Archives of Women's Mental Health

, Volume 16, Issue 1, pp 79–81 | Cite as

Comorbid bipolar disorder and premenstrual dysphoric disorder: real patients, unanswered questions

Short Communication


Large-scale clinical and epidemiological studies suggest a link between bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD). However, smaller studies using prospective charting failed to find this association. Here, we report three cases of individuals with BD and comorbid PMDD who responded successfully to adjunctive contraceptive agents in the management of their severe premenstrual symptoms. While controlled trials investigating pharmacological and non-pharmacological treatments are awaited, adjunctive treatment of contraceptive agents and mood stabilizers may be an option in the treatment of comorbid BD and PMDD.


Bipolar disorder Contraceptives Premenstrual dysphoric disorder Premenstrual syndrome Treatment 


  1. Choi J, Baek JH, Noh J, Kim JS, Choi JS, Ha K, Kwon JS, Hong KS (2011) Association of seasonality and premenstrual symptoms in bipolar I and bipolar II disorders. J Affect Disord 129(1–3):313–316. doi:10.1016/j.jad.2010.07.030 PubMedCrossRefGoogle Scholar
  2. Dias RS, Lafer B, Russo C, Del Debbio A, Nierenberg AA, Sachs GS, Joffe H (2011) Longitudinal follow-up of bipolar disorder in women with premenstrual exacerbation: findings from STEP-BD. Am J Psychiatry 168(4):386–394. doi:10.1176/appi.ajp. 2010.09121816 PubMedCrossRefGoogle Scholar
  3. Fornaro M, Perugi G (2010) The impact of premenstrual dysphoric disorder among 92 bipolar patients. Eur Psychiatry 25(8):450–454. doi:10.1016/j.eurpsy.2009.11.010 PubMedCrossRefGoogle Scholar
  4. Frey BN, Macritchie KA, Soares CN, Steiner M (2010) Bipolar disorder in women. In: Yatham LN, Maj M (eds) Bipolar disorder: clinical and neurobiological foundations. Wiley, West Sussex, pp 463–476CrossRefGoogle Scholar
  5. Karadag F, Akdeniz F, Erten E, Pirildar S, Yucel B, Polat A, Atmaca M (2004) Menstrually related symptom changes in women with treatment-responsive bipolar disorder. Bipolar Disord 6(3):253–259. doi:10.1111/j.1399-5618.2004.00112.x PubMedCrossRefGoogle Scholar
  6. Leibenluft E, Ashman SB, Feldman-Naim S, Yonkers KA (1999) Lack of relationship between menstrual cycle phase and mood in a sample of women with rapid cycling bipolar disorder. Biol Psychiatry 46(4):577–580PubMedCrossRefGoogle Scholar
  7. Marsh WK, Templeton A, Ketter TA, Rasgon NL (2008) Increased frequency of depressive episodes during the menopausal transition in women with bipolar disorder: preliminary report. J Psychiatr Res 42(3):247–251PubMedCrossRefGoogle Scholar
  8. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 64(5):543–552. doi:10.1001/archpsyc.64.5.543 PubMedCrossRefGoogle Scholar
  9. Munk-Olsen T, Laursen TM, Mendelson T, Pedersen CB, Mors O, Mortensen PB (2009) Risks and predictors of readmission for a mental disorder during the postpartum period. Arch Gen Psychiatry 66(2):189–195. doi:10.1001/archgenpsychiatry.2008.528 PubMedCrossRefGoogle Scholar
  10. Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I (2011) Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. doi:10.1001/archgenpsychiatry.2011.157
  11. Nordentoft M, Mortensen PB, Pedersen CB (2011) Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 68(10):1058–1064. doi:10.1001/archgenpsychiatry.2011.113 PubMedCrossRefGoogle Scholar
  12. Payne J (2011) Bipolar disorder in women with premenstrual exacerbation. Am J Psychiatry 168(4):344–346. doi:10.1176/appi.ajp. 2011.11010171 PubMedCrossRefGoogle Scholar
  13. Pearlstein T, Steiner M (2008) Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci 33(4):291–301PubMedGoogle Scholar
  14. Shivakumar G, Bernstein IH, Suppes T, Keck PE, McElroy SL, Altshuler LL, Frye MA, Nolen WA, Kupka RW, Grunze H, Leverich GS, Mintz J, Post RM (2008) Are bipolar mood symptoms affected by the phase of the menstrual cycle? J Womens Health (Larchmt) 17(3):473–478. doi:10.1089/jwh.2007.0466 CrossRefGoogle Scholar
  15. Sit D, Seltman H, Wisner KL (2011) Menstrual effects on mood symptoms in treated women with bipolar disorder. Bipolar Disord 13(3):310–317. doi:10.1111/j.1399-5618.2011.00921.x PubMedCrossRefGoogle Scholar
  16. Wittchen HU, Becker E, Lieb R, Krause P (2002) Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med 32(1):119–132PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  1. 1.Women’s Health Concerns Clinic, St. Joseph’s Healthcare HamiltonMcMaster UniversityHamiltonCanada
  2. 2.Mood Disorders Program, Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada

Personalised recommendations