noted that PMDD may likely be an onset leading to major depressive disorder. 
  • A study aimed to assess and determine the role of these mood symptoms in the diagnosis of PMDD. Sixty-seven women with PMDD and 75 other women answered comprehensive questionnaires. The results show that women with PMDD exhibited heightened mood symptoms. Depression ranked as the most prominent among the three mood disorders.

  • Symptoms of PMD and PMDD overlap and researchers correlated these with depression. They studied 116 women aged 18 to 40 years old. They found out that 46.6% of the women with depressive symptoms had major depression. The study further reveals that the diagnosis of major depression was significantly linked with the PMS and PMDD. Moreover, depression was increased alongside the gravity of PMS and the existence of PMDD.

Thus, researchers in another study highlighted the need for clinicians to carefully assess PMDD with major depressive disorder. They noted that future studies may be conducted to identify more appropriate treatments for PMDD women with major depression.

What causes psychological symptoms in Premenstrual Dysphoric Disorder?

Psychological symptoms of PMDD are attributed to the role of neurotransmitters in the brain. These neurotransmitters are serotonin, gamma-aminobutyric acid or GABA, glutamate, and beta-endorphins

Serotonin is involved with mood regulation. During the premenstrual or luteal phase, there is a decrease in serotonin levels which results in a bad mood. GABA levels decrease as well, but glutamate levels increase which are connected to PMDD. Serotonin though as a modulator leads to an increase in GABA and a decrease in glutamate

It has been extensively studied though that selective serotonin reuptake inhibitors and glutamate-targeting antidepressants are effective in the treatment of PMDD. Ketamine’s mechanism of action involves serotonin, GABA, and glutamate.


Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are known to increase serotonin levels in the brain, which is thought of as a mood booster. Participants received a continuous dose of SSRI during the luteal phase.

The review  established SSRIs as an effective first-line treatment of PMDD. Sertraline, an SSRI antidepressant revealed to be effective as a treatment for PMDD.

SSRI was significantly more effective than placebo. Another SSRI antidepressant, fluoxetine effectively treated mood and physical and social symptoms associated with PMDD.

SSRI’s response rate to treat PMDD is high as it targets irritability, mood swings, and emotional lability.

Role of ketamine in serotonin 1B receptors 

Ketamine may be a potential therapy for PMDD as it interacts with serotonin in the brain like SSRIs. Low levels of serotonin in the brain manifests in severe depression.

In an experiment, researchers saw an increase in serotonin turnover in the rat brain after ketamine administration. Using Positron Emission Testing (PET) molecular imaging, a study reveals that ketamine boosted serotonin activity in the brain of monkeys.

In the latest 2020 study, the number of serotonin 1B receptors increased with the administration of ketamine. Researchers also found out that ketamine worked among SSRI-resistant people with major depressive disorder. 

Gamma-aminobutyric acid or GABA

GABA has a possible role in PMDD. Some progesterone metabolites interact with GABA A receptors, which was tested among mice. Evidence suggests the importance of the GABA A receptor in the cause and potential treatment of mood disorders, such as PMDD. 

Preliminary findings in another study also suggest the abnormal levels of GABA+ and glutamate/mine associated with women with PMDD.

Serotonin reuptake inhibitors affect enzymes that create progesterone metabolites. This modulates GABA A receptors. SSRIs increased GABA concentrations in the brain of people with depression as a primary action

Role of ketamine in gamma-aminobutyric acid: People with depressive disorder may have altered levels of GABA A and glutamate in their brains. Ketamine reversed these neurochemical or physiological instabilities. Ketamine increased the activity of GABA A receptors in the brain, which leads to ketamine’s anti-depressive effect.


Role of ketamine in gamma-aminobutyric acid

People with depressive disorder may have altered levels of GABA A and glutamate in their brains. Ketamine reversed these neurochemical or physiological instabilities. Ketamine increased the activity of GABA A receptors in the brain, which leads to ketamine’s anti-depressive effect.


Changes in glutamate levels result from hormonal fluctuations during the menstrual period. Lower levels of glutamate lead to depressive symptoms experienced by women with PMDD. 

Role of ketamine in glutamate: Depressive symptoms during PMDD are associated with low levels of glutamate in the brain.

Ketamine has been shown to increase glutamate. Thus, infusing ketamine in the onset of PMDD symptoms may ease your mood and depressive symptoms.

  • Researchers proposed ketamine as a fast-acting antidepressant due to its effect on the glutamate N-methyl-D-aspartate receptor. 

  • Ketamine activates glutamate in the prefrontal of the brain as a key mechanism. This contributes to its temporary psychomimetic and sustained long-lasting antidepressant effects.

  • Estrogen and ketamine showed additive effects on AMPA receptors, which may have a role in ketamine’s therapeutic response in major depressive disorders. A subtype of ionotropic glutamate, the AMPA receptor imitates the effects of glutamate.

Interventions for Premenstrual Dysphoric Disorder

PMDD negatively impacts your life due to its physical, psychological, and behavioral symptoms.

The treatments available for you are SSRIs, hormonal therapy, psychotherapy, and supplements. Other therapies include proper diet or nutrition and exercise.

Psychological or mood symptoms during PMDD have been treated with SSRIs. SSRIs are fast-acting.

They are effective and have been shown to significantly improve psychological symptoms at the luteal phase of women with PMDD. It also improved the women’s quality of life.

Ketamine has been shown to interact with serotonin in the brain. Moreover, ketamine helps moderate the activity of GABA A receptors and increases the production of glutamate, which have abnormal levels in PMDD.

Best of all, ketamine has been used for people with major depressive disorder, who have been resistant to SSRIs

Premenstrual Dysphoric Disorder

Ketamine IV infusion, a potential therapy for PMDD

Ketamine’s mechanism of action is complex but studies have supported its antidepressant effects. Ketamine IV infusion for PMDD can be a promising therapy to relieve you of your mood symptoms.

You may consult with us on the appropriate intervention for you. Or you may visit us at the Injection and Infusion Clinic of ABQ for any ketamine-related concerns. Our ketamine-certified staff have been safely doing more than 2,000 infusions since 2017. Call us at 505 455 4300.

The Injection & Infusion Clinic of Albuquerque New Mexico offers exciting and cutting-edge IV infusions for the treatment of Depression, Bipolar Disorder, PTSD, Migraines, Multiple Chronic Pain Conditions, Fatigue, Nutritional Performance, Chemo Therapy Support, High Blood Pressure, and Pre/Post Surgery Support


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