In this review, guidelines for the treatment of PMDD are provided.
Selective serotonin reuptake inhibitors (SSRIs) are the most widely used pharmacologic agents for treating depression and anxiety disorders, and several have also emerged as first-line treatment for premenstrual dysphoric disorder (PMDD). In numerous clinical trials, SSRIs have demonstrated efficacy in reducing the physical and behavioral symptoms of PMDD and improving social and occupational functioning.
SSRIs may be given either intermittently or continuously.
The authors described 3 dosing strategies for SSRI use — continuous dosing (daily throughout the month), intermittent (luteal phase only) dosing, and semi-intermittent dosing (continuous with increased dose in the luteal phase) — and reviewed the results of 2 placebo-controlled studies that compared the efficacy of these dosing strategies. They also described the candidates who would be best suited for each dosing strategy.
7 Comments
I feel that as soon as the health global care profession stop treating PMS and PMDD as a psychological /psychiatric problem and start treating it as a physiological disease we will actually be on the way to getting some kind of effective treatment and relief for millions of handicapped and incapacitated women. I also, truly believe that if there were a disease or syndrome that affected and debilitated men in the same way as this horrible condition effects women we would be a lot further down the part to finding and actual cure or at least some form of effective treatment.
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Vixen Replied:
September 27th, 2011 at 7:04 am
@Lara, Yes, I agree! Aaaahh!
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Lara, can i ask you what your systems are and what you have tried to treat PMDD. I suffer and would like your comments…thanks lin
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While not diagnosed as PMDD I see an increasing number of women aged 35 to 55 that are treated with Lexapro at low doses and have great success in treating the symptoms associated with PMDD. Because of insurance they are forced to try other less expensive generics usually with very poor results. Are there any studies out there for Lexapro on PMDD? Do not get me wrong as soon as a product is available generically I recommend it full force but….
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Gina Replied:
October 27th, 2011 at 11:02 am
@Steven McNutt PharmD,
I am 49 and have had horrible anxiety, depression, anger, tears and physical symptoms about two weeks befroe my period. This started when i was 42 and has gotten worse every year. I no longer work and have tired natural ways to overcome this problem. I am at the end of my rope. Should I try Lexapro? What is a good starting point dose?
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MGH Center for Women's Mental Health Replied:
December 20th, 2011 at 2:47 pm
@Gina,
We cannot really advise you on what medications to take. This is a discussion you should have with your own doctor who knows you best.
That said, we know that SSRIs, such as Lexapro, are highly effective for the treatment of PMDD.
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My PMDD is terrible. I am already on celexa, but have found this ineffective in treating my symptoms. If men knew what it was like, I am sure there would be a medication specifically designed to treat PMDD. Has anyone found any meds helpful?
Thanks
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I have a 17 year old daughter that I believe suffers from pmdd. She is an angel most of the time but a week before she gets her period she gets moody, angry, doesnt sleep and sometimes gets violent, when she doesnt get her way once she gets her period she is an angel again. What can I do to help her ?
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I am diagnosed with PMDD I have lost days and weeks to depression and crying for no reason, I have lost relationships and suffer socially, I lose focus and cannot concentrate at work impacting my typically high performance. I requested a “specialist” at my obgyn – she tried 2 different birth control pills and 1 anti depressant (Wellbutrin) – they haven’t worked and it has been 4 months. I tried eliminating all hormone therapies and used the paragaurd which is a non hormonal IUD – I bled for the entire month and suffered severe cramps most weeks. The next option is to induce menopause. I am 38…. this doesn’t seem to make sense
Knowing the cause and not being able to fix it is the most frustrating part. I hate living like this. I feel like I am crazy. I eat healthy, I don’t drink excessively, I exercise, I see my doctor yet I feel hopeless.
If anyone has any suggestions of a doctor, clinic, trial or anything please let me know – I am really tired of fighting.
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MGH Center for Women's Mental Health Replied:
December 20th, 2011 at 11:05 am
@Lily, I am sorry to hear that you have such a bad run with PMDD, but I think there are some very good options which you have not yet tried.
The data on the efficacy of using oral contraceptives for the treatment of PMDD are pretty mixed. Many women with PMDD report that they are not helpful.
There is no data to support the use of bupropion (Wellbutrin) for the treatment of PMDD. Yes, bupropion is an antidepressant; however, it is only the serotonergic antidepressants that are beneficial for the treatment of PMDD. These include Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor and Cymbalta. It might be helpful for you to take a look at this page, which reviews the treatment of PMDD.
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I have found that Black Cohash taken at ovulation until my period starts has completly taken care of the anxiety. It helps lessen the severe irritability as well. It does not help the negative thinking/depressive thoughts, argumentative thinking and social withdrawl.
I work extremely hard at personal cognitive approaches, journaling, yoga, meditation and forcing myself to get out and continue with my regular routine. I also have to force myself to stay connected to close family members. These have not helped. Some months are better than others.
Staying off sugar and “white foods” does help. I need to do this before ovulation. Once I start eating sugar during the second half of my cycle it is hard to stop.lol.
I am considering trying medication. After all this hard work to still feel like a different person 2 weeks out of every month is not quality of life.
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Vixen Replied:
January 20th, 2012 at 9:24 pm
@Laura, I go through the same EXACT thing every month.. Anti-depressants don’t help. Yoga can only do so much in the moment it is done. Journaling is not even close to a resolution. Aaah! I have found that Taurine has given me enough energy to get out of bed. Thanks for the tip on Black Cohosh…will try also.
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