摘要
約80-90%生育年齡之女性於每次月經來臨前約7-10天會有所謂的經前症候群，其症狀如乳房脹痛、頭痛、下腹痛、食慾改變、嗜睡或失眠、煩躁或情緒不穩、易怒、注意力不集中、沮喪或焦慮等，這些症狀隨月經之開始而逐漸緩解，或經由藥物的協助再配合自我的調整即可改善，但並不致於影響女性之社交與職業功能。然而，1993年美國精神醫學會(DSM-IV)提出一種女性生理週期疾病一「經前憂鬱症」，症狀類似經前症候群，這些症狀擾亂女性日常生活，不但造成身體之不適，最重要的是足以導致工作、學業、生活方式或適應等方面的障礙，降低社交與職業功能，有別於經前症候群；在美國，大約有3-10%生育年齡女性患有此疾病；在台灣，應有相當比率的女性患有此疾病，但大多數可能都被當作一般所謂「經前症候群」而未得到適當的治療。非藥物治療如生活型態的改變及營養補充可改善一些較輕微的病例。然而，對於較嚴重之病例(如無法工作)，藥物治療是有幫助的，選擇性血清胺受體抑制劑(SSRI)被列為第一線用藥，如Fluoxetine(Prozac)、Sertraline(Zoloft)。低劑量抗焦慮劑如Alprazolam可用於第二線藥物，但須注意其藥物依賴性。荷爾蒙療法如性促素釋放素類似劑(GnRH agonist)可抑制排卵及月經，亦被報告有療效，但須注意其類似「停經」之副作用。另外，精神方面之探討及治療，如認知、行為或放鬆療法亦是治療之範疇。此篇文章乃針對臺灣331位生育年齡女性所作之調查，發現有相當高比率(27.8%)患有此疾病，其中大多數可能被當作經前症候群而未獲得適當治療。女性一生中須經歷長達到30-40年之月經週期，因此，對此病之原因及致病機轉加以探討並予以正確診斷與治療，以維持其社交與職業功能(如女性勞工之正常工作)，是值得重視的。
並列摘要
Premenstrual dysphoric disorder(PMDD) , named by Diagnostic and Statistical Manual of .Mental Disorder,4th ed (DSM-IV)in 1993, is a cyclical disorder consisting of distressing mood and behavioral symptom which affects emotional, cognitive, and physical symptoms related to their menstrual cycle. We called on 331 reproductive female, aged from 20 to 40 years old, including housewives, teachers, nurses, students, and laborers for the prevalence of PMDD. .Surprizingly,about 27% of these females were affected by this disorder at Taiwan, compared with from 3 to10 percent in the native. A diagnosis of premenstrual dysphoric disorder is best made by excluding other psychiatric and general medical conditions and by collecting daily ratings of symptom expression across the menstrual cycle. Non-pharmacological therapy, such as life style modification and nutritional supplement were suggested to the patients with mild to moderate symptom. However, the severe cases may response to pharmacological therapy. Sertaline , fluoxetine, citalopram, and clomipramine, classified as serotonin reuptake inhibitor (SSRI), were viewed as serotoninergic antidepressant for the first line pharmacological therapy which were prescribed effectively intermittently during the luteal phase of menstrual cycle. Low dose benzodiazepine , such as alprazone ,may be considered as the second line therapy. Additionally, hormonal therapy with gonadotropin-releasing hormone agonist(GnRH agonist), diuretics(eg. spironolactone)and non-steroid anti-inflammatory drugs(eg. ibuprofen)were also reported helpful in the treatment of premenstrual dysphoric disorder. The premenstrual dysphoric disorder should neither be neglected nor be misdiagnosed as premenstrual symptom.