PMDD & Bipolar: Connection, Similarities, & Differences

What Is Bipolar Disorder?

Bipolar disorder is a mental health condition, specifically a mood disorder that causes mood to fluctuate between depressive lows and manic highs. There are two types of bipolar disorders: bipolar 1 and bipolar 2. Bipolar 1 is linked with higher instances of mood extremes and bipolar 2 is associated with hypomania.

Bipolar signs and symptoms vary by individual. However, some of the common signs include episodes such as mania, hypomania, depression, and mixed emotions between depression and mania. Symptoms include restlessness, impulsivity, insomnia, high mood, low mood, fatigue, changes in eating and sleeping habits, poor concentration, and feelings of guilt.¹

Signs Of A Major Depressive Episode

A major depressive episode is a significant indicator of a mood disorder. To be diagnosed with a depressive episode, symptoms must last for at least 2 weeks and impact daily functioning. Depressive episodes can occur in a variety of mental health conditions so it is important to be aware of all your symptoms in order to get the right diagnosis and most relevant care that you need.²

Some signs of a major depressive episode include:

• Depressed mood all day, every day: Pervasive low mood that lasts most of the day, daily
• Feeling worthless every day: Ongoing negative thoughts about self, leading to feeling worthless
• Loss of interest: Diminished interest in activities you once enjoyed
• Weight changes: Unintended weight loss or gain
• Sleep changes: Insomnia or sleeping too much
• Fatigue: Persistent feelings of lethargy, poor energy, and tiredness
• Poor concentration: Inability to focus on tasks and execute decisions
• Physical issues: Backaches, headaches, pain, and other physical problems
• Withdrawal: Socially withdrawing from friends and family
• Suicidal thoughts: Intrusive thoughts of death or dying, attempted suicide

Signs Of A Manic Episode

A manic episode is a period of time when someone is unusually energetic or elevated. Manic episodes can also come with irritability and often come out of the blue and in extreme ways. Manic episodes are often associated with persistent high energy.³

Some signs of a mania episode include:

• Little need for sleep: Feeling energetic and insomniac as a result of the high-energy
• Racing thoughts: Rapid thoughts that are difficult to control
• Elevated mood: A sustained period of heightened mood that is different from the baseline
• Impulsivity: Participating in activities with high-risk potential without thinking about the long-term impact or consequences
• Increased energy: A high level of energy that is noticeable and often appears restless
• Distracted: Easily distracted by anything in their environment, which leads to difficulties accomplishing tasks

What Is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that is marked by severe mood disturbances and additional physical symptoms that begin in the luteal phase of the menstrual cycle- which begins about a week before your period and continues throughout the duration of your period. The luteal phase is the second half of the menstrual cycle that begins after ovulation and lasts until menstruation begins.

PMDD goes beyond the more common and milder symptoms of PMS, causing severe emotional and physical symptoms that can significantly impact a woman’s daily life. PMDD symptoms usually start about one to two weeks before menstruation and improve within a few days after the onset of the menstrual period. The exact cause of PMDD is not fully known, and more research is needed to learn its origins, but hormonal changes during the menstrual cycle are believed to play a role.⁴

Premenstrual Symptoms Vs. PMDD

Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS) are related conditions, both characterized by symptoms that occur in the luteal phase of the menstrual cycle. However, there are key differences between PMDD and PMS in terms of symptom severity, impact on daily functioning, and specific symptoms, such as the severity of anxiety before a period or level of irritability.

PMDD symptoms:

• Intense mood swings, including irritability, tension, and mood lability.
• Severe depression and feelings of hopelessness.
• Increased sensitivity to rejection or criticism.
• Fatigue and lack of energy.
• Changes in sleep patterns, such as insomnia or excessive sleep.
• Changes in appetite or food cravings.
• Physical symptoms like breast tenderness or swelling.
• Difficulty concentrating or focusing.
• Feelings of being overwhelmed or out of control.
• A sense of being on an emotional roller coaster.

PMS symptoms:⁵

• Emotional changes, including irritability, mood swings, anxiety, or feelings of sadness.
• Swelling, tenderness, or discomfort in the breasts.
• Fluid retention leads to a feeling of bloating and abdominal discomfort.
• Increased frequency or intensity of headaches.
• Feeling more tired or having low energy levels.
• Difficulty sleeping (insomnia) or increased need for sleep.
• Changes in appetite, including food cravings or increased hunger.
• Aches or pains in muscles and joints.
• Some women may experience skin changes, such as acne flare-ups.
• Difficulty focusing or concentrating on tasks.
• Heightened sensitivity to stimuli like light or sound.
• Swelling or mild fluid retention is often noticed in the hands or feet.

PMDD & Bipolar Similarities & Differences

Both Bipolar Disorder and PMDD involve mood disturbances. In BD, individuals experience episodes of mania and depression. PMDD, on the other hand, is characterized by severe mood swings, irritability, and emotional reactivity in the luteal phase of the menstrual cycle. Hormonal fluctuations during the menstrual cycle may impact individuals with Bipolar Disorder. Some women with Bipolar Disorder report that their mood symptoms worsen during specific phases of the menstrual cycle, similar to the pattern seen in PMDD.

PMDD is specifically linked to the menstrual cycle, with symptoms occurring in the luteal phase (the two weeks before menstruation). In contrast, Bipolar Disorder involves mood swings that can occur independently of the menstrual cycle. PMDD is primarily characterized by depressive symptoms during the luteal phase. In contrast, Bipolar Disorder involves distinct episodes of mania and depression, with periods of relatively stable mood in between independent of the menstrual phase. PMDD symptoms are cyclical and typically last for a specific duration each month. In Bipolar Disorder, mood episodes can last for weeks to months, and the length of stable periods between episodes can vary.⁶

Does PMDD Worsen Bipolar Symptoms?

There is some evidence to suggest that Premenstrual Dysphoric Disorder (PMDD) may exacerbate symptoms in individuals with Bipolar Disorder, particularly during the premenstrual phase. Both conditions involve mood fluctuations, and hormonal changes during the menstrual cycle may impact individuals with Bipolar Disorder, potentially influencing the severity of their mood symptoms.

However, the relationship between PMDD and Bipolar Disorder is complex, and not all individuals with Bipolar Disorder will experience a significant worsening of symptoms during the premenstrual phase. Additionally, not all women with PMDD will have Bipolar Disorder.

Some points to consider regarding the impact PMDD has on bipolar symptoms include:

• Potential Worsening of Mood Symptoms: This can lead to an intensification of depressive or manic/hypomanic symptoms.
• Increased Sensitivity to Hormonal Changes: Some individuals with Bipolar Disorder may be more sensitive to hormonal fluctuations, making them susceptible to mood changes during the menstrual cycle.
• Interaction with Medications: The treatment of PMDD and Bipolar Disorder may involve medications that interact with each other. For example, selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat PMDD, can potentially impact the mood stability of individuals with Bipolar Disorder and may need to be managed carefully.⁷

Treatment & Management

PMDD is diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To receive a diagnosis of PMDD, a woman must experience at least five of the listed symptoms, with at least one being a mood-related symptom. To treat PMDD, one must use a combination of treatment approaches, which can vary from person to person.

Some treatment options for people with bipolar who also have PMS/PMDD include:

Lifestyle Changes

Adopting a balanced and nutritious diet can have positive effects on overall well-being. A lot of our mental health is impacted by our nutrition, so making sure to eat nutrient-dense food is key. Limiting caffeine, alcohol, and salt intake might also benefit some individuals. Regular physical activity can help alleviate mood symptoms associated with PMDD and bipolar disorder.

Counseling/Therapy

Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can be effective in helping individuals cope with the emotional aspects of PMDD and bipolar disorder. Therapy may help develop coping mechanisms and improve overall emotional well-being during bipolar episodes as well as during the luteal phase, when PMDD may play a role in mood fluctuations.

Relaxation Therapy

Meditation and other relaxation therapies might help manage symptoms as well related to anxiety and restlessness. Guided imagery, journaling, and yoga are all practices that help to ground us in the present and can play an important role in moving out of an extreme mood. This can be especially true for those who have bipolar disorder and experience PMDD. Acupuncture is another option for bipolar disorder and PMDD.

Birth Control Pills

Exploring hormonal therapies, such as birth control pills or GnRH agonists, is an option under the guidance of a gynecologist. These treatments may help regulate hormonal fluctuations associated with PMDD. By stabilizing hormone levels, birth control pills can help reduce the severity of mood symptoms, physical discomfort, and other issues associated with PMDD. Hormonal fluctuations can also influence mood stability in individuals with Bipolar Disorder. Birth control pills may contribute to hormonal stability, potentially helping to manage mood swings and reduce the risk of mood episodes.⁸

When to Seek Professional Help for Bipolar

If you are struggling with your cycle and symptoms, and mood, it may be time to talk to a mental health professional and seek out therapy. You can search an online therapist directory to find a good therapist for you in person or consider an online therapy platform which can be a good choice for finding a therapist who specializes in bipolar disorder along with PMDD. If you are interested in considering medication for this, it is important to speak to a psychiatrist. If you see one, your therapist may work with a psychiatrist, or you can get a recommendation from your primary care doctor to search for in-network providers through your insurance. There are many online psychiatrist options that can be a good choice for finding bipolar disorder and PMDD medication management.