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PMDD or Depression

What is the Difference Between PMDD or Depression?
by Dr. Daniel J. Heller

There are many similarities between PMDD and depression including their symptoms, the drugs used to treat them, and the effects they have on women’s lives. Brandi’s story below isn’t unusual in that she has monthly symptoms of depression that make her tired, confused, and depressed. While it might seem unusual that Brandi has these symptoms in spite of having tried three different antidepressant drugs—drugs that are frequently prescribed for PMDD—many women with PMDD & PMS don’t get better when they take antidepressants (many women, of course, do).

"Dear PMS Comfort: I am 40 years of age, and for the last 5 or 6 months I have started to get really depressed, even though I am already taking antidepressants. I was on the highest dosage of Cymbalta® for a long time. I felt it stopped working, so I talked to my doctor, and he switched me to Pristiq®, which didn't seem to work. I went back to my doctor and asked him if I might have PMDD, because 1.5 to 2 weeks before my period my depression gets really bad: I am lethargic, with some suicidal thoughts, and I sleep 10 or 11 hours. It's so bad I really can't think. My doctor put me on Prozac® and after a few months it seemed ok. But still, right before my period I got severe depression and so we upped the medication. This past week and half has been so bad I can't think straight. I just keep wishing my period would come so I can feel somewhat normal. I really don't know what else to do. Brandi"

But the main reason we share Brandi’s letter is because it shows how similar PMDD and depression really are; how easy it can be to confuse them, for a doctor or a patient; and how difficult it can be to tell them apart. The clearest and best way to distinguish PMS, PMDD, and depression is based on the menstrual cycle: depression symptoms that are much worse, or that only exist, before the period, are the best and most obvious way to distinguish depression vs. PMDD. This is because PMDD has a hormonal component, while depression usually doesn’t, which is why hormones are sometimes used to treat PMDD, while antidepressants are often used to treat both PMDD and depression.

Depression Symptoms

Here are the most important symptoms of depression. You can see how similar they are to PMDD and PMS:

  • Decreased appetite with weight loss, or increased appetite
  • Decreased enjoyment of hobbies, interests, and usual activities
  • Difficulty concentrating, thinking, remembering, and making decisions
  • Fatigue, lack of energy, or feeling tired frequently
  • Feeling guilty, worthless, or helpless; low self-esteem and self-deprecating thoughts
  • Feeling hopeless or overwhelmingly pessimistic and negative
  • Feelings of sadness, anxiety, or emptiness
  • Persistent thoughts of death and dying or suicide
  • Restlessness (need to move around or fidget) and irritability
  • Sleeping too much or too little (hypersomnia or insomnia); waking early morning
  • Slow or labored thinking, speech, and motion
  • Unexplained medical problems that don't respond to treatment

PMDD Symptoms

This list of the most important PMDD symptoms includes many of the common symptoms of depression. Five or more of these symptoms need to be present, and severe, during most cycles during the previous year for a PMDD diagnosis.

  • Anxiety or tension, feeling "keyed up" or "on edge"
  • Change in appetite, overeating, or food cravings
  • Concentration difficulties
  • Decreased interest in usual activities (school, work, family, hobbies) or social withdrawal
  • Depressed mood, feelings of hopelessness, self-deprecating thoughts
  • Extreme mood changes such as feeling suddenly sad or tearful, or increased sensitivity to rejection
  • Feeling overwhelmed or out of control
  • Lack of energy, fatigability, or lethargyM
  • Persistent irritability or anger, increased conflict in relationships
  • Physical symptoms: breast tenderness, bloating, swelling of arms or legs, headache, joint or muscle pain, weight gain
  • Sleeping too much (hypersomnia) or insomnia

So, What are the Similarities of PMDD & Depression?

  • Both have symptoms of depression and anxiety
  • Both can effect appetite and sleep
  • Both impact feelings of self worth
  • Both affect your relationships
  • Both affect your concentration
  • Both can make you feel exhausted
  • Both make it hard to function in life
  • Both may respond to antidepressants
  • Women with depression are more susceptible to PMDD

So, What are the Differences?

  • PMDD usually has more anger and irritability
  • PMDD has a monthly cyclical pattern that follows the menstrual cycle
  • PMDD usually has the physical symptoms of PMS
  • Depression never responds to birth control

As you can see, PMDD and depression have much in common. However, don’t confuse the occasional symptoms of depression that nearly everyone experiences with persistent depression or recurrent PMDD symptoms. In other words, the symptoms of depression aren’t the same as depression, and PMS symptoms aren’t PMDD. Everyone gets in bad moods and feels irritable, negative, and discouraged from time to time, but these are very different from PMDD or depression.

PMDD symptoms last most of the week before your period, resolve within days of the onset of your period, and then don’t return in the seven days following your period. Depression symptoms will usually persist throughout the month. Ultimately, you and your doctor will have to decide what diagnosis best fits your symptoms. But knowing that PMDD and depression have so many similarities, and important differences, can help you understand your health in order to make informed, empowered choices.