Medical Health Encyclopedia

Individuals taking SSRIs report not only relief from premenstrual dysphoric disorder but also physical symptoms, irritability, and tension. SSRIs appear to work much faster for relieving PMS-related depression than when used in major depression. These drugs are typically prescribed with either continuous (daily) dosing throughout the month or an intermittent dosing regimen. With intermittent dosing, women take the antidepressant during the 14-day premenstrual period of their luteal phase. This approach is also associated with fewer adverse effects than the standard regimens for major depression.

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The following SSRIs are currently used or investigated 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 agent 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 study published in 2004 suggested that both dosing regimens are equally effective. Sertraline also may 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.