If you really want to understand Premenstrual Dysphoric Disorder (PMDD), you'd better have a pretty good understanding of the normal menstrual cycle.

It's been a year and a half now since TCR last took up the perennially hot topic of SSRI use in pregnancy (TCR Vol 1, No 5, 2003).

Over the last few years, the concept of menopause has hit the national radar screen with a vengeance. One of the reasons for the onslaught of publicity was a nasty bit of research news released in 2002, when the initial results of the Women's Health Initiative Study were made public (JAMA. 2002; 288:321-333).

The concept of a difficult spell preceding the menstrual period in some women is not new. Hippocrates was said to have noted it, and in 1847, Dr. Ernst von Feuchtersleben said, "The menses in sensitive women is almost always attended by mental uneasiness, irritability, and sadness."

When we were planning this issue, several friends and readers were a bit surprised. "A whole issue on OCD? Is there anything new to say about it?" There's plenty to say that's both new and old.

When it comes to a neuroanatomical understanding of psychiatric symptoms, OCD is considered the superstar of the field. A wealth of data has implicated the involvement of a specific neuroanatomical loop in OCD.

You're a cutting edge psychiatrist. Not only are you great with meds, but you have a passing knowledge of CBT (cognitive-behavior therapy) techniques for the treatment of OCD. Sorry. You're already behind the curve.

The symptoms of OCD have been known for a long time. Who can forget Lady Macbeth at the sink, scrubbing away at the imagined evidence of her guilt. But the term obsessive-compulsive disorder is a relatively recent one.

Where does it hurt? These are the “four little words” that Eli Lilly (in ubiquitous ads) is encouraging us to ask our depressed patients.

Here's a fairly typical scenario: An elderly woman comes to you as a referral from her PCP for the treatment of depression and anxiety. She hands you a well-worn 3-by-5 card with her meds listed in shaky handwriting.