Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder: A Systematic Review

Verinder Sharma, MBBS; Dwight Mazmanian, PhD, CPsych; Heidi Eccles, MSc

J Clin Psychiatry 2022;83(6):22r14416

ABSTRACT

Objective: Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD) in women with BD and those of a diagnosis of BD in women with PMDD deserve systematic review.

Data Sources: A systematic search of PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Reviews databases was carried out on November 19, 2021, using the terms [late luteal phase disorder OR premenstrual dysphoric disorder] AND comorbidity AND bipolar disorder. Articles from 1987–2021 were searched. Case studies, intervention studies, reviews, and systematic analyses were excluded.

Study Selection: All studies that included a diagnosis of PMDD and BD were included.

Data Extraction: The selected articles were reviewed to extract data using a data extraction form developed for this study.

Results: A total of 5 studies were included in the review. Extant literature, although limited, suggests that PMDD is more common among women with BD than in the general population. Similarly, BD is more common among women with PMDD than in the general population. The proportion of people with PMDD and diagnosed with BD ranged from 10% to 15%. Conversely, the proportion of people with BD who received a diagnosis of PMDD ranged from 27% to 76%.

Conclusions: Only a small number of relevant studies were available, and the findings from these were limited by the failure to employ prospective monitoring of symptoms—perhaps the most important feature necessary for confirming PMDD and differentiating it from premenstrual exacerbation of BD. Given the important clinical and heuristic implications, prospective studies are needed to clarify the relationship between the two disorders in order to improve their detection, diagnosis, and treatment.

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