6 It is underscored that the symptom pattern, rather than specific symptoms or the number of symptoms, defines the disorder. For a PMS/PMDD diagnosis, it is essential to confirm the symptom pattern for two to three menstrual cycles with prospective daily symptom ratings maintained by the patient, especially if the symptoms are mild. Less than half the women who report PM.S provide daily symptom reports that corroborate their retrospective reports,22 which are less reliable when Inhibitors,research,lifescience,medical symptoms are not consistent and severe.23 The major consideration after identifying the symptom pattern is whether the condition is purely PMS/PMDD or a premenstrual exacerbation

of other psychiatric problems or medical conditions. Premenstrual exacerbation of symptoms may occur in other conditions such as asthma,24,25 migraine,26 seizure disorders,27 alcohol intake,28,29 depression,14 and schizophrenia.30 There is no laboratory test that identifies PMS/PMDD, and such tests are useful only Inhibitors,research,lifescience,medical if there are other questions that might, be answered. PMS and PMDD

are based on regular menstrual cycles within the normal range of 22 to 35 days, and patients with irregular cycling should be examined for other conditions. Standard hematology and blood chemistry profiles are conducted to confirm general good health. A thorough examination Inhibitors,research,lifescience,medical includes a review of current and past psychiatric status, particularly mood and anxiety disorders that are commonly Inhibitors,research,lifescience,medical associated with PMS/PMDD. A gynecologic examination is important to rule out problems such as

endometriosis, which might account for the symptoms. Serotonergic antidepressants The serotonergic antidepressants, particularly the SSRIs, appear to be the treatment of choice for severe PMS and PMDD at this time. Modulating serotonergic function is consistent with the dominant theoretical view that the normal gonadal steroid fluctuations of the menstrual cycle trigger an abnormal serotonergic response in vulnerable women. Indications of abnormalities in markers of serotonergic transmission in women with severe PMS include evidence of a lowered platelet imipramine binding (a peripheral marker Inhibitors,research,lifescience,medical of serotonin [5-hydroxytryptamine, 5-HT] function) in the luteal phase,31 decreased platelet 5-HT content and 5-HT uptake during the luteal phase,32,33 and significantly decreased science whole blood 5-HT levels premenstrually.34 PMS patients showed a lower 5-HT response to tryptophan (a 5-HT precursor) during the luteal phase compared with the follicular or midluteal phases.35 Challenge tests depleting tryptophan provoked PMS symptoms,36 while tryptophan supplementation relieved PMS symptoms in open-label treatment.37. Following administration of the serotonin -NVP-BEZ235 purchase releasing fenfluramine, the women with PMDD had a significantly blunted prolactin response compared with the normal controls.38 Fenfluramine administered to PMS subjects improved depressed mood and food cravings.