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Arch Womens Ment Health (2013) 16:7981 DOI 10.1007/s00737-012-0313-z
SHORT COMMUNICATION
Comorbid bipolar disorder and premenstrual dysphoric disorder: real patients, unanswered questions
Benicio N. Frey & Luciano Minuzzi
Received: 23 July 2012 /Accepted: 23 October 2012 /Published online: 8 November 2012 # Springer-Verlag Wien 2012
Abstract Large-scale clinical and epidemiological studies suggest a link between bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD). However, smaller studies using prospective charting failed to find this association. Here, we report three cases of individuals with BD and comorbid PMDD who responded successfully to adjunctive contraceptive agents in the management of their severe premenstrual symptoms. While controlled trials investigating pharmacological and non-pharmacological treatments are awaited, adjunctive treatment of contraceptive agents and mood stabilizers may be an option in the treatment of comorbid BD and PMDD.
Keywords Bipolar disorder . Contraceptives . Premenstrual dysphoric disorder . Premenstrual syndrome . Treatment
Introduction
Bipolar disorder (BD) is a chronic major mental illness that affects 4 % of the population and is one of the leading causes of disability and all-cause mortality among all neuropsychiatric disorders (Merikangas et al. 2007). A recent national Danish cohort study that investigated the absolute risk of completed suicide within 36 years after the first psychiatric contact found that BD was the second most common psychiatric condition associated with suicide in women (Nordentoft et al. 2011). It has been long recognized that a significant
proportion of bipolar women experience mood worsening during periods of intense hormone fluctuation (e.g., premenstrually, postpartum, transition to menopause), which points towards a link between female reproductive life events and BD (Frey et al. 2010). Women with a first-time psychiatric contact in the early postpartum period have a fourfold greater risk to be diagnosed with BD at follow-up as compared to women with a first psychiatric contact outside the postpartum period (Munk-Olsen et al. 2011). Also, a diagnosis of BD is the strongest predictor of psychiatric hospitalization within the first month after childbirth (Munk-Olsen et al. 2009). Finally, data from the longitudinal Systematic Treatment Enhancement Program for Bipolar Disorder study found that the presence of premenstrual exacerbation is an independent risk factor for early relapse in women with BD (Dias et al. 2011) and that bipolar women have an increased risk to develop depressive...