User:Peacefulplaces/sandbox

Connection to PMS/PMDD
The legitimacy of premenstural dysphoric disorder (PMDD) as a psychiatric disorder has been questioned in part due to its reliance on the existence of premenstural syndrome (PMS) as evidence for PMDD. PMS is a social concept that has been described as “beyond the diagnostic capacities of 21st century medicine” because it varies so much in its meaning and applications across professional and popular cultures. The term PMS is often used to describe mood alone, or mood plus physical symptoms, and clarification is rarely made either in lay discussions or scientific literature PMDD is currently listed in the DSM-V, and was originally included as luteal phase dysphoric disorder LPDD in the DSM-III. In many parts of the world, PMDD is not recognized as a disease and it is not listed as a separate disorder in the World Health Organization's [International Classification of Diseases] (ICD).

LPDD was written into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in response to two homicide cases in which the defendants cited premenstrual hormonal fluctuations as causes for their out-of-control behaviors. This legal precedent, as well as the acceptance of PMS by Western women during the 1970s women’s health movement (cite), made the creation of LPDD as a diagnostic category possible. There were protests when it was included in the DSM-III-R, which led to its relocation to the appendix, but this did not prevent LPDD from being implemented as a valid diagnosis. In 1994 LPDD was changed to Premenstrual Dysphoric Disorder. Critics of the disorder’s inclusion as an illness have pointed out that this change in language further conflates the physical symptomology of PMS with mental illness.

The treatment of PMDD with Selective serotonin re-uptake inhibitors (SSRI) such as Prozac has received criticism, given the lack of evidence for PMDD as a psychiatric disorder and the conflict of interest for drug companies that fund and disseminate PMDD research. In (date) patent holders at Eli Lilly for Prozac held a roundtable meeting with the DSM-IV subcommittee on LPPD/PMDD. The groups emerged from the roundtable meeting with evidence to suggest that PMDD was treatable with Prozac, the decision allowed for the extension of Prozac’s patent. The roundtable meeting spurred an article by Endicott et al. (1999) that espoused the effectiveness of Prozac and calcium for depression treatment. Calcium however, was not recommended for therapeutic purposes. Drug trials for Prozac as a treatment for PMDD did not control for preexisting mental illness, meaning that evidence of symptomatic relief in trials do not explicitly confirm the existence of PMDD as a diagnosable disorder outside of PMS or comorbid mental illness. Prozac is currently marketed as Sarafem and authorized for the treatment of PMDD. The legitimacy of both PMDD and PMS as categories of illness have been called into question as a result of said methodological issues as well as the conflict of interest represented by the makers of Prozac.

The existence of PMDD and its inclusion in the DSM-IV is often cited as evidence for the legitimacy of PMS. For example, self-help books on PMS point to the presence of PMDD in the DSM as evidence of the reality of PMS symptoms (cite). The significant overlap between the more than 150 possible symptoms for both PMS and PMDD have been noted as evidence for this mutually reinforcing relationship. Current research has yet to establish a causal relationship between premenstrual hormones and the symptoms attributed to PMDD or PMS. While further research on both PMS and PMDD has produced large amounts of data on biological and psychological phenomena correlating with the menstrual cycle, the premise of a causal relationship between mood and menstrual cycle remains flawed.