Premenstrual Syndrome - Medications

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Studies are needed to determine if these drugs offer any additional benefits compared to standard SSRIs.

Tricyclics. Before the introduction of SSRIs, tricyclics, such as desipramine (Norpramin) or amitriptyline (Elavil, Endep), had been the standard treatment for depression. They are not very useful, in general, for premenstrual dysphoric disorder or other PMS symptoms. One exception may be clomipramine (Anafranil), which affects serotonin and has been helpful for some women. Patients report more side effects with Anafranil than with SSRIs, although low doses are used for premenstrual syndrome and may be beneficial for some women. Patients should not take tricyclics with either SSRIs or other antidepressants known as monoamine oxidase inhibitors (MAOIs).

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[For more information on antidepressants, see In-Depth Report #08: Depression.]

Antianxiety Drugs

Antianxiety drugs (called anxiolytics) may be helpful for women with severe premenstrual anxiety that is not relieved by SSRIs or other treatments.

Benzodiazepines. The standard anxiolytics are the benzodiazepines, with alprazolam (Xanax) most often used for PMS. Experts, however, generally do not recommend these drugs for PMS-related anxiety. Dependence is a common danger and can occur after as short a time as 3 months of use. (Using Xanax for only a few days per month when symptoms are most severe reduces this risk.) Common side effects are daytime drowsiness and a hung-over feeling. Respiratory problems may be worsened. Benzodiazepines also stimulate an increase in appetite, particularly for fats, during the premenstrual cycle. Overdose is very serious, although rarely fatal. Benzodiazepines are potentially dangerous when used in combination with alcohol.

Buspirone. Buspirone (BuSpar) is a unique anti-anxiety drug known as an azapirone. A 2001 study reported that it reduced premenstrual irritability. Unlike benzodiazepines, buspirone is not addictive. Buspirone also seems to have less pronounced side effects than benzodiazepines and no withdrawal effects, even when the drug is discontinued quickly. Common side effects include dizziness, drowsiness, and nausea.