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Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges

Authors Sepede G, Brunetti M, Di Giannantonio M

Received 29 November 2019

Accepted for publication 30 January 2020

Published 10 February 2020 Volume 2020:16 Pages 415—426


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder

Gianna Sepede,1 Marcella Brunetti,1 Massimo Di Giannantonio1,2

1Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy; 2Department of Mental Health - Chieti, National Health Trust, Chieti, Italy

Correspondence: Gianna Sepede
Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Via Dei Vestini 33, Chieti, Chieti Scalo (CH) 66013, Italy
Tel +39 0871 3556901
Fax +39 0871 3556930

Abstract: Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.

Keywords: womens’ health, comorbid mood disorders, combined intervention, treatment challenges

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