Multiple suicide attempts in a patient with premenstrual dysphoric disorder: a case report

Premenstrual syndrome (PMS) is characterised by cyclic subjective changes in mood and general sense of physical and psychological well-being correlated with the menstrual cycle. Premenstrual dysphoric disorder (PMDD) describes a subset of women (2-9%) with PMS, where the nature, severity and timing of the symptoms are critical in establishing the diagnosis. Findings support that PMDD is due of the impact of ovarian circle upon vulnerable central processes underlying mood and behaviour rather than from the abnormal ovarian secretion.

We describe the case of a woman 37 years old with very severe PMDD which had caused her significant social and occupational impairment. This patient committed 9 serious suicide attempts during 1 year. During the luteal phase of her menstrual circle, she was manifesting marked anxiety, tension, irritability, depressed mood, self-depreciating thoughts, feelings of hopelessness, marked affective liability, increased interpersonal conflicts with her family, decreased interest in everyday activities, difficulty in concentrating, overeating and insomnia. Because of the extreme severity and the gradual aggravation of the symptomatology, as the luetal phase proceeded, the patient was «forced» to commit suicidal attempts just before menses. In several attempts, she had taken potentially lethal doses of amitriptyline, but she managed to survive. In addition, she showed a remarkable tolerance in several drugs that she received during her stay in our clinic. These data lead to the hypothesis that the patient is an extensive metaboliser of certain drugs.

Eventually, the symptomatology of the patient subsided dramatically after the continual administration of a high-dosage composite pharmacologic treatment (gabapentin, fluoxetine, mirtazapine, lorazepam, chloropromazine, and oral contraceptives). After a 5 month - follow up, she is completely free of symptoms and her functioning has been restored.

Key words: Sucicide, hormons, drug tolerability.