Once a patient meets the DSM-IV criteria and is diagnosed with premenstrual dysphoric disorder, therapy should be initiated. Consistent with many disorders and disease states, nonpharmacological therapy should be attempted initially.
Nonpharmacological Therapy
Nonpharmacological therapy consists of dietary modifications, moderate regular exercise, stress management, and supportive therapy. Dietary modifications include reduction in daily salt, caffeine, and alcohol intake. Although these modifications are not confirmed with substantial evidence, many patients have been found to benefit with these changes. Some studies also suggest smaller, more frequent meals with high carbohydrate content or complex carbohydrate drinks. Reducing chocolate consumption has been recommended, but no clinical link to alleviation of symptoms has been found.
Moderate regular exercise has been shown to modify endorphin levels and improve mood during premenstrual dysphoric disorder. Clinical studies have not found any major correlation between exercise and improved mood, but epidemiological studies have validated a positive relationship, i.e., mood improves with increasing exercise.
Supportive therapy includes family support through discussions and daily symptom recordings to determine menstrual links between symptoms and behavior. Again, the use of supportive therapy has not been well studied, but anecdotal information implies that it is beneficial for some patients. It allows women to learn more about the timing of their symptoms as well as the triggers and exacerbations. Monitoring or recording symptoms may then enhance awareness and help patients make lifestyle changes to prevent exacerbations and foster a decline in symptoms.Another nonpharmacological option found to be effective in improving symptoms is cognitive behavioral relaxation therapy. This includes yoga, relaxation exercises, stress management exercises, cognitive therapy, and group coping skills.