Premenstrual depression: A distinct entity.

Abstract

The validity of the Premenstrual Assessment Form (PAF) typological category "Major Depressive Syndrome", as a distinct subtype of premenstrual change, was assessed. The nature of the depression associated with the premenstrual phase was investigated with standardized measures of depression and a test of dysphoric attentional bias derived from Beck's cognitive model of depression. Three subject groups were delineated based on prospective daily ratings: PMD (depression only premenstrually), controls (no depression), and INTD (intermittent depression throughout cycle). The control group did not exhibit a dysphoric attentional bias. The INTD group demonstrated a dysphoric attentional bias both pre- and postmenstrually. The PMD group, despite clinically elevated premenstrual depression levels, failed to show an associated dsyphoric attentional bias. These findings suggest that although PMD and clinical depression share an affective component, they may differ with regard to other features of depression (i.e. cognitive/information processing). As well, phenomenological differences between PMD and clinical depression were suggested by subjects' prospective daily ratings. For confirmed PMD subjects, depressive mood was only one facet of a multidimensional symptom picture which included signs of water retention, breast pain, fatigue, irritability, anxiety, and associated dysmenorrhea. These findings raise questions concerning the construct validity of premenstrual depression (specifically PAF Major Depressive Syndrome) as a distinctive subtype of premenstrual change.