Comorbid bipolar disorder and premenstrual dysphoric disorder: real patients, unanswered questions.

Large-scale clinical and epidemiological studies suggest a link between bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD). However, smaller studies using prospective charting failed to find this association. Here, we report three cases of individuals with BD and comorbid PMDD who responded successfully to adjunctive contraceptive agents in the management of their severe premenstrual symptoms. While controlled trials investigating pharmacological and non-pharmacological treatments are awaited, adjunctive treatment of contraceptive agents and mood stabilizers may be an option in the treatment of comorbid BD and PMDD.