| Resumen: | El trastorno disfórico premenstrual (TDP) es una entidad clínica con características propias y bases biológicas conocidas, aunque no definitivas. Se diferencia del síndrome premenstrual (SPM) y constituye para muchos, el extremo más severo de él, con síntomas de la esfera depresiva, ansiosa y cambios en la conducta que alteran la vida de relación. Los tratamientos efectivos en SPM no lo han sido para el TDP. Deben considerarse las medidas generales y sintomáticas. Entre aquellas que evidencien estacionalidad, la exposición diaria a la luz natural matinal o a la luz blanca artificial son medidas accesorias a considerar. El uso de ISRS, preferentemente intermitente, es el tratamiento de primera línea. Si los síntomas físicos persisten luego de tres ciclos de iniciado tratamiento, es conveniente asociar fármacos que alivien esos síntomas. En pacientes donde fracasan los esquemas anteriores, se plantea el uso continuado de ISRS, cambiar de ISRS, potenciar su acción con privación de sueño o luminoterapia como medidas necesarias antes de llegar a usar los agonistas GnRH, tanto por la sintomatología colateral que provocan como por el breve lapso en que se pueden usar. Este último tipo de fármacos pueden, teóricamente, ser usados para confirmar el cuadro, en casos de difícil diagnóstico. Hoy en día se considera el TDP es un cuadro crónico, que si no es tratado, aumenta el riesgo de trastorno depresivo mayor, depresión post parto así como de otros cuadros del ôespectro serotoninérgicoõ y cuya recaída es altamente probable si se suspende la terapéutica. (AU)^iesThe inclusion of premenstrual dysphoric disorder (PMDD) in DSM IV recognizes the fact that some women have extremely distressing, emotional and behavioural symptoms premenstrually. PMDD can be differentiated from premenstrual syndrome (PMS), which presents with milder physical symptoms and more minor mood changes. The DSM IV diagnostic criteria stipulate a minimum of 5 symptoms, one of which must be a mood symptom (feeling sad, feeling tense, marked lability, irritability). These symptoms must regularly occur during the last week of the luteal phase, and the symptoms disappear completely shortly after the onset of menstruation. In addition, these symptoms must cause a significant impairment in lifestyle and relationships. Disorder is confirmed by prospective daily ratings during at least 2 consecutive symptomatic cycles. PMDD can be differentiated from premenstrual magnification of physical or psychological symptoms of a concurrent psychiatric or medical disorder. As many as 75% of women with regular menstrual cycle experience some symptoms of PMS, according to epidemiologic surveys. PMDD is much less common; it affects 2% to 9% of women in this group. The etiology of PMDD is unknown, but the current consensus is that normal ovarian function (rather than hormone imbalance) is the cyclical trigger for PMDD-related biochemical events within the central nervous system. The serotonergic system in a close reciprocal relation with the gonodal hormones and has been identified as the most plausible target for interventions. Almost all treatments used for 50 years are not of real utility. Hormonal therapies, such as gonadotropin-releasing (GnRH) agonists, estradiol, and danazol, are occasionally taken to ameliorate PMDD symptoms, but the side-effect profile of these therapies makes them less desirable for the treatment option, with excelent efficacy and minimal side effects, specially in intermitent use (premenstrual only). (AU)^ien.
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