--- title: Can PMDD be severe enough to lead to self-harm, and does treatment help? description: Yes. This case describes a young woman whose PMDD led to a self-harm attempt, and she improved within a month of starting treatment with fluoxetine. url: https://niyora.com/research/papers/from-despair-to-diagnosis-premenstrual-dysphoric-disorder-and-self-harm-in-a-2024/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Can PMDD be severe enough to lead to self-harm, and does treatment help? Study, 2024 # Can PMDD be severe enough to lead to self-harm, and does treatment help? Yes. This case describes a young woman whose PMDD led to a self-harm attempt, and she improved within a month of starting treatment with fluoxetine. Early or limited evidence A 21-year-old woman in Nepal with PMDD who attempted self-harm. ## What they did This is a single case report of a 21-year-old psychology student in Nepal with no earlier mental or physical illness. She had monthly premenstrual symptoms since age 18 and was seen in the emergency room after swallowing 10 tablets of mefenamic acid. She was diagnosed with PMDD, started on fluoxetine, and followed up after one month. ## What they found Each month before her period, from age 18, she had low self-esteem, anxiety, irritability, and emotional instability peaking just before her period and easing afterward, leading to feelings of worthlessness and suicidal thoughts. Guilt about her irritability led her to take 10 tablets of mefenamic acid. She improved at her one-month follow-up after starting fluoxetine. The case notes that up to 90% of women have mild premenstrual symptoms, around 8% have PMDD, and PMDD affects 3-8% of menstruating women, with higher rates of suicidal thoughts linked to it. A review of self-harm cases in Nepal did not identify PMDD as a factor in any case. ## What it means for you This single story shows that PMDD can become severe enough to cause self-harm, and that it can be missed as a cause of distress. It also shows one woman improved with treatment. Because it is just one person's story, it cannot tell us how common this is or guarantee the same result for others. up to 90% Women with mild premenstrual symptoms around 8% Women with PMDD (case report figure) 10 Tablets of mefenamic acid taken ## About the study Original title From despair to diagnosis: Premenstrual dysphoric disorder and self-harm in a young Nepali female Authors Ayurda Pradhan, Nikeshmani Rajbhandari, Ashish Dutta Journal Journal of Psychiatrists Association of Nepal Year 2024 Study design Study What was tested Fluoxetine (an SSRI antidepressant) after a PMDD diagnosis. Open access Yes Read the paper [doi.org/10.3126/jpan.v13i1.68183](https://doi.org/10.3126/jpan.v13i1.68183) Original abstract Up to 90% of women experience mild premenstrual symptoms and around 8% suffering from premenstrual dysphoric disorder (PMDD), which is often overlooked and linked to higher suicidal thoughts. This case involves a young woman who attempted self-harm by ingesting 10 tablets of mefenamic acid due to PMDD-related symptoms. A 21-year-old psychology student with no previous mental or chronic physical illnesses attempted self-harm by ingesting 10 tablets of mefenamic acid. She had been experiencing low self-esteem, anxiety, irritability, and emotional instability predictably each month before her menses since age 18. These symptoms led to feelings of worthlessness and suicidal thoughts, peaking just before her menstrual bleeding and subsiding afterward. On the day of her emergency room visit, intense guilt about past irritability triggered her self-harm. She was diagnosed with PMDD, prescribed fluoxetine, and showed improvement in her symptoms at the one-month follow-up. PMDD, characterized by hormone-related symptoms like mood swings and fatigue, affects 3-8% of menstruating women and can severely impact daily life. Studies highlight elevated rates of suicidal thoughts among women with PMDD, independent of other psychiatric conditions. In Nepal, a review of deliberate self-harm cases found that most incidents occurred in individuals under 35 years old, with suicides peaking between ages20 to 25, yet PMDD was not identified as a contributing factor in any study. Research supports SSRIs as highly effective and well-tolerated treatments for PMDD, especially when used intermittently during the premenstrual phase, offering a promising therapeutic option. Reproduced under CC-BY. ## Topics [Premenstrual syndrome (PMS)](https://niyora.com/research/topics/condition-pms/)[Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[Irritability and anger](https://niyora.com/research/topics/symptom-irritability-anger/)[Suicidality](https://niyora.com/research/topics/symptom-suicidality/)[SSRIs and antidepressants](https://niyora.com/research/topics/treatment-ssri/)[Diuretics and other drugs](https://niyora.com/research/topics/treatment-diuretics-other-drugs/) Research tells you what helps on average. Niyora helps on the day it hits. Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor. ## Related studies Randomised trial, 1998 Is intermittent citalopram during the luteal phase more effective than continuous dosing? Randomised trial, 1995 Does fluoxetine help premenstrual dysphoria? Randomised trial, 2025 Does escitalopram reduce aggressive behavior in women with premenstrual anger and irritability? Randomised trial, 2025 Does escitalopram improve attention and reduce impulsivity in women with premenstrual irritability and anger? Cohort study, 2023 Does the menstrual cycle affect how often women have suicidal thoughts? Cohort study, 2022 What are PMS and PMDD and how should they be diagnosed and treated? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗