PMDD vs. bipolar disorder: What’s the Difference?

PMDD vs. bipolar disorder: What’s the Difference?

Reviewed by:
Caitlin Gardiner, MD
Staff Psychiatrist
at Talkiatry
March 26, 2024
In this article

Mood swings happen to all of us. But if you notice that your moods and emotions are interfering with your daily life, it could be a sign of an underlying condition such as PMDD (premenstrual dysphoric disorder) or bipolar disorder—two distinct psychiatric conditions known for causing abrupt changes in mood.  

In this article, we’ll explain what PMDD and bipolar disorder are, what they have in common and how they’re different. Most importantly, we’ll walk you through what you need to know to get a proper diagnosis—which means getting the right treatment, too.  

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What is PMDD?

PMDD (premenstrual dysphoric disorder) is a more intense form of PMS (premenstrual syndrome) that affects up to 10% of women or people assigned female at birth (AFAB) of reproductive age. If you have PMDD, it generally happens in the week or two before your period (during what’s called the luteal phase).  

While PMS and PMDD both have similar emotional and physical symptoms, like breast tenderness, bloating, cramping, fatigue, and changes in sleep and eating habits, PMDD is characterized by extreme mood shifts that can disrupt your daily life. The cause of PMDD isn’t clear, though it’s likely due to the hormonal changes that occur after ovulation and before menstruation.  

Some people are more likely to experience PMDD than others. This includes if you have underlying anxiety or depression, PMS symptoms, a family history of PMS, PMDD, or mood disorders, and a family history of these conditionse or trauma, abuse, or other highly stressful events in your past.  

PMDD Symptoms  

PMDD symptoms vary from person to person and go away a few days after your period starts. In addition to the common symptoms of PMS, people with PMDD may have one or more of the following symptoms according to the DSM-5:  

  • Mood swings  
  • Anger or irritability
  • Insomnia  
  • Anxiety and panic attacks
  • Depression and suicidal thoughts
  • Difficulty concentrating
  • Fatigue and low energy
  • Food cravings, binge eating or changes in appetite
  • Headaches
  • Feeling on edge, overwhelmed or tense

Related article: What is postpartum depression?

What is bipolar disorder?

Bipolar disorder is a mental health condition characterized by intense swings in a person’s mood, energy levels, behavior, and ability to function. These distinct swings, or episodes, typically last days or weeks at a time.  

Bipolar episodes can range from extreme emotional “highs” (manic or less severe hypomanic episodes) involving euphoric, energized, or irritable behavior to “lows” (depressive episodes) involving intense hopelessness or indifference. While “highs” and “lows” are a normal part of most people’s lives, bipolar disorder causes symptoms that regularly interfere with your ability to live your life and get things done.

Symptoms of mania

Symptoms of mania may make you feel good at first, but quickly become uncomfortable and erratic. Manic episodes may last 7 days or longer, and may be severe enough to require hospitalization or cause impairment in your functioning.  

  • Risky or out-of-control behavior
  • Feelings of elation or extreme irritability
  • A decreased need for sleep
  • Euphoria (a sense of well-being that exceeds reality or a feeling of invincibility
  • Talkativeness that seems out of character
  • Racing thoughts
  • Difficulty focusing
  • Poor decision making (spending sprees, reckless driving)

Symptoms of hypomania

Hypomania is characterized by milder symptoms than mania, and may last less than a week. People with bipolar disorder usually don’t realize they are in a hypomanic episode, since they feel extremely motivated to get things done. However close friends and family may occasionally notice behavioral changes.

Symptoms of depression

As with major depressive disorder (MDD), symptoms of bipolar depression are much more extreme than just a run-of-the-mill sadness. The depressive symptoms may 2 weeks or longer and they include:

  • Feeling very down, sad, or anxious
  • Lack of interest or enjoyment in activities
  • Low energy or fatigue
  • Hopelessness
  • Lack of focus or concentration, slowed behavior
  • Decrease or increase in appetite
  • Decrease or increase in sleep
  • Excessive feelings of worthlessness or guilt
  • Suicidal thoughts or frequent thoughts of death

If you think you are experiencing symptoms of bipolar disorder, answer a few questions to learn more and get a sense of what you’re going through.

Similarities and differences between PMDD and bipolar disorder

Both bipolar disorder and PMDD involve mood disturbances and share a number of common symptoms, like experiencing a depressive episode. Additionally, some women and AFAB people with bipolar disorder report that their mood symptoms worsen during specific phases of the menstrual cycle, similar to the pattern seen in PMDD.  

When it comes to treating bipolar disorder and PMDD, both conditions can be effectively managed with a combination of medication and talk therapy, like cognitive-behavioral therapy (CBT). Treatment options for PMDD include contraceptives and antidepressants, like SSRIs (selective serotonin reuptake inhibitors), while bipolar disorder is treated with mood stabilizers and antipsychotics. To learn more, check out this article on PMDD and antidepressant medications.

Despite these similarities, bipolar disorder and PMDD are two distinct conditions. While PMDD is primarily characterized by depressive symptoms during the week or two before menstruation, bipolar disorder involves distinct episodes of mania and depression, with periods of relatively stable mood in between independent of the menstrual phase.

PMDD Bipolar
Symptoms Mood swings, irritability, and emotional reactivity Mood swings in the form of distinct episodes of mania and depression
Related to menstruation Symptoms are cyclical and typically last for a specific period of time each month No; symptoms occur independent of menstruation
Duration Symptoms are cyclical and typically last for a specific period of time each month Mood episodes can last for weeks to months, and the length of stable periods in between can vary
Treatment Antidepressants, birth control, lifestyle changes, therapy Mood stabilizers and antipsychotics, talk therapy

Can I have both PMDD and bipolar disorder?

It is possible to have both PMDD and bipolar disorder, though it’s not known how common it is to have both among women and AFAB who ovulate. The connection between the two conditions is complex, though it is likely that they appear together in some people because they share some common biological mechanisms that result in more severe mood swings.  

However, if you do have comorbid PMDD and bipolar disorder, your PMDD could impact your bipolar symptoms by worsening your depressive or manic/hypomanic symptoms. At the same time, bipolar disorder can make you more sensitive to hormonal fluctuations, causing increased mood changes during the menstrual cycle.

Because of the prevalence of overlapping symptoms, women and AFAB with PMDD are frequently misdiagnosed as having bipolar disorder. In order to receive an accurate diagnosis and proper treatment, it’s important that you seek out a professional diagnosis if you suspect you have PMDD, bipolar disorder, or both.

If you’re interested in learning more about what’s involved in an evaluation, check out: Do I have bipolar disorder?

Do I have PMDD or bipolar disorder?

Living with mood swings is challenging, and can be especially so if you haven’t yet found a correct diagnosis and proper treatment. The good news is that help is out there, and there are a number of ways to treat both bipolar and PMDD so that you can live without symptoms interfering with your daily life.  

The only way to receive your diagnosis is to talk to a qualified clinician, like a psychiatrist. Before your appointment, try to track your own symptoms and moods in order to inform your provider and help them identify patterns. Try to pay attention to your premenstrual mood as well. When you see your doctor, they'll take all this information into account, and use their expertise, to give you a diagnosis and come up with the best treatment plan.  

If you're struggling with mood swings and your mental health, don’t wait to get help. Talkiatry is a national psychiatry practice that provides 100% virtual in-network care. We treat a number of mental health conditions, major depression, with a combination of medication and therapy. Get started by filling out a short online assessment.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Dr. Caitlin Gardiner is a board-certified psychiatrist specializing in child and adolescent psychiatry and psychotherapy.

Dr. Caitlin Gardiner's practice is based on the biopsychosocial model and believes that the foundation of healing is in psychotherapy and human connection. She is known for incorporating therapy into her medication management practice. Typically she offers 30-minute follow-up visits for medication management with focused therapy based on individual needs.

As a known helper, Dr. Gardiner started her career with a bachelors degree in social work from Cazenovia College in Cazenovia, NY. After changing career paths she received her medical degree from SUNY Upstate Medical University in Syracuse, NY. She stayed at Upstate to complete her general psychiatry residency where she was chief resident during the beginning of the COVID-19 pandemic. Following this, she completed her child and adolescent psychiatry fellowship at Upstate due to the high quality of training. Dr. Gardiner has completed 3 years of advanced training in Dynamic Deconstructive Psychotherapy as well as specialized training in DBT.

Dr. Gardiner is a well -rounded psychiatrist who enjoys treating youth and young adults during transitional phases of life while providing a safe and supportive environment. She believes strongly in reducing polypharmacy and providing high-quality medication management through a therapeutic and developmental lens.

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