Premenstrual Syndrome - Medications

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The following SSRIs are currently approved for PMS and PMDD:

• Sarafem was the first branded SSRI to be approved for premenstrual syndrome, including both physical and emotional symptoms. Approved in 2000, Sarafem contains the same ingredient (fluoxetine) as Prozac, but the drug is usually prescribed as intermittent therapy with daily dosing for the 14 days prior to the onset of menstruation. Studies show very positive effects on premenstrual dysphoric disorder, particularly at 20 mg. According to a 2003 study, once a woman stops this treatment, PMS symptoms may recur in the following cycle.
• Sertraline (Zoloft) was approved in 2000 for treating PMDD as both a daily dose and intermittent therapy. A 2004 study suggested that both dosing regimens are effective. Sertraline may also have specific benefits, including improvement in sleep and memory and a lower risk for prolactin production. (Overproduction of this hormone has been associated with bone loss and absence of menstruation.)
• Paroxetine (Paxil) was approved by the FDA in 2003 for the treatment of PMDD symptoms. As with fluoxetine and sertraline, it can be taken either on a continuous or intermittent basis. In 2006, the FDA warned that paroxetine may increase suicidal behavior, particularly in young adults. Women planning on becoming pregnant should be aware that paroxetine may cause birth defects if it is taken during the first trimester of pregnancy.

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General side effects of SSRIs may include nausea, drowsiness, headache, weight gain and sexual dysfunction.

Designer Antidepressants. Non-SSRI antidepressants sometimes prescribed for PMDD include:

• Venlafaxine (Effexor) is a serotonin-noradrenaline reuptake inhibitor. It is similar to fluoxetine (Prozac) in effectiveness and tolerability for most patients. Some trials have reported significant improvement in premenstrual dysphoria. Research is needed to determine whether intermittent treatment would be useful.
• Studies have been mixed on the use of intermittent treatment with nefazodone (Serzone), another designer antidepressant. Patients should be aware that nefazodone has been associated with increased risk of liver failure.