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Premenstrual Dysphoric Disorder

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

Symptoms of this condition can include:

  • feeling depressed or having mood swings
  • feeling anxious
  • being easily tired or not having interest in normal activities
  • being irritable
  • having changes in eating or sleeping habits irritability
  • feeling overwhelmed and out of control

sad womanSymptoms occur repeatedly during the premenstrual phase of the woman's cycle and decrease or disappear around the onset of her period or shortly after. Symptoms must occur in most of the menstrual cycles during the past year. They also must make it difficult to work or interact with other people. Women who have major depressive disorder tend to experience this condition as well.

How this disorder is displayed can be closely related to social and cultural background characteristics. These can include family perspectives, religious beliefs, social tolerance, and female gender role issues. For example, in some families or cultures, women can express sadness or irritability with ease. In other families or cultures, women are expected to be silent followers of male leaders and not express their feelings or thoughts. While in other religions and cultures, the menstrual cycle is a time of rest and respect for women, and women are excused from daily tasks in order to deal with their biology. In this situation, women may feel more free to display any emotional or depressive symptoms they are experiencing. Thus, this particular condition is tied closely to cultural, social, and religious perspectives of women and women's issues in general.

Approximately 1.8% to 5.8% of menstruating women suffer from this condition. It can happen at any time after a woman's first period. Many women report symptoms get worse as they approach menopause. However, after menopause symptoms stop. If hormone replacement treatment is used, then symptoms can happen again. It is not currently known whether this condition has genetic risk factors or runs in families. Because of the social, cultural, and religious perceptions of women, the range for estimating if this disorder is inherited is between 30% to 80%.

Additional environmental risk factors include stress, history of trauma, and seasonal changes. Women who use oral contraceptives ("the pill") may have fewer symptoms than women who do not use them.

While this condition is displayed and accepted in a variety of different ways in various societies, it is not a bound to any one culture, religion, society, ethnicity, or country. It is found all over the world. However, how often it happens, how intense it is, how it is displayed, and if women/families seek help are strongly influenced by where the woman lives. For example, if a woman lives in a culture that ignores this condition and brushes it off as a women's problem that does not require medical attention, she will likely not seek help. But if that same woman moves to a more accepting culture or marries into a more accepting family, she may go on to receive medical attention. Symptoms can affect marriages, relationships with children or other family members, and can cause problems at work.

There are a number of medical and mental health conditions that may make this condition worse. These include asthma, allergies, seizure disorders, depressive and bipolar disorders, anxiety disorders, bulimia nervosa, and substance use disorders.


Reader Comments

Dysthymic is Me - Just Discovering - Nov 16th 2011

Reading this has been a huge revelation for me. I had no idea so many others struggled with this.

The symptoms describe me accurately for the past 15 years. I too was highly motivated, positive, funny and full of life and optimism.

Then, I got married. My wife left because we were struggling financially. She was pregnant at the time & moved several states away to be with her parents. I could not even afford to fly there to see my child born.

From that point, parts of myself died more and more each day. I never really stopped being able to function, but the spark was gone. No more real accomplishments or achievements.

I tried to let my daughter be my inspiration but the depair would always win out. I've been remarried now for 8 years. We have a two yr old daughter who has been a huge light in my life.

The problem is the sadness, the look of defeat & despair that has become permanently engraved on my face have become a part of who I am now. The only time I light up is for my little girl. Not for my wife nor my stepson.

Now, my wife has been dragged down into my dysfunction. She was so full of life when we met, now she is just like me & its killing her and us as couple and family. 

I can't lose my family but I just don't know how to be energetic, happy and full of laughter again. I don't know what to do. I need help. Anyone, please help me.  

counselors need help as well - k - Dec 4th 2010

Those who have posted who believe they have dysthymic disorder... do not be afraid to seek professional help!  It is part of our self care... empathy is something that we have and can make us more open to being depressed more often and it is important to talk to someone about it... and get help processing our feelings out loud and not always in our head... or just for emotional support at times.  I am a counselor and I am in therapy for depression and relationship issues that I need help working through...  as a counselor, I believe it is the responsible thing to do.  

Dysthimic diorders - - Nov 22nd 2010

I just discovered on this blog what double depression is.   I have had a dysthimic disorder for more than 15 years.    It seems that it  has worsened since I quit smoking a year ago and after my brain surgery (non malignant tumor) 6 months ago that left me with some balance pb. spaciness and nearly half deaf since the tumor affected the hearing nerve. 

I am easily bored, I don't really have the drive to do thing unless I am with somebody who energize me.  People are getting tired of my complaints, down attitude.

I feell like I am dead inside.   As I am getting close to 50, I feel like I lived my life and that now things are getting worse in terms of health, looks and I as say I can only get worse.  I function pretty normally but every day seems to be an effort, actually a huge effort without much hope because I don't what makes me happy anymore.

I have read that Abilify can help when the antidepressant does not seem sufficient anymore

What do you think?



Secretly confessing... - Another in the Mental Health Profession - Sep 15th 2010

I currently work in the mental health field as a counselor. That's what makes this all the more difficult - I know I should be getting help, but I keep thinking I should be able to do the work myself ("Heal thyself, physician!").

I'm in my late 20s and been married several years. I've never been unemployed, been arrested, or had major relationship trouble (with my significant other or family) due to my illness. We've had our fair share of arguments, typically revolving around my self-esteem or feelings of inadequacy, but we've been able to work through them time and time again. As such, I have a hard time feeling like I meet the criteria for dysthymia - no imminent distress or social/occupational/legal impairment, but often feeling like I'm just hanging on. I relate to what Stephen King said about his drug/alcohol habits in that "If you [screw] this up, it's all over." And it's that fear that keeps me from cycling downward beyond control.

I've found solace in several over-the-counter herbal remedies: St. John's Wort (which is prescribed for depression/dysthymia in Europe) and 5-HTP (an amino acid used in the production of serotonin). These have probably made the most significant difference in being able to combat negative feelings and hopelessness. With making a career change to a fulfilling field (mental health) and pursuing some hobbies, I feel like I've taken proactive steps toward success in overcoming life obstacles. Still, it's a battle for maintaining this forward movement.

Anywho, this is a confession of an ordinary citizen dealing with these feelings. I've overheard plenty of people say to others "Just get over it" or "Suck it up," and that's all the more reason why I don't bother telling anyone else about my inner struggle. It's not that easy, and I'll never chide anyone for despairing like they do. Maybe posting this is a first step to reaching out for help from others, or maybe I'm just delaying it further by considering this to be my attempt. Either way, something else needs to change lest I continue in my struggling trends.

low grade depression - - Nov 4th 2009

Hello there...I know a thing or two about mental health - I work in the field.  I wanted to share my story because I seriously think I have dysthymia, and have thought this for a while now. 

As a child, I remember some sad times as we went through the recession, and my mother was quite stressed at the time.  I was very close with my sister, but somehow recall never really being a happy child. 

The happiest times for me were in undergrad - I lived on my own, was academically a high achiever, and was in a love relationship in which I was in complete control, and was very much loved. I was young, healthy, vibrant, and happy.  That relationship ended and my next relationship was very different - I didn't feel loved in the same way, and the girl was very 'unavailable'.  At the same time my mother was going through cancer, I entered grad school, my grandma died and my dad was having health problems (among other problems).  I remember during this time, staying in bed for the entirety of the weekend, and feeling fatigued and soooo tired and 'dead'.  It was hard to work.  I couldn't cry for some reason.  I remember wishing I'd just melt into the mattress...just melt away.  I am shocked remembering this. 

I never got that bad again...but since that time I can't say i've been happy.  A good day is about a 7 on a happiness scale but that is rare....for many days over the past years i've been at a 5 or 6.  I keep telling myself that I'm accomplished, have great loving family, a few close friends....but my 'happiness' doesn't seem to last very long and i know the sadness will creep back.  I would never harm myself, but at times I wish I could just disappear or fall asleep and not wake up. 

I keep trying to give myself therapy - ask myself 'what would 9/10 look like?  what would make you happy? what do u want from life? what are the good things in your life?" All I want is to be happy!!!  And even if i was granted all the 'things' i wanted, i still don't think i'd be a 9/10. 

So....thanks for posting to those of you who have....I know I'm not alone. 


Confessions from a Dysthymic - FC Mendel - Sep 30th 2009

About a year ago I was diagnosed with Dysthymia. At the time I was studying mental health in school and so I did make an effort to learn about the condition. One of the first things I found was that much less is understood about Dysthymia when compared with other related disorders like Major Depression. Where information is available to the public, Dysthymia typically always explained by virtue of the ways in which it is not major depressive disorder, and little more. This was a disappointment - a common experience for someone suffering with depression. I'm quite sure that the current picture of the relationship between dysthymia and other forms of depression is not as clear as these descriptions suggest.


However, this lack of strong information, especially in the public eye, has lead me to be at least more willing to talk about my problems than I might be otherwise. As such, I've decided to confess some of my own struggles with this condition.


Prior to the year that I was diagnosed, I was working a good job and studying hard in my 3rd year of university. Progressively I fell behind at work and in my studies. Eventually I began drinking too much, probably due to the stress associated with my declining motivation.


I began to recluse socially and in the span of a year I had dissociated myself from most of my friends and family. I quit my job and abandoned my course work. This cost me financially and irreparably damaged my relationships with school faculty, not to mention friends and family. At the time I found it very hard to understand why I would do these things. I felt very guilty about my poor performance at school and work. It had been my goal for over 2 years to get that job, and I remember thinking that I should be happier about it when it happened. I was doing more or less exactly what I wanted to do, and I loved the work but I still wasn't happy.


I still don't really understand why I stopped working hard and attending my courses. At one point I would remain in the house for full weeks on end, and would sleep for large parts of the day and night. This transition from working to hardly leaving home happened gradually but did not take very long. One day I woke up drunk and had this terrible feeling that I was doing something horribly wrong with my life. It reminded me of a story I read about William James' father who would sometimes wake up in a terrible panic. Looking at my situation as an outsider I was a real mess, but I felt anywhere from indifferent to very badly about the situation. I didn't know what to do, but on some level I just didn't care.


Since being diagnosed I have failed on one occasion to properly deal with my problem. For the second time in 2 years I lost one whole term of courses and have not yet completed my degree. Once again I am at a very low point in my life. I've spent less time out doors this week than I have in writing this passage tonight.


Dealing with a Dysthymic episode is intellectually challenging and emotionally taxing. I think that when you're trying to cope with this disorder you have to find ways to hold onto the things that you used to feel about yourself and remain in contact with those around you to give you some perspective. You have to remind yourself who you are and what matters to you on a daily basis, almost like a mantra.


When I'm dealing with this condition, my natural inclinations are suspect. I often tend to think things like "I'm not capable of achieving my goals", "I'll never achieve anything in my life", "I'm not smart enough", "The people around me don't  have time for my problems", "I just don't care anymore."


These tenancies are a real challenge to deal with, and they are very pervasive. When you are the abuser and the victum of abuse, its very difficult to stage an intervention. Even when our judgements are negative I think we tend to hold onto them and even defned them irrationally. Its hard to really believe that our ability to value ourselves has become comprimised. After months of continuously feeling a certain way about yourself its very difficult to fight off with rational thinking.


I have found that I can think logically about my disorder but can often fail to act accordingly. This discontinuity between what I think i should do and what I end up doing leads me to question myself in so many different ways. I find it difficult to trust my thoughts and emotions and believe that my words lack sincerity because I often do not follow through on them and do what I know to be correct. After several months of feeling really poorly about things it leads me to wonder if I am wrong about the world on my better days. Maybe people simply overstate their own self worth, their own intelligence... Perhaps I am right to be pessimistic. Perhaps I do not deserve to be happy. Perhaps  being happy is not worth the effort.


Once my beliefs start to change, my logic can become very frail. For example; my relationship with my girlfriend has been deteriorating for several long months. We fell in love the moment we met and even after I moved away from school for a while we managed to stay together. Now, my personal financial problems and my emotionally distant tendencies put a strain on our relationship. Despite some effort to find work, I am unemployed and openly admit that I could look harder for a job. I am not in school and have no ambition. I know that if I were to find work it could help our relationship. Since that's the case, when I fail to look harder for work I begin to wonder if I really care about her and wonder if we would simply be better off apart. This is just one example. I find it very easy to doubt just about everything.


I often have trouble maintaining a regular sleep schedule. In general, I am sleeping perhaps an average amount, but I stay up slightly longer than usual. If I fell asleep at 10:30 on Monday night, chances are good that by next Monday I would be falling a sleep at 5am and waking up some time in the mid-afternoon. This trend continues and eventually I will be sleeping normal hours once again. This period of normal sleep lasts only a few nights.


I do not lead an active lifestyle. Growing up I played several sports including Basketball for a local traveling team. In high school I was a member of the student's council. I played on school sports teams and helped organize many school events. I no longer play any sports. I have lost almost all interest in spending time with other people.


I do not have very good personal hygiene and do not eat properly. When I get dressed for the day, I never have the intention of going outside. I shower perhaps 3 times  a week. There's always a pile (or two) of laundry laying around. I'll often have 1-2 meals a day. I drink a lot of coffee and pop (cola). I brush my teeth once a day and sometimes less. I get my hair cut probably twice a year but I don't really know. I have not purchased new shoes in a long time so my shoes are worn out.


As mentioned before, I am socially reclusive. I typically think that I have nothing to offer others in a social situation. I also do not like most people that I meet. Generally speaking, I don't like people. These days, I have no close friends at all. I call home maybe once a month or less and visit 3-4 times a year or less.


I have financial problems. I'm in debt approximately $60,000 between my student debts and some outstanding credit. I have no income. As mentioned, I have been looking for work but find the idea of working in many different places to be very depressing. I honestly think I would decide to kill myself if I were working in a fast food restaurant or something like that. Somehow I think that working in such a place would give me an overwhelming sense of failure that I couldn't stand to bare.


I often contemplate suicide. I don't want to die, but I often think that people that I have an impact on would be better off in the long run without me. I don't expect them to feel the same way.


I occasionally get really angry with my life. The anger will kind of well up and I'll hit desk tops or counter tops. My hand has grown a high pain tolerance over time, and I find myself hitting things much harder now than I did before. Recently I hit the sink so hard that it broke into three peices. These behaviors are very destructive and unhealthy.


I have once again reached a breaking point and am in need of some form of treatment. My feeling is that the situation is quite hopeless, but in some other sense of the word I do hope to advance beyond this counterproductive cycle and lead a more enjoyable/progressive life. I do not yet know how this will happen. I am often unreceptive to the advice of others and perhaps this stems from my tendency to doubt everything. I have talked with therapists, but I haven't made much progress in therapy.

Hi Julie - - Oct 14th 2008

I hope you are feeling well/ better.  Are you on meds now?  I have self diagnosed myself and I think I have Dysthymic depression also.  I am just doing research right now and it's not looking too good for us :(  I just started taking Zoloft about a week ago so we'll see if that helps.

I am in my mid 30s, 3 kids, married so I do have a lot to lose too if I don't get well.

a life - Julie - Feb 28th 2008

I think this might be my kind of depression, although as a child I was always somewhat depressive. I remember becoming very depressed after my mother died of cancer when I was 16. I was productive for a time after and then around 19 became an alcohol abuser. My life was a nightmare until I had my last two children around my 30's. I put alcohol down and put everything into being a good Mother and wife. Until I found out my husband was lieing and cheating I became depressed again, paranoid that he was still lieing to me unable to ever trust him again. We wound up going through a hellish divorce and I've missed so much time with my children. What I have felt is my main purpose in life and the thing I feel I do better than anything. Being a Mother to my children. I only have my children half the time and we are in different States. The times that I have without them is hell to me. I feel more depressed in my life now than ever. I feel that I can't move to be productive, even though logically I know I have a lot to offer the world and community and I am a very hard worker I feel paralyzed, touchy I cry at anything I feel worthless ,guilty.I am so scared I'm going to leave this world without ever having the courage to experience a normal life . I never let my children see this side to me other than I can't seem to leave the house very much. This year they are with their father I will have them next year. The only thing I desire to really do with my life is to make a good role model for them so they can grow up and do great things and never have to experience this type of pain.