Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges Original paper
Researched by:
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Divine Aleru
ID
Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Divine Aleru
Researched by:
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Divine Aleru
ID
Divine Aleru
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was studied?
This review analyzed existing literature on the management and treatment challenges of comorbid Premenstrual Dysphoric Disorder (PMDD) in women diagnosed with Bipolar Disorder (BD). It focused on identifying pharmacological and non-pharmacological strategies to manage the complex interaction of mood symptoms in this dual-diagnosed population.
Who was studied?
The review included data from a small number of case reports and case series comprising six women with comorbid BD and PMDD. Additionally, it integrated broader findings from separate research on BD and PMDD to inform treatment hypotheses for this specific comorbid group.
What were the most important findings?
The study emphasized that optimal management requires first stabilizing bipolar symptoms using mood stabilizers such as lithium and lamotrigine, followed by targeted treatment of PMDD symptoms, typically through estroprogestins during euthymic BD phases. Antidepressants may be cautiously used during depressive episodes but carry a risk of inducing manic switches. Atypical antipsychotics may help manage manic episodes and some PMDD symptoms. Psychotherapeutic interventions like cognitive behavioral therapy (CBT), including internet-based delivery, show promise as adjuncts, though evidence specific to comorbid BD/PMDD is limited. Alternative treatments such as lifestyle modifications, supplements (calcium, vitamin B6), and mind-body therapies have been reported anecdotally. The complexity of comorbid BD/PMDD necessitates individualized, multimodal treatment approaches, yet randomized controlled trials (RCTs) in this population remain scarce, highlighting a critical gap in evidence.
What are the greatest implications of this study?
This review underscores the clinical challenges of managing comorbid BD and PMDD, a condition marked by more severe mood instability and poorer outcomes than either disorder alone. It advocates for careful mood stabilization before addressing PMDD symptoms to prevent exacerbations and cautions regarding antidepressant use in BD due to manic risk. The limited but encouraging data on hormonal treatments and psychotherapy suggest these as valuable components of integrated care. The paucity of RCTs specific to comorbid BD/PMDD calls for urgent research to establish evidence-based protocols. Clinicians must adopt tailored, multidisciplinary strategies combining pharmacological, psychological, and lifestyle interventions to improve quality of life in this vulnerable population.