Am J Psychiatry 154:10, October 1997 MASKALL, LAM, MISRI, ET AL. SEASONALITY OF SYMPTOMS IN LLPDD Seasonality of Symptoms in Women With Late Luteal Phase Dysphoric Disorder Douglas D. Maskall, M.D., Raymond W. Lam, M.D., Shaila Misri, M.D., Diana Carter, M.B.B.S., Annie J. Kuan, B.A., Lakshmi N. Yatham, M.B.B.S., and Athanasios P. Zis, M.D. Objective: Both late luteal phase dysphoric disorder (LLPDD) and seasonal affective dis- order are cyclical disorders often manifested by “atypical” depressive features. The goal of this study was to determine whether patients with LLPDD demonstrate substantial seasonal variation in symptoms. Method: Consecutive female patients attending a subspecialty clinic in a university teaching hospital were assessed by means of DSM-III-R criteria. All subjects completed the Seasonal Pattern Assessment Questionnaire, modified to include items on the seasonality of premenstrual symptoms. The results were compared with those of a group of female nonclinical subjects (N=50). Results: One hundred patients met the DSM-III-R criteria for LLPDD. Compared to the nonclinical group, the LLPDD patients had a significantly higher mean global seasonality score (an index of seasonality of mood and vegetative symp- toms) and a significantly higher rate of seasonal affective disorder (38% versus 8%) as deter- mined by Seasonal Pattern Assessment Questionnaire criteria. Twenty-five percent of the LLPDD group rated their seasonal variation in premenstrual symptoms as marked or severe, while 30% considered seasonal changes in overall symptoms to be a marked or severe problem. Conclusions: These results suggest that patients with LLPDD have substantial seasonal pat- terns in mood and premenstrual symptoms. These seasonal patterns have implications for the clinical assessment and treatment of LLPDD. For example, light therapy may be beneficial for women with seasonal worsening of LLPDD. (Am J Psychiatry 1997; 154:1436–1441) L ate luteal phase dysphoric disorder (LLPDD) is a cyclical disorder in women in which symptoms are synchronous with the menstrual cycle (DSM-III-R). Specifically, symptoms are present during the last week of the luteal phase and remit within a few days after the onset of the follicular phase. Similarly, seasonal affec- tive disorder is a diagnostic entity in which characteris- tic symptoms recur and remit in a rhythmic pattern. In this disorder, depressive symptoms cycle in response to the time of year, the most usual pattern being symptom onset in the fall or winter and remission in the spring (1). In DSM-IV, LLPDD has been renamed premen- strual dysphoric disorder, with minor wording changes and the addition of one new symptom in the set of cri- teria, and is included as a research category in Appen- dix B (Criteria Sets and Axes Provided for Further Study). Seasonal affective disorder is presented as the longitudinal course specifier “with seasonal pattern” for recurrent major depressive episodes. The characteristic symptoms that cyclically recur and remit in LLPDD and seasonal affective disorder are strikingly similar. Both disorders include depressed mood, poor concentration, loss of interest in usual ac- tivities, and the more specific “atypical” features of de- pression: hypersomnia, hyperphagia, carbohydrate craving, and anergy (1, 2). The overlap in these two disorders may also extend to the epidemiologic and treatment aspects. In a com- munity survey of premenstrual syndrome (PMS) (3), it was noted that approximately 70% of women with this disorder reported fewer symptoms during the sum- mer. One of us (R.W.L., unpublished data) has ob- served that 51% of 200 consecutive female patients with seasonal affective disorder complained of sub- Preliminary results of this study were presented at the 44th annual meeting of the Canadian Psychiatric Association, Ottawa, Sept. 21– 23, 1994, and at the 148th annual meeting of the American Psychiat- ric Association, Miami, May 20–25, 1995. Received Sept. 24, 1996; revision received March 24, 1997; accepted April 25, 1997. From the Division of Mood Disorders, Department of Psychiatry, University of British Columbia; the Vancouver Hospital and Health Sciences Cen- tre; and the British Columbia Women’s Hospital and Health Sciences Centre, Vancouver. Address reprint requests to Dr. Lam, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, B.C., Canada V6T 2A1; rlam@unixg.ubc.ca (e-mail). Supported in part by grants from the Medical Research Council of Canada to Dr. Lam and Dr. Zis. 1436 Am J Psychiatry 154:10, October 1997