Premenstrual
Dysphoric Disorder

PMDD is a DSM-5-TR diagnosis requiring at least five specified symptoms — among them marked irritability or anger, depressed mood, anxiety or tension, and emotional lability — present in the final week before menses, improving within a few days of bleeding starting, and largely absent in the week afterwards. The severity threshold is real: symptoms have to interfere with work, relationships, or usual activities. Estimates put it at roughly 1–6% of women of reproductive age, and it is distinct from PMS, which is far more common and far less severe.

Diagnosis is where most of the value sits, and it takes work. PMDD requires prospective daily symptom ratings across at least two menstrual cycles. Recall is not good enough — looking backwards reliably overstates the premenstrual pattern — and skipping this step confuses PMDD with something that looks almost identical from the outside: premenstrual exacerbation, where an underlying depressive or anxiety disorder present all month simply worsens before menses. That is a different condition with a different treatment plan, and it is the single most common misdiagnosis here.

SSRIs are first-line, and PMDD is genuinely unusual in psychiatry: response comes within days rather than weeks, which makes intermittent dosing possible. Medication can be taken continuously, during the luteal phase only, or from symptom onset, and doses are often lower than those used for major depression. Fluoxetine, sertraline, and controlled-release paroxetine hold FDA indications for PMDD; other serotonergic agents have evidence but are used off-label.

Hormonal treatment is the other route. A drospirenone-containing combined oral contraceptive is the only hormonal preparation FDA-approved for PMDD, and is typically considered after an inadequate response to SSRI treatment or where contraception is wanted anyway. Where hormonal and psychiatric treatment overlap, the two plans have to be built together rather than in parallel.

Thyroid dysfunction, anemia, and an underlying mood or anxiety disorder all deserve exclusion before the cyclical label is applied. Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to that sorting.

A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers your cycle and how symptoms map onto it, how long this has been happening, what the symptoms cost you, your psychiatric and medical history, contraception and any hormonal treatment, and every medication tried.

If PMDD is on the table you'll leave with a tracking method and a follow-up already booked, because the diagnosis can't be finalised in one visit. Telehealth is available throughout South Carolina and New York. In-person appointments are available at the Bluffton, SC office.