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