Unfortunately, there is very little scientific research on PME, and our understanding of PME in different disorders remains in very early stages. We still don’t understand whether the causes of PME in various disorders (for example, PME of major depression, PME of alcohol use disorder) are the same or different from the causes of PMDD. Many clinicians and scientists believe that there are subtypes of hormone sensitivity that affect different patients in different ways. These hormone sensitivities may interact with other risk factors for mental health disorders to create different profiles of symptoms (PMDD, PME, etc.). For now, patients with PME are generally treated in two complementary ways:

  1. The underlying disorder should be treated directly if possible. For example, if someone is diagnosed with post-traumatic stress disorder (PTSD) and also has PME, we would recommend that the normal science-backed treatments for PTSD, like exposure therapy, be used.

  2. At the same time, it is usually helpful to try to treat the underlying hormone sensitivity that is causing cyclical worsening (PME) of the disorder. In most cases, first and second-line treatments for PMDD (SSRIs, Yaz) can be tried in those with PME. While some studies show that these treatments may be less effective in PME of depression specifically, these were small studies that don’t give us definitive answers, and we don’t know anything about whether they work better or worse in PME of anxiety or other disorders. Therefore, the typical PMDD treatment path is usually followed in those with PME. One exception is that GnRHa is typically not used in PME since one study found that it did not improve symptoms in people with PME of depression. However, many clinicians feel that a trial of this treatment with stable hormone addback is still warranted if SSRIs and Yaz are not effective.

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- Dr Tory Eisenlohr-Moul, IAPMD Clinical Advisory Board

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