Primary clinical findings:
(1) markedly depressed mood, feelings of hopelessness, or self-depreciating thoughts
(2) marked anxiety, tension, feeling of being "keyed up" or "on edge"
(3) marked affective lability (feeling suddenly sad or tearful or increased sensitivity to rejection)
(4) persistent and marked anger or irritability or increased interpersonal conflict
(5) decreased interest in usual activities (work, friends, hobbies)
(6) subjective sense of difficulty in concentrating
(7) lethargy, easy fatigability, or marked lack of energy
(8) marked change in appetite, overeating or specific food cravings
(9) hypersomnia or insomnia
(10) a subjective sense of being overwhelmed or out of control
(11) physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, a feeling of "bloating" and/or weight gain.
Criteria:
(1) Clinical pattern:
(1a) It involves most menstrual cycles during the past year.
(1b) 5 or more of the clinical features must be present for most of the time during the last week of the luteal phase (premenstrual period).
(1c) Symptoms begin to remit within a few days after the onset of the follicular phase.
(1d) The symptoms are absent in the week after menses.
(1e) At least one of the clinical findings consists of items #1 to #4.
(2) The disturbance markedly interferes with work, school or usual social activities and relationships with others. This may include avoidance of social activities, decreased productivity, and decreased efficiency at work or at school.
(3) The disturbance is not merely an exacerbation of the symptoms of another disorder (major depressive disorder, panic disorder, dysthymic disorder, or personality disorder). It may be superimposed on any of these disorders.
Diagnosis:
(1) All 3 criteria must be present on prospective daily ratings during 2 or more symptomatic cycles. Note that one of features of the first criterion is that symptoms occur in most menstrual cycles over the previous year (retrospective).
(2) A premenopausal woman without a uterus but one or both ovary(ies) intact may require monitoring of serum levels of LH, FSH, estrogen and progesterone to identify the temporal relationships.
